Percutanous transhepatic intrahepatic portosystemic shunt for chronic portal vein occlusion and cavernous transformation with symptomatic portal hypertension

Objective To investigate the efficacy and safety of percutanous transhepatic intrahepatic portosystemic shunt (PTIPS) for chronic portal vein occlusion and cavernous transformation with symptomatic portal hypertension. Methods The clinical and imaging data of 38 patients with chronic portal vein occlusion and cavernous transformation with symptomatic portal hypertension, who received PTIPS in our hospital from November 2009 to June 2016, were analyzed retrospectively. The differences of the portosystemic pressure gradient (PPG) measured before and after PTIPS procedure was analyzed by a paired samples t-test. All the patients were followed up and the curative effect and operation-correlated complications were observed. Results The PTIPS procedure was technically successful in 36 patients. The other two patients with unsuccessful PTIPS underwent medical treatment, and one of them died of recurrent variceal bleeding 25 months later. Effective portal decompression and free antegrade shunt flow were achieved in 36 patients with successful PTIPS. And the mean PPG was decreased from (25.2±2.9) to (13.2±1.3) mmHg (1 mmHg=0.133 kPa) before and after PTIPS respectively and the difference was statistically significant (P<0.05) . During the procedure, arterial hemorrhage occurred in two patients who subsequently underwent embolization. Biliary injury occurred in one case and percutanous transhepatic biliary drainage (PTBD) was then performed. The mean follow-up period of the 36 patients was (26.7±10.4) months (range from 3.0 to 74.0 months) . Hepatic encephalopathy appeared in 4 cases, among which, 3 patients recovered after receiving medical treatment, while 1 patient experienced Grade 3 hepatic encephalopathy and recovered after implanting a smaller cover-stent. Shunt dysfunction occurred in 10 cases, of which 8 cases recovered after shunt revision with stent implantation or ballon angioplasty, while 2 cases underwent anticoagulation by warfarin only. During follow-up period, 7 patients died of liver failure (n=4) , hepatic cellular carcinoma (n=1) , recurrent varicose vein bleeding (n=1) , and renal failure (n=1) . The other patients remained asymptomatic and shunt patency. Conclusions PTIPS is both safe and effective for the treatment of symptomatic portal hypertension caused by chronic portal vein occlusion and cavernous transformation. The technical success rate is high, and the short-term curative effect is satisfied. Key words: Hypertension, portal; Hepatic veno-occlusive disease; Radiology, interventional; Portacaval shunt