Brief Article
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World J Gastroenterol. Feb 14, 2014; 20(6): 1602-1607
Published online Feb 14, 2014. doi: 10.3748/wjg.v20.i6.1602
Transjugular intrahepatic portosystemic shunt with covered stents for hepatocellular carcinoma with portal vein tumor thrombosis
Jian-Bo Zhao, Chao Feng, Qiao-Hua Zhu, Xiao-Feng He, Yan-Hao Li, Yong Chen
Jian-Bo Zhao, Chao Feng, Xiao-Feng He, Yan-Hao Li, Yong Chen, Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Qiao-Hua Zhu, Department of Interventional Radiology, People’s Hospital, Southern Medical University, Shunde 528000, Guangdong Province, China
Author contributions: Zhao JB, Li YH and Chen Y designed the study; Zhao JB, Li YH, Chen Y and He XF performed the study; Feng C provided new reagents or analytic tools and analyzed the data; Zhao JB and Zhu QH wrote the paper.
Supported by Science and Technology Planning Project of Guangdong Province, China, No. 2012B010200027; The Key Technologies RD Program of Guangzhou, China; The Presidential Foundation of the Nanfang Hospital, Southern Medical University, Guangzhou, China, No. 2011B006
Correspondence to: Yong Chen, MD, Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou South Avenue, Guangzhou 510515, Guangdong Pronvince, China. cheny102@163.com
Telephone: +86-20-61642084 Fax: +86-20-61648365
Received: September 23, 2013
Revised: November 13, 2013
Accepted: December 12, 2013
Published online: February 14, 2014
Processing time: 147 Days and 12.7 Hours
Abstract

AIM: To evaluate transjugular intrahepatic portosystemic shunt (TIPS) with covered stents for hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (PVTT).

METHODS: Eleven advanced HCC patients (all male, aged 37-78 years, mean: 54.3 ± 12.7 years) presented with acute massive upper gastrointestinal bleeding (n = 9) or refractory ascites (n = 2) due to tumor thrombus in the main portal vein. The diagnosis of PVTT was based on contrast-enhanced computed tomography and color Doppler sonography. The patients underwent TIPS with covered stents. Clinical characteristics and average survival time of 11 patients were analyzed. Portal vein pressure was assessed before and after TIPS. The follow-up period was 2-18 mo.

RESULTS: TIPS with covered stents was successfully completed in all 11 patients. The mean portal vein pressure was reduced from 32.0 to 11.8 mmHg (t = 10.756, P = 0.000). Gastrointestinal bleeding was stopped in nine patients. Refractory ascites completely disappeared in one patient and was alleviated in another. Hepatic encephalopathy was observed in six patients and was resolved with drug therapy. During the follow-up, ultrasound indicated the patency of the shunt and there was no recurrence of symptoms. Death occurred 2-14 mo (mean: 5.67 mo) after TIPS in nine cases, which were all due to multiple organ failure. In the remaining two cases, the patients were still alive at the 16- and 18-mo follow-up, respectively.

CONCLUSION: TIPS with covered stents for HCC patients with tumor thrombus in the main portal vein is technically feasible, and short-term efficacy is favorable.

Keywords: Transjugular intrahepatic portosystemic shunt; Covered stent; Portal hypertension; Main portal vein tumor thrombus; Hepatocellular carcinoma

Core tip: Tumor thrombus invasion of portal veins is very common in advanced hepatocellular carcinoma patients, especially in the patients presenting with upper gastrointestinal hemorrhage. Transjugular intrahepatic portosystemic shunt (TIPS) with bare stents has been attempted to treat those patients. We choose Fluency stent (Bard Inc, Germany) in this study, and our primary experience showed that the efficacy of TIPS with covered stents is favorable for treatment of complications related to portal hypertension due to tumor thrombus invasion in the main portal vein. Significant improvement of symptoms was observed in all the patients. The patency rate was 100%.