Portal vein thrombosis in cirrhosis: Controversies and latest developments

Table 4 Summary of retrospective case series reporting the use of transjugular intrahepatic portosystemic stent-shunt for portal vein thrombosis in cirrhosis

	Study type and stent characteristics	n	Baseline severity liver disease: Child’s A/B/C (%)	TIPSS indication (%)	PVT characteristics: Complete/ partial/ cavernoma (%)	Successful cannulation (%)	Outcome	Significant complications/ notes
Luca et al[102]	Series 2003-2010	70	A: 17 (24)	Bleeding: 48	Complete: 24	70/70 (100) cannulation.	Complete recanalisation in 40 (57%): 38 maintained patency at mean follow up 20.7 mo.
	13 bare Wallstent, 57 covered Viatorr ePTFE covered (WL Gore and Associates)		B: 42 (60)	Ascites/ hydrothorax: 18	Cavernoma: 2	Complete recanalisation or significant reduction in thrombosis: 61 (87)
			C: 11 (16)	Specific treatment of PVT: 4
Perarnau et al[100]	Series 1990-2004	34	A: 3 (14)	Bleeding: 27 (79)	Complete acute: 15	No cavernoma: 15/15 (100)	Mean F/U 30 mo.	Failed cannulation in presence of thrombosed intrahepatic PV branches or peri-hilar cavernoma
	Palmaz (Cordis) or Wallstent (Boston Scientific) bare stents		B: 11 (52)	Ascites: 5 (15)	Complete + cavernoma: 19	Cavernoma: 12/19 (63)	26/34 (72%) long-term patency
			C: 7 (33)	Other: 2
			(incomplete details)
Senzolo et al[104]	Series 1994-2005	28 (15 non-cirrhotic)	Not stated	Bleeding: 15	Complete: 8 (3 with, 5 without cavernoma)	19/28 (73%)	Primary patency mean 18 mo in 14/19.
	26 Memotherms (Angiomed) bare stents, 3 Viatorr covered stents			Ascites: 5	Partial: 5		Stent thrombosis in 2 non-cirrhotic subjects (Budd-Chiari syndrome)
				Portal biliopathy: 3
				Specific treatment PVT: 1
Han et al[99]	Series 2001-2008	57	A: 25 (44)	Bleeding: 56	Complete: 14	Overall: 43/57 (75)	Primary patency maintained in 26/43 (17 required shunt revisions to maintain patency)	Failure related to presence of cavernoma.
	Uncovered stents in all patients		B: 26 (46)	Ascites: 1	Cavernoma: 30	Complete PVT: 8/14 (57)		1 case of delayed severe intra-abdominal haemorrhage following percutaneous trans-hepatic approach.
			C: 6 (30)		Partial: 35	Partial PVT: 35/35 (100)
						Cavernoma: 16/30 (53%)
Van Ha et al[106]	Series 1995-2003	15	B: 11 (73)	Bleeding: 10	Complete: 4/partial: 7/complete with cavernoma: 4	Overall: 13/15 (87)	Mean F/U 17 mo.
	12 bare Wallstent (Boston Scientific), 1 bare Zilver stent (Cook)		C: 4 (27)	Ascites: 5		Cavernoma: 3/4	1 stent occlusion
						No cavernoma: 10/11 (91)
D’Avola et al[101]	Series 1995-2009	15 (+ 8 controls with PVT)	Mean Child’s 8	Prevention of complete PVT pre-liver transplant: 8	All partial PVT	Series describes only patients who successfully underwent TIPSS	3/15 TIPSS thrombosis: all successfully treated.
	Bare and covered stents			Bleeding: 6			Median time TIPSS to transplant: 185 d.
				Ascites: 1			100% portal vein patency at time of transplant vs 50% patency at transplant in controls (P = 0.008)
Bauer et al[103]	Series 1999-2005	9	Cirrhosis: disease severity not stated	Primary indication: maintain PV patency for future liver transplantation	Complete: 7	Series describing only patients who successfully underwent TIPSS	1/9 re-thrombosed.
	3 covered stents: others bare stent				Partial: 2		2 patients transplanted with no PVT present
					Cavernoma: 4
Blum et al[114]	Case series	7	Cirrhosis: disease severity not stated	Bleeding: 7	PVT severity not stated.	Series of successful cases
	All bare stents				No cavernoma.

PVT: Portal vein thrombosis; TIPSS: Transjugular intrahepatic portosystemic stent-shunt; F/U: Follow up.