Abstract
Purpose
Portal vein thrombus (PVT) can worsen portal hypertension and hepatic decompensation in patients with cirrhosis and impact liver transplant outcomes. This retrospective case series describes large bore mechanical thrombectomy of PVT with the Inari FlowTriever device during, or remotely after, transjugular intrahepatic portosystemic shunt (TIPS) placement.
Materials and Methods
Ten patients with PVT were treated with large bore thrombectomy. All patients had underlying cirrhosis, complicated by portal hypertension with acute/subacute PVT. Thrombectomy was performed either with TIPS placement, or via a previously placed thrombosed shunt. Median time from TIPS placement to thrombectomy was 3 years.
Results
Thrombectomy was technically successful in all patients with a majority achieving complete resolution of PVT in a single session. During mean follow-up of 13.3 months, all patients achieved complete resolution of PVT without recurrence.
Conclusion
Large bore mechanical thrombectomy together with TIPS is a feasible and effective treatment of acute/subacute PVT in cirrhotic patients with portal hypertension, often with complete resolution in a single session.
References
Primignani M, et al. Risk factors for thrombophilia in extrahepatic portal vein obstruction. Hepatology. 2005;41:603–8. https://doi.org/10.1002/hep.20591.
Ögren M, et al. Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23 796 consecutive autopsies. World J Gastroenterol: WJG. 2006;12:2115.
Kumar S, Sarr MG, Kamath PS. Mesenteric venous thrombosis. N Engl J Med. 2001;345:1683–8.
Primignani M. Portal vein thrombosis, revisited. Dig Liver Dis. 2010;42:163–70. https://doi.org/10.1016/j.dld.2009.08.003.
Northup PG, et al. Vascular liver disorders, portal vein thrombosis, and procedural bleeding in patients with liver disease: 2020 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;73:366–413. https://doi.org/10.1002/hep.31646.
Bilbao JI, et al. Transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of venous symptomatic chronic portal thrombosis in non-cirrhotic patients. Cardiovasc Intervent Radiol. 2004;27:474–80. https://doi.org/10.1007/s00270-004-0241-z.
Thornburg B, et al. Pretransplantation portal vein recanalization and transjugular intrahepatic portosystemic shunt creation for chronic portal vein thrombosis: final analysis of a 61-patient cohort. J Vasc Interv Radiol. 2017;28:1714-1721 e1712. https://doi.org/10.1016/j.jvir.2017.08.005.
Chamarthy MR, Anderson ME, Pillai AK, Kalva SP. Thrombolysis and transjugular intrahepatic portosystemic shunt creation for acute and subacute portal vein thrombosis. Tech Vasc Interv Radiol. 2016;19:42–51. https://doi.org/10.1053/j.tvir.2016.01.005.
Seedial SM, Mouli SK, Desai KR. Acute portal vein thrombosis: current trends in medical and endovascular management. Semin Intervent Radiol. 2018;35:198–202. https://doi.org/10.1055/s-0038-1660798.
Yerdel MA, et al. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation. 2000;69:1873–81.
Acknowledgements
None.
Funding
None. This study was not supported by any funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
For this type of study, formal consent is not required.
Informed consent
Informed consent was obtained from all individual participants in this study.
Consent for publication
Consent for publication was obtained from every individual person’s data included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Sullivan, I.W., Fonseca, A., Brown, M. et al. Large Bore Portal Vein Thrombectomy: An Inari FlowTriever Case Series. Cardiovasc Intervent Radiol 46, 136–141 (2023). https://doi.org/10.1007/s00270-022-03286-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-022-03286-w