Could TIPS be Applied in All Kinds of Portal Vein Thrombosis: We are not Sure!

Luo, Xuefeng; Yang, Li

doi:10.5604/01.3001.0010.5291

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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "979" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Xuefeng Luo, Li Yang" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Xuefeng" "apellidos" => "Luo" ] 1 => array:2 [ "nombre" => "Li" "apellidos" => "Yang" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China" "identificador" => "aff1" ] ] ] ] "textoCompleto" => "Dear editorWe read with interest the recent article by Chinchilla-Lopez, et al. regarding the role of transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory as-cites and portal vein thrombosis (PVT).<a class="elsevierStyleCrossRef" href="#bib0010">1</a> We should applaud their work for the extend of TIPS indication in this population, since high-quality clinical trials has demonstrated that patients with refractory ascites and/or PVT could benefit from this procedure.<a class="elsevierStyleCrossRefs" href="#bib0015">2,3</a> However, several issues need further clarification.A reduced portal flow velocity has shown to be an important underlying mechanism of PVT formation in patients with cirrhosis.<a class="elsevierStyleCrossRef" href="#bib0025">4</a> TIPS creation could restore portal vein flow, recanalize portal venous system and relieve the complications of portal hypertension. However, the intra-hepatic PVT (such as the case presented by Chinchilla-Lopez) couldn’t resolve because the intrahepatic portal branch flow was further decreased after TIPS.<a class="elsevierStyleCrossRef" href="#bib0010">1</a> The TIPS indication in patients with intrahepatic PVT need further evaluated.A post-TIPS portosystemic pressure gradient (PSG) below than 12 mmHg was usually considered the target threshold of de nova TIPS creation.<a class="elsevierStyleCrossRef" href="#bib0030">5</a> It is uncommon for the authors to report pre- and post-TIPS portal pressure instead of PSG.<a class="elsevierStyleCrossRef" href="#bib0010">1</a> In addition, a significant low post-TIPS PSG may lead to deprivation of portal perfusion, aggravated liver function and increased incidence of hepatic en-cephalopathy.Conflicts of InterestThe authors disclose no conflicts." 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ISSN: 1665-2681

Annals of Hepatology (AoH) is an international, open access journal published bi-monthly with funds from the Fundación Clínica Médica Sur. It is the official journal of the Mexican Association of Hepatology (AMH), the Latin American Association for the Study of the Liver (ALEH), the Canadian Association for the Study of the Liver (CASL) and the Czech Society of Hepatology (CSH). AoH publishes editorials, opinions, concise reviews, original articles, brief reports, letters to the editor, news from affiliated associations, clinical practice guidelines and summaries of congresses in the field of Hepatology.

Topics covered by AoH include alcoholic liver disease, autoimmune hepatitis, biliary diseases, drug-induced liver injury, genetic liver diseases, NAFLD/NASH and viral hepatitis (HAV, HBV, HCV, HDV, HEV). Our journal seeks to publish articles on basic clinical care and translational research focused on preventing rather than treating the complications of end-stage liver disease.

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We read with interest the recent article by Chinchilla-Lopez, et al. regarding the role of transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory as-cites and portal vein thrombosis (PVT).1 We should applaud their work for the extend of TIPS indication in this population, since high-quality clinical trials has demonstrated that patients with refractory ascites and/or PVT could benefit from this procedure.2,3 However, several issues need further clarification.

A reduced portal flow velocity has shown to be an important underlying mechanism of PVT formation in patients with cirrhosis.4 TIPS creation could restore portal vein flow, recanalize portal venous system and relieve the complications of portal hypertension. However, the intra-hepatic PVT (such as the case presented by Chinchilla-Lopez) couldn’t resolve because the intrahepatic portal branch flow was further decreased after TIPS.1 The TIPS indication in patients with intrahepatic PVT need further evaluated.

A post-TIPS portosystemic pressure gradient (PSG) below than 12 mmHg was usually considered the target threshold of de nova TIPS creation.5 It is uncommon for the authors to report pre- and post-TIPS portal pressure instead of PSG.1 In addition, a significant low post-TIPS PSG may lead to deprivation of portal perfusion, aggravated liver function and increased incidence of hepatic en-cephalopathy.

Conflicts of Interest

The authors disclose no conflicts.

References

[1.]

Chinchilla-López P., Hamdan-Pérez N., Guerrero-Ixtlahuac J., Barranco-Fragoso B., Méndez-Sánchez N..

The Role of TIPS in patients with Refractory Ascites and Portal Vein Thrombosis.

Ann Hepatol, 16 (2017), pp. 619-620

http://dx.doi.org/10.5604/01.3001.0010.0310 | Medline

[2.]

Bureau C., Thabut D., Oberti F., Dharancy S., Carbonell N., Bou-vier A., Mathurin P., et al.

Transjugular Intrahepatic Portosys-temic Shunts With Covered Stents Increase Transplant-free Survival of Patients With Cirrhosis and Recurrent Ascites.

Gastroenterology, 152 (2017), pp. 157-163

http://dx.doi.org/10.1053/j.gastro.2016.09.016 | Medline

[3.]

Luo X., Wang Z., Tsauo J., Zhou B., Zhang H., Li X..

Advanced Cirrhosis Combined with Portal Vein Thrombosis: A Randomized Trial of TIPS versus Endoscopic Band Ligation Plus Propranolol for the Prevention of Recurrent Esophageal Variceal Bleeding.

Radiology, 276 (2015), pp. 286-293

http://dx.doi.org/10.1148/radiol.15141252 | Medline

[4.]

Zocco M.A., Di Stasio E., De Cristofaro R., Novi M., Ainora M.E., Ponziani F., Riccardi L., et al.

Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development.

J Hepatol, 51 (2009), pp. 682-689

http://dx.doi.org/10.1016/j.jhep.2009.03.013 | Medline

[5.]

Boyer T.D., Haskal Z.J..

The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension: update 2009.

Hepatology, 51 (2010), pp. 306

http://dx.doi.org/10.1002/hep.23383 | Medline