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2017, Number 6

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Ann Hepatol 2017; 16 (6)

Could TIPS be Applied in All Kinds of Portal Vein Thrombosis: We are not Sure!
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Luo X, Yang L
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Language: English
References: 13
Page: 979-980
PDF size: 98.16 Kb.


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Dear editor:
We read with interest the recent article by Chinchilla- Lopez, et al. regarding the role of transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory ascites and portal vein thrombosis (PVT). We should applaud their work for the extend of TIPS indication in this population, since high-quality clinical trials has demonstrated that patients with refractory ascites and/or PVT could benefit from this procedure. However, several issues need further clarification. A reduced portal flow velocity has shown to be an important underlying mechanism of PVT formation in patients with cirrhosis. TIPS creation could restore portal vein flow, recanalize portal venous system and relieve the complications of portal hypertension. However, the intrahepatic PVT (such as the case presented by Chinchilla- Lopez) couldn’t resolve because the intrahepatic portal branch flow was further decreased after TIPS. The TIPS indication in patients with intrahepatic PVT need further evaluated.


REFERENCES

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  2. Bureau C, Thabut D, Oberti F, Dharancy S, Carbonell N, Bouvier A, Mathurin P, et al. Transjugular Intrahepatic Portosystemic Shunts With Covered Stents Increase Transplant-free Survival of Patients With Cirrhosis and Recurrent Ascites. Gastroenterology 2017; 152: 157-63.

  3. Luo X, Wang Z, Tsauo J, Zhou B, Zhang H, Li X. Advanced Cirrhosis Combined with Portal Vein Thrombosis: A Randomized Trial of TIPS versus Endoscopic Band Ligation Plus Propranolol for the Prevention of Recurrent Esophageal Variceal Bleeding. Radiology 2015; 276: 286-93.

  4. Zocco MA, Di Stasio E, De Cristofaro R, Novi M, Ainora ME, Ponziani F, Riccardi L, et al. Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development. J Hepatol 2009; 51: 682-9.

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  7. Boyer T, Haskal Z, AASLD Practice Guidelines: The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension. Hepatology 2010; 1: 1-16.

  8. Rössle M. TIPS: 25 years later. J Hepatol 2013; 59: 1081-93.

  9. Tsochatzis EA, Gerbes AL. Diagnosis and treatment of ascites. J Hepatol 2017; (67) 184-5.

  10. Wong F. The use of TIPS in chronic liver disease. Annals of Hepatology 2006; 1: 5-15.

  11. García-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal Hypertensive Bleeding in Cirrhosis: Risk Stratification, Diagnosis and Management: 2016 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2017; 1: 310-35.

  12. Moreno A, Meneu JC, Moreno E, Fraile M, Garcia I, Loinaz C, Abradelo M, et al. Liver transplantation and transjugular intrahepatic portosystemic shunt. Transplant Proc 2003; 35: 1869-70.

  13. Gonzales P, Dhanasekaran R, West J, Subramanian R, Parekh S, Spivey JR, PreetiReshamwala, et al. Influence of transjugular intrahepatic portosystemic shunt in patients awaiting orthotopic liver transplant on post-transplant outcome. Gastrointestinal Intervention 2012; 1: 69-73.




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Ann Hepatol. 2017;16