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Z Gastroenterol 2018; 56(03): 221-237
DOI: 10.1055/s-0043-121348
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Transjugular portal vein recanalization with creation of intrahepatic portosystemic shunt (PVR-TIPS) in patients with chronic non-cirrhotic, non-malignant portal vein thrombosis

Transjuguläre Pfortaderrekanalisation mit intrahepatischem portosystemischem Shunt (PVR-TIPS) bei Patienten mit chronischer nicht-zirrhotischer, nicht-maligner Pfortaderthrombose.
Christoph Klinger
1   Medizinische Klinik I, Klinikum Ludwigsburg, Germany
,
Bettina Riecken
1   Medizinische Klinik I, Klinikum Ludwigsburg, Germany
,
Arthur Schmidt
1   Medizinische Klinik I, Klinikum Ludwigsburg, Germany
2   Gastroenterologie, Universität Freiburg, Germany
,
Andrea De Gottardi
3   Hepatology, Inselspital Universitatsspital Bern, Switzerland
,
Benjamin Meier
1   Medizinische Klinik I, Klinikum Ludwigsburg, Germany
,
Jaime Bosch
3   Hepatology, Inselspital Universitatsspital Bern, Switzerland
4   Hepatic Hemodynamic Laboratory, Liver Unit Hospital Cliníc, IDIBAPS and Ciberehd, Barcelona, Spain
,
Karel Caca
1   Medizinische Klinik I, Klinikum Ludwigsburg, Germany
3   Hepatology, Inselspital Universitatsspital Bern, Switzerland
› Author Affiliations
Further Information

Publication History

22 June 2017

08 October 2017

Publication Date:
07 November 2017 (online)

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Abstract

Purpose To determine safety and efficacy of transjugular portal vein recanalization with creation of intrahepatic portosystemic shunt (PVR-TIPS) in patients with chronic non-cirrhotic, non-malignant portal vein thrombosis (PVT).

Methods This retrospective study includes 17 consecutive patients with chronic non-cirrhotic PVT (cavernous transformation n = 15). PVR-TIPS was indicated because of variceal bleeding (n = 13), refractory ascites (n = 2), portal biliopathy with recurrent cholangitis (n = 1), or abdominal pain (n = 1). Treatment consisted of a combination of transjugular balloon angioplasty, mechanical thrombectomy, and—depending on extent of residual thrombosis—transjugular intrahepatic portosystemic shunt and additional stenting of the portal venous system.

Results Recanalization was successful in 76.5 % of patients despite cavernous transformation in 88.2 %. Both 1- and 2-year secondary PV and TIPS patency rates were 69.5 %. Procedure-related bleeding complications occurred in 2 patients (intraperitoneal bleeding due to capsule perforation, n = 1; liver hematoma, n = 1) and resolved spontaneously. However, 1 patient died due to subsequent nosocomial pneumonia. During follow-up, 3 patients with TIPS occlusion and PVT recurrence experienced portal hypertensive complications.

Conclusions PVR-TIPS is safe and effective in selected patients with chronic non-cirrhotic PVT. Due to technical complexity and possible complications, it should be performed only in specialized centers with high experience in TIPS procedures.

Zusammenfassung

Ziel Untersuchung der Sicherheit und Effektivität der transjugulären Pfortaderrekanalisation mit intrahepatischem portosystemischem Shunt (PVR-TIPS) bei Patienten mit chronischer nicht-zirrhotischer, nicht-maligner Pfortaderthrombose (PVT).

Methoden In diese retrospektive Studie wurden 17 konsekutive Patienten mit chronischer nicht-zirrhotischer PVT (kavernöse Transformation, n = 15) eingeschlossen. Indikationen zur interventionellen Therapie waren Varizenblutung (n = 13), therapierefraktärer Aszites (n = 2), portale Biliopathie mit rezidivierenden Cholangitiden (n = 1) sowie abdominelle Schmerzen (n = 1). Die interventionelle Therapie bestand aus einer Kombination von transjugulärer Ballonangioplastie, mechanischer Thrombektomie und Anlage eines transjugulären intrahepatischen portosystemischen Shunts (TIPS). Abhängig von der Ausdehnung einer evtl. noch vorhandenen Restthrombose erfolgte ggf. eine zusätzliche Stenteinlage im portalvenösen System.

Ergebnisse Die Rekanalisation mittels PVR-TIPS war bei 76,5 % der Patienten erfolgreich, obwohl bei 88,2 % eine kavernöse Transformation vorlag. Die sekundären 1- und 2-Jahresoffenheitraten betrugen 69,5 %. Selbstlimitierende Blutungskomplikationen traten bei 2 Patienten auf (intraperitoneale Blutung aufgrund einer Perforation der Leberkapsel, n = 1; Leberhämatom, n = 1). Einer der beiden Patienten verstarb jedoch im Verlauf des Indexaufenthalts aufgrund einer nosokomialen Pneumonie. Während des Follow-Ups entwickelten drei Patienten aufgrund eines PVT-Rezidivs portalhypertensive Komplikationen.

Schlussfolgerung PVR-TIPS ist eine sichere und effektive Methode zur Behandlung ausgewählter Patienten mit chronischer nicht-zirrhotischer PVT. Aufgrund der Komplexität des Eingriffs sowie der möglichen Risiken sollte die Methode nur in spezialisierten Zentren mit einer hohen Erfahrung bezüglich TIPS-Prozeduren durchgeführt werden.

Key words

portal vein thrombosis - transjugular intrahepatic portosystemic shunt - JAK2 - portal hypertension - treatment - thrombectomy

Schlüsselwörter

Pfortaderthrombose - transjugulärer intrahepatischer portosystemischer Shunt - JAK2 - portale Hypertension - Behandlung - Thrombektomie
 

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