Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2019; 7(17): 2450-2462
Published online Sep 6, 2019. doi: 10.12998/wjcc.v7.i17.2450
Incidence of portal vein thrombosis after splenectomy and its influence on transjugular intrahepatic portosystemic shunt stent patency
Fang Dong, Shi-Hua Luo, Li-Juan Zheng, Jian-Guo Chu, He Huang, Xue-Qiang Zhang, Ke-Chun Yao
Fang Dong, Department of Vascular Surgery, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
Shi-Hua Luo, Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
Li-Juan Zheng, Department of Gastroenterology, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
Jian-Guo Chu, He Huang, Department of Radiology, Air Force Medical Center of PLA, Beijing 100142, China
Xue-Qiang Zhang, Department of Gastroenterology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Ke-Chun Yao, Department of Ultrasound, Air Force Medical Center of PLA, Beijing 100142, China
Author contributions: Dong F designed the research; Luo SH wrote the manuscript; Huang H carried out the experiment; Zheng LJ prepared the figures and tables; Zhang XQ performed data analysis; Chu JG was responsible for the experiment; and Yao KC supervised the study.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Air Force Medical Center of PLA, Beijing, China.
Informed consent statement: This is a retrospective study, and informed written consent was thus waived.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this study.
Data sharing statement: No additional data are available.
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/
Corresponding author: Shi-Hua Luo, MD, Postdoc, Department of Radiology, Zhongnan Hospital of Wuhan University, 169#, Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China. doctorluosh@sina.com
Telephone: +86-13871529785
Received: April 15, 2019
Peer-review started: April 15, 2019
First decision: May 31, 2019
Revised: July 11, 2019
Accepted: July 20, 2019
Article in press: July 20, 2019
Published online: September 6, 2019
Processing time: 146 Days and 4.4 Hours
Abstract
BACKGROUND

Transjugular intrahepatic portosystemic shunt (TIPS) is widely accepted as an alternative to surgery for management of complications of portal hypertension. TIPS has been used to treat portal vein thrombosis (PVT) in many centers since the 1990s. Although TIPS has good therapeutic effects on the formation of PVT, the effect of PVT on TIPS stenting has rarely been reported. Patients with splenectomy and pericardial devascu-larization have a high incidence of PVT, which can markedly affect TIPS stent patency and increase the risk of recurrent symptoms associated with shunt stenosis or occlusion.

AIM

To investigate the incidence of PVT after splenectomy and its influence on the patency rate of TIPS in patients with cirrhosis and portal hypertension.

METHODS

Four hundred and eighty-six patients with portal hypertension for refractory ascites and/or variceal bleeding who required TIPS placement between January 2010 and January 2016 were included in this retrospective analysis. Patients without prior splenectomy were defined as group A (n = 289) and those with prior splenectomy as group B (n = 197). The incidence of PVT before TIPS was compared between the two groups. After TIPS placement, primary patency rate was compared using Kaplan–Meier analysis at 3, 6, 9 and 12 mo, and 2 and 3 years. The clinical outcomes were analyzed.

RESULTS

Before TIPS procedure, the incidence of PVT in group A was lower than in group B (P = 0.003), and TIPS technical success rate in group A was higher than in group B (P = 0.016). The primary patency rate in group A tended to be higher than in group B at 3, 6, 9 and 12 mo, 2 years and 3 years (P = 0.006, P = 0.011, P = 0.023, P = 0.032, P = 0.037 and P = 0.028, respectively). Recurrence of bleeding and ascites rate in group A was lower than in group B at 3 mo (P ≤ 0.001 and P = 0.001), 6 mo (P = 0.003 and P = 0.005), 9 mo (P = 0.005 and P = 0.012), 12 mo (P = 0.008 and P = 0.024), 2 years (P = 0.011 and P = 0.018) and 3 years (P = 0.016 and P = 0.017), respectively. During 3-years follow-up, the 1-, 2- and 3-year survival rate in group A were higher than in group B (P = 0.008, P = 0.021, P = 0.018, respectively), but there was no difference of the incidence of hepatic encephalopathy (P = 0.527).

CONCLUSION

Patients with prior splenectomy have a high incidence of PVT, which potentially increases the risk of recurrent symptoms associated with shunt stenosis or occlusion.

Keywords: Portal hypertension; Transjugular intrahepatic portosystemic shunt; Splenectomy; Portal vein thrombosis

Core tip: There are several approaches for treatment of portal hypertension related varices and variceal hemorrhage, including drugs, endoscopic variceal ligation, transjugular intrahepatic portosystemic shunt, splenectomy with pericardial devascularization and liver transplantation. Transjugular intrahepatic portosystemic shunt is widely accepted as an alternative to surgery for management of complications of portal hypertension such as variceal bleeding, refractory ascites, Budd–Chiari syndrome, hepatorenal syndrome, hepatic hydrothorax and even hepatopulmonary syndrome. Patients with splenectomy with pericardial devascularization had a high incidence of portal vein thrombosis, which can markedly affect transjugular intrahepatic portosystemic shunt stent patency and potentially increase the risk of recurrent symptoms associated with shunt stenosis or occlusion.