Jiang TT, Luo XP, Sun JM, Gao J. Clinical outcomes of transcatheter selective superior mesenteric artery urokinase infusion therapy vs transjugular intrahepatic portosystemic shunt in patients with cirrhosis and acute portal vein thrombosis. World J Gastroenterol 2017; 23(41): 7470-7477 [PMID: 29151701 DOI: 10.3748/wjg.v23.i41.7470]
Corresponding Author of This Article
Jian Gao, PhD, Professor, Chief, Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing 400010, China. ykdxdeyy@public.cta.cq.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Randomized Controlled Trial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Nov 7, 2017; 23(41): 7470-7477 Published online Nov 7, 2017. doi: 10.3748/wjg.v23.i41.7470
Clinical outcomes of transcatheter selective superior mesenteric artery urokinase infusion therapy vs transjugular intrahepatic portosystemic shunt in patients with cirrhosis and acute portal vein thrombosis
Ting-Ting Jiang, Jian Gao, Department of Gastroenterology and Hepatology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
Xiao-Ping Luo, Department of Radiology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
Jian-Ming Sun, Department of Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
Author contributions: Jiang TT and Gao J designed the research; Jiang TT, Luo XP, and Sun JM performed the research and participated in data acquisition and analysis; Jiang TT wrote the paper.
Supported by the National Natural Science Foundation of China, No. 81572888.
Institutional review board statement: The study was reviewed and approved by the ethics committee of the Second Affiliated Hospital of Chongqing Medical University (Number: 2012-076).
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: None declared.
Data sharing statement: None declared.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jian Gao, PhD, Professor, Chief, Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing 400010, China. ykdxdeyy@public.cta.cq.cn
Telephone: +86-23-63693325 Fax: +86-23-63693323
Received: July 23, 2017 Peer-review started: July 25, 2017 First decision: August 30, 2017 Revised: September 10, 2017 Accepted: September 29, 2017 Article in press: September 28, 2017 Published online: November 7, 2017 Processing time: 104 Days and 20.9 Hours
ARTICLE HIGHLIGHTS
Research background
Acute portal vein thrombosis is a common complication of cirrhosis and would lead to adverse prognosis. Endovascular selective catheterization thrombolytic therapy and transjugular intrahepatic portosystemic shunt has been increasingly successfully implemented, which brings new opportunities for the treatment of acute portal vein thrombosis (PVT).
Research motivation
The aim of this study was to compare the clinical outcomes of transcatheter selective superior mesenteric artery (SMA) urokinase infusion therapy and transjugular intrahepatic portosystemic shunt (TIPS) in patients with cirrhosis and acute PVT to evaluate their effectiveness and safety for acute PVT.
Research objectives
To evaluate the effectiveness and safety of transcatheter selective SMA urokinase infusion therapy and TIPS in patients with cirrhosis and acute PVT to provide theoretical support for the implementation of new therapies.
Research methods
A randomized controlled trial was performed, and the total follow-up time was 24 mo. The outcome measures were the change in portal vein patency status, rebleeding, and hepatic encephalopathy.
Research results
Both treatments can quickly relieve symptoms within 48 h. The main portal vein thrombosis was significantly reduced in both groups and there was no significant difference between them. No fatal complications occurred.
Research conclusions
Transcatheter SMA infusion therapy and TIPS are both safe and effective treatments for patients with cirrhosis and acute PVT, particularly for grade I and II PVT, and transcatheter SMA urokinase infusion therapy is more ideal for the treatment of fresh thrombus in the mesentery.
Research perspectives
Further large-scale studies are needed. It is better to have a separate anticoagulant group as a control.
