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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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).

Research results

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.

Research conclusions

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

Research perspectives

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.