Published online Sep 6, 2019. doi: 10.12998/wjcc.v7.i17.2450
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
Splenectomy with pericardial devascularization (SPD) without liver transplantation has been widely accepted for the treatment of cirrhosis in patients with variceal bleeding and secondary hypersplenism in China. However, when compared with other treatments, simple splenectomy and SPD are associated with an increased incidence of postoperative complications, such as portal vein thrombosis (PVT). Transjugular intrahepatic portosystemic shunt (TIPS), as an alternative to surgery, is now commonly used for management of complications of portal hypertension. Patients with SPD had 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.
SPD is one of the common treatment methods used in China for patients with cirrhosis and portal-hypertension-related complications and hypersplenism. It can correct hypersplenism and reduce PV blood flow and pressure within a short period of time. However, it may aggravate the portal hypertension, cause PVT, increase the probability of rebleeding and ultimately affects quality of life. In this study, we evaluated the incidence of PVT after splenectomy and its influence on the patency rate of TIPS in patients with cirrhosis and portal hypertension.
The main objective of this study was to investigate the effects of high incidence of PVT in patients with portal hypertension and prior SPD on the TIPS stent patency and the risk of recurrent symptoms associated with shunt stenosis or occlusion.
We conducted a retrospective study to compare the incidence of PVT before TIPS for patients without prior SPD (group A) and those with prior SPD (group B). 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 are expressed as mean ± SD. Patency time was calculated using the Kaplan-Meier method, and the median time was compared by means of the log-rank test. Logistic regression analysis was performed on the variables. The differences between the groups were compared using one-way analysis of variance followed by least significant difference t tests. Differences were considered significant at P < 0.05. The statistical analysis was performed with SPSS version 20.0 (SPSS, Chicago, IL, United States).
The incidence of PVT in group B was higher than in group A, and the difference was significant between the two groups (P = 0.003). The success rate of TIPS in group A was higher than in group B, and 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. Recurrence of bleeding and ascites rate in group A were lower than in group B at 3 mo, 6 mo, 9 mo, 12 mo, 2 years and 3 years. During the 3-year follow-up, the 1-, 2- and 3-year survival rates in group A were higher than in group B, but there was no difference of the incidence of hepatic encephalopathy.
Patients with a SPD have a high incidence of PVT, which potentially increases the risk of recurrent symptoms associated with TIPS stenosis or occlusion.
This study showed that patients with portal hypertension with prior splenectomy had a high incidence of PVT, which is an important determinant of TIPS stent patency and potentially increases the risk of recurrent symptoms associated with shunt stenosis or occlusion. Patients with portal hypertension may avoid splenectomy when they are undergoing TIPS treatment. However, this is only a retrospective study, and randomized controlled trials are needed to verify our results.