Embedded Files
Welcome to the Academic and Educational pages of the
Department of Radiology
Seth G.S. Medical College and K.E.M. Hospital, Mumbai , India
Interventional Case Record
Interventional Case Record
Transjugular intrahepatic portosystemic shunt in case of portal vein thrombosis.
Transjugular intrahepatic portosystemic shunt in case of portal vein thrombosis.
.Contributed by : Yash Khandwe
.Contributed by : Yash Khandwe
Introduction:
Introduction:
Portal vein thrombosis (PVT) refers to the blockage of blood flow within the portal venous system due to the formation of a thrombus. This condition may extend to involve the splenic and superior mesenteric veins to varying degrees. Globally, PVT affects approximately 1–2% of individuals, with incidence rates continuing to rise. (1, 2). Multiple factors contribute to its development, including prothrombotic disorders, abdominal infections or inflammation, malignancies, cirrhosis, and iatrogenic causes.
Portal vein thrombosis (PVT) refers to the blockage of blood flow within the portal venous system due to the formation of a thrombus. This condition may extend to involve the splenic and superior mesenteric veins to varying degrees. Globally, PVT affects approximately 1–2% of individuals, with incidence rates continuing to rise. (1, 2). Multiple factors contribute to its development, including prothrombotic disorders, abdominal infections or inflammation, malignancies, cirrhosis, and iatrogenic causes.
The clinical impact of PVT depends on the thrombus’s extent, rate of development, and underlying hepatic function. While acute, widespread thrombosis may cause symptoms such as abdominal pain, fever, variceal bleeding, or ascites, some patients—especially in early stages—may remain asymptomatic, with the condition only discovered incidentally during imaging. Over time, chronic PVT may lead to cavernous transformation of the portal vein, particularly in asymptomatic or undiagnosed cases.
The clinical impact of PVT depends on the thrombus’s extent, rate of development, and underlying hepatic function. While acute, widespread thrombosis may cause symptoms such as abdominal pain, fever, variceal bleeding, or ascites, some patients—especially in early stages—may remain asymptomatic, with the condition only discovered incidentally during imaging. Over time, chronic PVT may lead to cavernous transformation of the portal vein, particularly in asymptomatic or undiagnosed cases.
Case presentation:
Case presentation:
A 30-year-old man working as a mechanic and following a vegetarian diet, presented with a two-month history of recurrent upper gastrointestinal bleeding. He had 7–8 episodes of hematemesis (~200 mL each), followed by melena, dizziness, and fatigue, requiring transfusion of six units of packed red blood cells and four units of platelets. He had no known comorbidities, denied any prior history of liver disease, deep vein thrombosis, or anticoagulant use. He reported occasional alcohol intake (once a month) and was a chronic tobacco chewer. On examination, he was hemodynamically stable with mild pallor. Abdominal examination revealed moderate splenomegaly and mild ascites. Upper gastrointestinal endoscopy (UGIE) performed at different intervals showed large esophageal varices , post-endoscopic variceal ligation (EVL) ulcers, and mild portal hypertensive gastropathy. Three sessions of EVL were performed during hospitalization .A contrast-enhanced CT of the abdomen revealed hepatomegaly (liver span 17.8 cm) with caudate lobe hypertrophy, moderate splenomegaly (16 cm), and chronic thrombosis of the main portal vein with cavernomatous transformation. (FIG 1, VID 1, VID 2)
A 30-year-old man working as a mechanic and following a vegetarian diet, presented with a two-month history of recurrent upper gastrointestinal bleeding. He had 7–8 episodes of hematemesis (~200 mL each), followed by melena, dizziness, and fatigue, requiring transfusion of six units of packed red blood cells and four units of platelets. He had no known comorbidities, denied any prior history of liver disease, deep vein thrombosis, or anticoagulant use. He reported occasional alcohol intake (once a month) and was a chronic tobacco chewer. On examination, he was hemodynamically stable with mild pallor. Abdominal examination revealed moderate splenomegaly and mild ascites. Upper gastrointestinal endoscopy (UGIE) performed at different intervals showed large esophageal varices , post-endoscopic variceal ligation (EVL) ulcers, and mild portal hypertensive gastropathy. Three sessions of EVL were performed during hospitalization .A contrast-enhanced CT of the abdomen revealed hepatomegaly (liver span 17.8 cm) with caudate lobe hypertrophy, moderate splenomegaly (16 cm), and chronic thrombosis of the main portal vein with cavernomatous transformation. (FIG 1, VID 1, VID 2)
vid 1.mp4vid 2.mp4VID 9.mp4VID 9.mp4Figure 1: Coronal CECT (A+P) showing Chronic portal vein thrombosis with cavernoma formation and nonopacification of intrahepatic portal radicles.
Video 1: Coronal CECT (A+P) showing Chronic portal vein thrombosis with cavernoma formation and non-opacification of intrahepatic portal radicles.
Video 2 :Axial CECT (A+P) showing Chronic portal vein thrombosis with cavernoma formation and non-opacification of intrahepatic portal radicles.
Segmental thrombosis of the splenic vein was also noted. Extensive collateral formation was seen in the perigastric, perisplenic, peripancreatic, and paraesophageal regions. There was no focal hepatic lesion or radiologic evidence of cirrhosis. Fibroscan showed a liver stiffness measurement (LSM) of 5.1 kPa, suggestive of preserved hepatic architecture. A comprehensive thrombophilia workup including protein C and S levels, antithrombin III activity, MTHFR mutation, lupus anticoagulant, and anticardiolipin antibodies was negative. Liver function tests were preserved (AST 29, ALT 13, ALP 32.8, INR 1.45, Albumin 3.4 g/dL), and echocardiography revealed normal left ventricular function with no signs of cardiac cause for portal hypertension.
Segmental thrombosis of the splenic vein was also noted. Extensive collateral formation was seen in the perigastric, perisplenic, peripancreatic, and paraesophageal regions. There was no focal hepatic lesion or radiologic evidence of cirrhosis. Fibroscan showed a liver stiffness measurement (LSM) of 5.1 kPa, suggestive of preserved hepatic architecture. A comprehensive thrombophilia workup including protein C and S levels, antithrombin III activity, MTHFR mutation, lupus anticoagulant, and anticardiolipin antibodies was negative. Liver function tests were preserved (AST 29, ALT 13, ALP 32.8, INR 1.45, Albumin 3.4 g/dL), and echocardiography revealed normal left ventricular function with no signs of cardiac cause for portal hypertension.
A final diagnosis of non-cirrhotic portal hypertension (NCPH) due to chronic extrahepatic portal vein thrombosis (EHPVO) with cavernoma formation was made. In view of recurrent variceal bleeding despite adequate endoscopic therapy, the patient was referred for Transjugular Intrahepatic Portosystemic Shunt (TIPSS).
A final diagnosis of non-cirrhotic portal hypertension (NCPH) due to chronic extrahepatic portal vein thrombosis (EHPVO) with cavernoma formation was made. In view of recurrent variceal bleeding despite adequate endoscopic therapy, the patient was referred for Transjugular Intrahepatic Portosystemic Shunt (TIPSS).
Pre-procedural imaging confirmed feasibility with patent intrahepatic portal branches and hepatic veins. TIPSS was planned to achieve portal decompression and prevent further bleeding episodes.
Pre-procedural imaging confirmed feasibility with patent intrahepatic portal branches and hepatic veins. TIPSS was planned to achieve portal decompression and prevent further bleeding episodes.
Interventional technique
Interventional technique
Following informed consent, the taken and procedure performed under general Anaesthesia. 6 F sheath access was established through the right common femoral artery . A superior arteriogram with a arterio Portogram performed was obtained. This showed chronic thrombosis of the portal vein and faint opacification of the intra hepatic portal branches with cavernoma formation. The extrahepatic portal vein was well seen as was the porto-mesentric confluence (VID 3)
Following informed consent, the taken and procedure performed under general Anaesthesia. 6 F sheath access was established through the right common femoral artery . A superior arteriogram with a arterio Portogram performed was obtained. This showed chronic thrombosis of the portal vein and faint opacification of the intra hepatic portal branches with cavernoma formation. The extrahepatic portal vein was well seen as was the porto-mesentric confluence (VID 3)
VID 3..mp4Video 3: Arterio Portograms hows chronic thrombosis of the portal vein and faint opacification of the intra hepatic portal branches with cavernoma formation. The extrahepatic portal vein is well see and the portomesentric confluence too.
A 7 F sheath access was obtained in the right IJV and right hepatic vein catheterised using a H1 catheter. The sheath was exchanged for a long 10F sheath and a Colapinto needle along with a Chiba needle was introduced. After confirming the location of the right intrahepatic portal radical on fluoroscopy on the APG, the portal radical was punctured using Chiba needle. (VID 4)
A 7 F sheath access was obtained in the right IJV and right hepatic vein catheterised using a H1 catheter. The sheath was exchanged for a long 10F sheath and a Colapinto needle along with a Chiba needle was introduced. After confirming the location of the right intrahepatic portal radical on fluoroscopy on the APG, the portal radical was punctured using Chiba needle. (VID 4)
VID 4 ..mp4Video 4 : Chiba needle puncture into right portal radical.
A 0.014 ” nitrex wire was passeg through the radical into the portal vein and into the superior mesenteric vein. ( FIG 2)
A 0.014 ” nitrex wire was passeg through the radical into the portal vein and into the superior mesenteric vein. ( FIG 2)
Predilatation of the track was done using a 4 x 40 mm balloon. (FIG 3)
Predilatation of the track was done using a 4 x 40 mm balloon. (FIG 3)
Figure 2,3
FIG 2 : Nitrex wire (0.014”) access secured in the portal vein.
FIG 3 : Track dilatation done using 4 x 40 mm balloon
VID 5.mp4VID 6.mp4VID 7.mp4Video 5 6 7
Vid 5 : Venogram from the portal end after the H1 catheter access.
Vid 6 : Marker pigtail angiogram.
VID 7 : 10 x 120 mm Lifestar Stent being deployed.
Dilatation of the stent was done using a 6 x 40 mm balloon at the site of the portal end. (Fig 4).
Dilatation of the stent was done using a 6 x 40 mm balloon at the site of the portal end. (Fig 4).
Figure 4:
Fig 4 : Dilatation of the Lifestar stent using a 6 mm x 40 mm balloon.
A 10 X 100 mm Fluency stent graft was deployed across the track from the portal vein into the Hepatic vein (VID 8). Post stenting dilatation was done using 10 mm x 40 mm balloons. (FIG 5,VID 9)
A 10 X 100 mm Fluency stent graft was deployed across the track from the portal vein into the Hepatic vein (VID 8). Post stenting dilatation was done using 10 mm x 40 mm balloons. (FIG 5,VID 9)
VID 8.mp4VID 9.mp4Video 8 9
Fig 5 Dilatation of the stent with 10 mm x 40 mm balloon.
Video 8 (Top) 10 x 100 mm Fluency Stent being deployed. .
Video 9 (Bottom) Dilatation of the stent with 10 mm x 40 mm balloonhe stent from the portal into the IVC.
Angiogram showed adequate luminal increase in the stent and free forward flow from portal vein into IVC. (FIG 6 ,VID 10)
Angiogram showed adequate luminal increase in the stent and free forward flow from portal vein into IVC. (FIG 6 ,VID 10)
VID 10.mp4Fi6 video 10
Fig. 6 , Vid 10 : Angiogram showing adequate forward flow via the stent from the portal into the IV
Discussion:
Discussion:
The management of portal vein thrombosis (PVT), particularly in chronic settings, presents a multifaceted clinical challenge, especially when associated with cirrhosis or prior liver decompensation. Transjugular intrahepatic portosystemic shunt (TIPSS) has emerged as a promising therapeutic modality in this context—not only for reducing portal hypertension and its complications but also for restoring portal venous flow in selected patients. However, the role of TIPSS in PVT remains controversial, primarily due to heterogeneity in patient profiles, technical variability in procedural approaches, and inconsistent outcome measures across published studies.
The management of portal vein thrombosis (PVT), particularly in chronic settings, presents a multifaceted clinical challenge, especially when associated with cirrhosis or prior liver decompensation. Transjugular intrahepatic portosystemic shunt (TIPSS) has emerged as a promising therapeutic modality in this context—not only for reducing portal hypertension and its complications but also for restoring portal venous flow in selected patients. However, the role of TIPSS in PVT remains controversial, primarily due to heterogeneity in patient profiles, technical variability in procedural approaches, and inconsistent outcome measures across published studies.
One of the central difficulties in interpreting data on TIPSS in PVT is the variability in patient selection. Many cohorts include both cirrhotic and non-cirrhotic individuals, with differing degrees of thrombosis—ranging from partial to complete occlusion—and variable chronicity. Moreover, an important anatomic consideration that often lacks consistent reporting is the presence or absence of a portal cavernoma. The development of cavernous transformation not only represents chronicity but also markedly increases procedural complexity by obliterating the normal portal vein trajectory, making standard transjugular access technically demanding. Senzolo et al. conducted one of the earlier and more influential studies in this domain, assessing TIPSS outcomes in a heterogeneous group of 28 patients, including both cirrhotic and non-cirrhotic individuals. Of these, 23 had complete PVT and 9 had developed cavernous transformation (3). Using a conventional transjugular approach, the authors achieved a technical success rate of 73%. While there were several minor procedural complications—including biliary and capsular punctures—none resulted in clinically significant adverse outcomes. Importantly, one case of extrahepatic portal vein laceration was successfully managed with a covered stent. The study also highlighted a significantly lower re-bleeding rate in the TIPSS group compared to those in whom the procedure failed. The primary shunt patency was maintained in 74% of patients at a mean follow-up of 18.1 months. Crucially, this was among the first studies to propose that portal cavernoma, although technically challenging, should not be viewed as an absolute contraindication for TIPSS .Subsequent studies have reinforced and extended these findings. A study involving 17 patients with chronic, non-cirrhotic PVT reported a technical success rate of 76.5% using a purely transjugular approach, with a 24-month secondary portal vein patency rate of nearly 70% (4). Notably, two major bleeding episodes occurred but were effectively managed conservatively. These data underscore the fact that, while technically feasible in chronic PVT, transjugular access alone may be suboptimal in certain anatomical scenarios, necessitating alternate access strategies.
One of the central difficulties in interpreting data on TIPSS in PVT is the variability in patient selection. Many cohorts include both cirrhotic and non-cirrhotic individuals, with differing degrees of thrombosis—ranging from partial to complete occlusion—and variable chronicity. Moreover, an important anatomic consideration that often lacks consistent reporting is the presence or absence of a portal cavernoma. The development of cavernous transformation not only represents chronicity but also markedly increases procedural complexity by obliterating the normal portal vein trajectory, making standard transjugular access technically demanding. Senzolo et al. conducted one of the earlier and more influential studies in this domain, assessing TIPSS outcomes in a heterogeneous group of 28 patients, including both cirrhotic and non-cirrhotic individuals. Of these, 23 had complete PVT and 9 had developed cavernous transformation (3). Using a conventional transjugular approach, the authors achieved a technical success rate of 73%. While there were several minor procedural complications—including biliary and capsular punctures—none resulted in clinically significant adverse outcomes. Importantly, one case of extrahepatic portal vein laceration was successfully managed with a covered stent. The study also highlighted a significantly lower re-bleeding rate in the TIPSS group compared to those in whom the procedure failed. The primary shunt patency was maintained in 74% of patients at a mean follow-up of 18.1 months. Crucially, this was among the first studies to propose that portal cavernoma, although technically challenging, should not be viewed as an absolute contraindication for TIPSS .Subsequent studies have reinforced and extended these findings. A study involving 17 patients with chronic, non-cirrhotic PVT reported a technical success rate of 76.5% using a purely transjugular approach, with a 24-month secondary portal vein patency rate of nearly 70% (4). Notably, two major bleeding episodes occurred but were effectively managed conservatively. These data underscore the fact that, while technically feasible in chronic PVT, transjugular access alone may be suboptimal in certain anatomical scenarios, necessitating alternate access strategies.
To overcome these anatomical challenges, adjunctive percutaneous techniques such as the transhepatic and trans-splenic routes have been increasingly utilized. A study on 18 cirrhotic patients with chronic PVT employed a percutaneous transhepatic route without ultrasound guidance and achieved a technical success rate of 78% (5) Failures were limited to patients with non-visualized intrahepatic portal branches. Importantly, only one case of shunt dysfunction was reported during a median follow-up of 16 months, suggesting that with careful imaging assessment and patient selection, the transhepatic approach offers a viable alternative in difficult anatomy. Among the most promising innovations in this space has been the trans-splenic approach, which has demonstrated superior outcomes in technically complex cases. In a cohort of 44 liver transplant candidates with chronic complete or near-complete PVT (30% of whom had cavernoma), a combined approach utilizing transjugular, transhepatic, and trans-splenic access yielded a remarkable technical success rate of 98% and a 5-year patency rate of 89% (6) . The trans-splenic route, in particular, has shown increasing utility as both a rescue and a primary approach, especially in cases where standard techniques have failed. A smaller study from the same institution involving 11 patients achieved 100% technical success without major complications, and all patients maintained TIPS patency at 6.4 months of follow-up (7). These encouraging outcomes have been echoed in studies involving non-cirrhotic populations as well. One small series of five non-cirrhotic patients demonstrated 100% technical success and TIPS patency at a mean follow-up of 8.2 months. These results contrast with earlier reports where transjugular or transhepatic routes had failure rates as high as 22–27%, with up to one-third of technically successful cases requiring shunt revisions. Such findings strongly advocate for the integration of alternate access routes—particularly trans-splenic—as part of the standard TIPSS algorithm in chronic PVT. In the context of liver transplantation, TIPSS has been increasingly recognized not only for symptomatic relief but also for its ability to facilitate surgical planning and improve long-term outcomes. A retrospective analysis of 35 patients undergoing TIPSS for chronic obliterative PVT prior to liver transplant demonstrated that TIPS significantly simplified portal vein reconstruction, allowing for tension-free end-to-end anastomoses and , in most cases, obviating the need for thrombectomy (8) . Another study involving 30 patients on the transplant list showed complete or partial resolution of PVT in 80% of cases post-TIPSS, reinforcing its role as a pre-transplant optimization strategy. Two major meta-analyses on TIPS in cirrhotic patients with PVT further validate its therapeutic potential. These studies reported post-procedure PVT resolution rates of 74% and 78%, with encephalopathy occurring in 25% and 16% of patients, respectively—rates comparable to those observed in conventional TIPS cohorts. Importantly, the benefits of restored portal flow, reduced portal pressure, and improved transplant eligibility appear to outweigh these manageable complications in well-selected cases.
To overcome these anatomical challenges, adjunctive percutaneous techniques such as the transhepatic and trans-splenic routes have been increasingly utilized. A study on 18 cirrhotic patients with chronic PVT employed a percutaneous transhepatic route without ultrasound guidance and achieved a technical success rate of 78% (5) Failures were limited to patients with non-visualized intrahepatic portal branches. Importantly, only one case of shunt dysfunction was reported during a median follow-up of 16 months, suggesting that with careful imaging assessment and patient selection, the transhepatic approach offers a viable alternative in difficult anatomy. Among the most promising innovations in this space has been the trans-splenic approach, which has demonstrated superior outcomes in technically complex cases. In a cohort of 44 liver transplant candidates with chronic complete or near-complete PVT (30% of whom had cavernoma), a combined approach utilizing transjugular, transhepatic, and trans-splenic access yielded a remarkable technical success rate of 98% and a 5-year patency rate of 89% (6) . The trans-splenic route, in particular, has shown increasing utility as both a rescue and a primary approach, especially in cases where standard techniques have failed. A smaller study from the same institution involving 11 patients achieved 100% technical success without major complications, and all patients maintained TIPS patency at 6.4 months of follow-up (7). These encouraging outcomes have been echoed in studies involving non-cirrhotic populations as well. One small series of five non-cirrhotic patients demonstrated 100% technical success and TIPS patency at a mean follow-up of 8.2 months. These results contrast with earlier reports where transjugular or transhepatic routes had failure rates as high as 22–27%, with up to one-third of technically successful cases requiring shunt revisions. Such findings strongly advocate for the integration of alternate access routes—particularly trans-splenic—as part of the standard TIPSS algorithm in chronic PVT. In the context of liver transplantation, TIPSS has been increasingly recognized not only for symptomatic relief but also for its ability to facilitate surgical planning and improve long-term outcomes. A retrospective analysis of 35 patients undergoing TIPSS for chronic obliterative PVT prior to liver transplant demonstrated that TIPS significantly simplified portal vein reconstruction, allowing for tension-free end-to-end anastomoses and , in most cases, obviating the need for thrombectomy (8) . Another study involving 30 patients on the transplant list showed complete or partial resolution of PVT in 80% of cases post-TIPSS, reinforcing its role as a pre-transplant optimization strategy. Two major meta-analyses on TIPS in cirrhotic patients with PVT further validate its therapeutic potential. These studies reported post-procedure PVT resolution rates of 74% and 78%, with encephalopathy occurring in 25% and 16% of patients, respectively—rates comparable to those observed in conventional TIPS cohorts. Importantly, the benefits of restored portal flow, reduced portal pressure, and improved transplant eligibility appear to outweigh these manageable complications in well-selected cases.
Recent case series have also explored the transmesenteric route, particularly in patients with extensive thrombosis or post-splenectomy anatomy. While data remain limited to small cohorts, early outcomes are promising, with excellent technical success and no major access site complications reported. This route may be especially advantageous in patients with splenic vein thrombosis or surgically altered anatomy. One of the most comprehensive analyses of TIPSS in chronic non-cirrhotic PVT comes from a recent study involving 39 patients—all of whom had chronic PVT and varying degrees of cavernous transformation, with or without associated mesenteric or splenic vein thrombosis. Using a combination of transjugular, transhepatic, trans-splenic, and transmesenteric routes, the authors achieved 100% technical success. At 36 months, the primary patency rate was 63% and secondary patency reached 81%. Notably, 87% of patients demonstrated significant clinical or biochemical improvement during follow-up, with a relatively low incidence of post-TIPS encephalopathy (8%) and no cases of hepatic decompensation. Three hepatic hematomas were encountered, two of which required active intervention (9),
Recent case series have also explored the transmesenteric route, particularly in patients with extensive thrombosis or post-splenectomy anatomy. While data remain limited to small cohorts, early outcomes are promising, with excellent technical success and no major access site complications reported. This route may be especially advantageous in patients with splenic vein thrombosis or surgically altered anatomy. One of the most comprehensive analyses of TIPSS in chronic non-cirrhotic PVT comes from a recent study involving 39 patients—all of whom had chronic PVT and varying degrees of cavernous transformation, with or without associated mesenteric or splenic vein thrombosis. Using a combination of transjugular, transhepatic, trans-splenic, and transmesenteric routes, the authors achieved 100% technical success. At 36 months, the primary patency rate was 63% and secondary patency reached 81%. Notably, 87% of patients demonstrated significant clinical or biochemical improvement during follow-up, with a relatively low incidence of post-TIPS encephalopathy (8%) and no cases of hepatic decompensation. Three hepatic hematomas were encountered, two of which required active intervention (9),
In summary, this case and the existing literature underscore the evolving and increasingly sophisticated role of TIPSS in the management of chronic portal vein thrombosis. While technical success and clinical outcomes are heavily dependent on patient selection, anatomical considerations, and procedural expertise, the integration of alternate access routes—particularly trans-splenic and transmesenteric—has greatly expanded the therapeutic window. Portal cavernoma, once considered a contraindication, is now recognized as a technical hurdle rather than an exclusion criterion. As experience and device technology continue to evolve, TIPSS is poised to become a cornerstone in the multidisciplinary management of chronic PVT, both in pre- and post-transplant settings.
In summary, this case and the existing literature underscore the evolving and increasingly sophisticated role of TIPSS in the management of chronic portal vein thrombosis. While technical success and clinical outcomes are heavily dependent on patient selection, anatomical considerations, and procedural expertise, the integration of alternate access routes—particularly trans-splenic and transmesenteric—has greatly expanded the therapeutic window. Portal cavernoma, once considered a contraindication, is now recognized as a technical hurdle rather than an exclusion criterion. As experience and device technology continue to evolve, TIPSS is poised to become a cornerstone in the multidisciplinary management of chronic PVT, both in pre- and post-transplant settings.
References:
References:
1. Ögren, M.; Bergqvist, D.; Björck, M.; Acosta, S.; Eriksson, H.; Sternby, N.H. Portal vein thrombosis: Prevalence, patient characteristics and lifetime risk: A population study based on 23 796 consecutive autopsies. World J. Gastroenterol. 2006, 12, 2115–2119. [CrossRef] [PubMed]
1. Ögren, M.; Bergqvist, D.; Björck, M.; Acosta, S.; Eriksson, H.; Sternby, N.H. Portal vein thrombosis: Prevalence, patient characteristics and lifetime risk: A population study based on 23 796 consecutive autopsies. World J. Gastroenterol. 2006, 12, 2115–2119. [CrossRef] [PubMed]
2. Rajani, R.; Björnsson, E.; Bergquist, A.; Danielsson, Å.; Gustavsson, A.; Grip, O.; Melin, T.; Sangfelt, P.; Wallerstedt, S.; Almer, S. The epidemiology and clinical features of portal vein thrombosis: A multicentre study. Aliment. Pharmacol. Ther. 2010, 32, 1154–1162. [CrossRef] [PubMed]
2. Rajani, R.; Björnsson, E.; Bergquist, A.; Danielsson, Å.; Gustavsson, A.; Grip, O.; Melin, T.; Sangfelt, P.; Wallerstedt, S.; Almer, S. The epidemiology and clinical features of portal vein thrombosis: A multicentre study. Aliment. Pharmacol. Ther. 2010, 32, 1154–1162. [CrossRef] [PubMed]
3. Senzolo, M.; Tibbals, J.; Cholongitas, E.; Triantos, C.K.; Burroughs, A.K.; Patch, D. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with and without cavernous transformation. Aliment. Pharmacol. Ther. 2006, 23, 767–775. [CrossRef][PubMed]
3. Senzolo, M.; Tibbals, J.; Cholongitas, E.; Triantos, C.K.; Burroughs, A.K.; Patch, D. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with and without cavernous transformation. Aliment. Pharmacol. Ther. 2006, 23, 767–775. [CrossRef][PubMed]
4. Klinger, C.; Riecken, B.; Schmidt, A.; De Gottardi, A.; Meier, B.; Bosch, J.; Caca, K. Transjugular portal vein recanalization
4. Klinger, C.; Riecken, B.; Schmidt, A.; De Gottardi, A.; Meier, B.; Bosch, J.; Caca, K. Transjugular portal vein recanalization
with creation of intrahepatic portosystemic shunt (PVR-TIPS) in patients with chronic non-cirrhotic, non-malignant portal vein
with creation of intrahepatic portosystemic shunt (PVR-TIPS) in patients with chronic non-cirrhotic, non-malignant portal vein
thrombosis. Z. Gastroenterol. 2018, 56, 221–237. [CrossRef] [PubMed]
thrombosis. Z. Gastroenterol. 2018, 56, 221–237. [CrossRef] [PubMed]
5. Chen, Y.; Ye, P.; Li, Y.; Ma, S.; Zhao, J.; Zeng, Q. Percutaneous transhepatic balloon-assisted transjugular intrahepatic portosystemic
5. Chen, Y.; Ye, P.; Li, Y.; Ma, S.; Zhao, J.; Zeng, Q. Percutaneous transhepatic balloon-assisted transjugular intrahepatic portosystemic
shunt for chronic, totally occluded, portal vein thrombosis with symptomatic portal hypertension: Procedure technique, safety,
shunt for chronic, totally occluded, portal vein thrombosis with symptomatic portal hypertension: Procedure technique, safety,
and clinical applications. Eur. Radiol. 2015, 25, 3431–3437. [CrossRef]
and clinical applications. Eur. Radiol. 2015, 25, 3431–3437. [CrossRef]
6. Salem, R.; Vouche, M.; Baker, T.; Herrero, J.I.; Caicedo, J.C.; Fryer, J.; Hickey, R.; Habib, A.; Abecassis, M.; Koller, F.; et al. Pretransplant Portal Vein Recanalization—Transjugular Intrahepatic Portosystemic Shunt in Patients with Complete Obliterative Portal Vein Thrombosis. Transplantation 2015, 99, 2347–2355. [CrossRef]
6. Salem, R.; Vouche, M.; Baker, T.; Herrero, J.I.; Caicedo, J.C.; Fryer, J.; Hickey, R.; Habib, A.; Abecassis, M.; Koller, F.; et al. Pretransplant Portal Vein Recanalization—Transjugular Intrahepatic Portosystemic Shunt in Patients with Complete Obliterative Portal Vein Thrombosis. Transplantation 2015, 99, 2347–2355. [CrossRef]
7. Habib, A.; Desai, K.; Hickey, R.; Thornburg, B.; Vouche, M.; Vogelzang, R.L.; Salem, R. Portal Vein Recanalization–Transjugular Intrahepatic Portosystemic Shunt Using the Transsplenic Approach to Achieve Transplant Candidacy in Patients with Chronic Portal Vein Thrombosis. J. Vasc. Interv. Radiol. 2015, 26, 499–506. [CrossRef]
7. Habib, A.; Desai, K.; Hickey, R.; Thornburg, B.; Vouche, M.; Vogelzang, R.L.; Salem, R. Portal Vein Recanalization–Transjugular Intrahepatic Portosystemic Shunt Using the Transsplenic Approach to Achieve Transplant Candidacy in Patients with Chronic Portal Vein Thrombosis. J. Vasc. Interv. Radiol. 2015, 26, 499–506. [CrossRef]
8. Talwar, A.; Varghese, J.; Knight, G.M.; Katariya, N.; Caicedo, J.; Dietch, Z.; Borja-Cacho, D.; Ladner, D.; Christopher, D.; Baker, T.; et al. Preoperative portal vein recanalization–transjugular intrahepatic portosystemic shunt for chronic obliterative portal vein thrombosis: Outcomes following liver transplantation. Hepatol. Commun. 2022, 6, 1803–1812.
8. Talwar, A.; Varghese, J.; Knight, G.M.; Katariya, N.; Caicedo, J.; Dietch, Z.; Borja-Cacho, D.; Ladner, D.; Christopher, D.; Baker, T.; et al. Preoperative portal vein recanalization–transjugular intrahepatic portosystemic shunt for chronic obliterative portal vein thrombosis: Outcomes following liver transplantation. Hepatol. Commun. 2022, 6, 1803–1812.
9. Knight, G.M.; Clark, J.; Boike, J.R.; Maddur, H.; Ganger, D.R.; Talwar, A.; Riaz, A.; Desai, K.; Mouli, S.; Hohlastos, E.; et al. TIPS for Adults without Cirrhosis with Chronic Mesenteric Venous Thrombosis and EHPVO Refractory to Standard-of-Care Therapy. Hepatology 2021, 74, 2735–2744. [CrossRef] [PubMed]
9. Knight, G.M.; Clark, J.; Boike, J.R.; Maddur, H.; Ganger, D.R.; Talwar, A.; Riaz, A.; Desai, K.; Mouli, S.; Hohlastos, E.; et al. TIPS for Adults without Cirrhosis with Chronic Mesenteric Venous Thrombosis and EHPVO Refractory to Standard-of-Care Therapy. Hepatology 2021, 74, 2735–2744. [CrossRef] [PubMed]
Google Sites
Report abuse