Systematic review with meta-analysis: portal vein recanalisation and transjugular intrahepatic portosystemic shunt for portal vein thrombosis

Susana G Rodrigues; Sebastian Sixt; Juan G Abraldes; Andrea De Gottardi; Christoph Klinger; Jaime Bosch; Iris Baumgartner; Annalisa Berzigotti

doi:10.1111/apt.15044

Systematic review with meta-analysis: portal vein recanalisation and transjugular intrahepatic portosystemic shunt for portal vein thrombosis

Aliment Pharmacol Ther. 2019 Jan;49(1):20-30. doi: 10.1111/apt.15044. Epub 2018 Nov 18.

Authors

Susana G Rodrigues¹, Sebastian Sixt², Juan G Abraldes³, Andrea De Gottardi¹, Christoph Klinger⁴, Jaime Bosch^{1

5}, Iris Baumgartner², Annalisa Berzigotti¹

Affiliations

¹ Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, Department of Biomedical Research, University of Bern, Berne, Switzerland.
² Clinic for Angiology, Swiss Cardiovascular Center, Inselspital, University of Bern, Berne, Switzerland.
³ Cirrhosis Care Clinic, Division of Gastroenterology (Liver Unit), CEGIIR, University of Alberta, Edmonton, Canada.
⁴ Department of Gastroenterology, Hepatology and Oncology, Hospital of Ludwigsburg, Ludwigsburg, Germany.
⁵ Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, Ciberehd, University of Barcelona, Barcelona, Spain.

PMID: 30450634
DOI: 10.1111/apt.15044

Abstract

Background: Transjugular intrahepatic portosystemic shunt has been increasingly used in patients with portal vein thrombosis to obtain patency, but evidenced-based decisions are challenging.

Aim: To evaluate published data on efficacy and safety of endovascular therapy in portal vein thrombosis.

Methods: Systematic search of PubMed, ISI, Scopus, and Embase for studies (in English, until October 2017) reporting feasibility, safety, 12-month portal vein recanalisation, transjugular intrahepatic portosystemic shunt patency, and survival in patients with benign portal vein thrombosis undergoing endovascular treatment. An independent extraction of articles using predefined data fields and quality indicators was used; pooled analyses based on random-effects models; heterogeneity assessment by Cochran's Q, I² statistic, subgroup analyses, and meta-regression.

Results: Thirteen studies including 399 patients (92% cirrhosis; portal vein thrombosis: complete 46%, chronic 87%, cavernous transformation 17%, superior mesenteric vein involvement 55%) were included. Transjugular intrahepatic portosystemic shunt was technically feasible in 95% (95% CI: 89%-98%) with heterogeneity (I² = 57%, P < 0.001) explained by cavernous transformation. Major complications occurred in 10% (95% CI: 6.0%-18.0%; I² = 52%, P = 0.55). Additional catheter-directed thrombolysis was associated with more complications compared to transjugular intrahepatic portosystemic shunt alone or plus thrombectomy (17.6% vs 3.3%). Twelve-month portal vein recanalisation was 79% (95% CI: 67%-88%; I² = 78%, P < 0.01). Shunt patency at 12 months was 84% (95% CI: 76%-90%; I² = 62%, P < 0.01). Overall 12-month survival rate was 89%, with no heterogeneity.

Conclusions: Transjugular intrahepatic portosystemic shunt for portal vein thrombosis recanalisation was highly feasible, effective, and safe. Cavernous transformation was the main determinant of technical failure. Additional catheter-directed thrombolysis was associated with higher risk of severe complications.

Keywords: TIPSS patency; cirrhosis; complication; endovascular therapy; splanchnic thrombosis.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Humans
Liver Cirrhosis / epidemiology
Portal Vein / pathology*
Portasystemic Shunt, Transjugular Intrahepatic / methods*
Survival Rate
Treatment Outcome
Venous Thrombosis / surgery*