Could TIPS be Applied in All Kinds of Portal Vein Thrombosis: We are not Sure!
Xuefeng Luo, Li Yang
Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
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Conboy, Taofic Mounajjed, Kymberly D. Watt, Dusica Babovic-Vuksanovic, Shailendra B. Patel, Patrick S. Kamath" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Fateh" "apellidos" => "Bazerbachi" ] 1 => array:2 [ "nombre" => "Erin E." "apellidos" => "Conboy" ] 2 => array:2 [ "nombre" => "Taofic" "apellidos" => "Mounajjed" ] 3 => array:2 [ "nombre" => "Kymberly D." "apellidos" => "Watt" ] 4 => array:2 [ "nombre" => "Dusica" "apellidos" => "Babovic-Vuksanovic" ] 5 => array:2 [ "nombre" => "Shailendra B." "apellidos" => "Patel" ] 6 => array:2 [ "nombre" => "Patrick S." "apellidos" => "Kamath" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119304661?idApp=UINPBA00004N" "url" => "/16652681/0000001600000006/v1_201906040957/S1665268119304661/v1_201906040957/en/main.assets" ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Could TIPS be Applied in All Kinds of Portal Vein Thrombosis: We are not Sure!" "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" => "<span class="elsevierStyleSections"><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">Dear editor</span><p id="p0010" class="elsevierStylePara elsevierViewall">We read with interest the recent article by Chinchilla-Lopez, <span class="elsevierStyleItalic">et al</span>. 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"><span class="elsevierStyleSup">1</span></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"><span class="elsevierStyleSup">2,3</span></a> However, several issues need further clarification.</p><p id="p0015" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">4</span></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"><span class="elsevierStyleSup">1</span></a> The TIPS indication in patients with intrahepatic PVT need further evaluated.</p><p id="p0020" class="elsevierStylePara elsevierViewall">A post-TIPS portosystemic pressure gradient (PSG) below than 12 mmHg was usually considered the target threshold of <span class="elsevierStyleItalic">de nova</span> TIPS creation.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">5</span></a> It is uncommon for the authors to report pre- and post-TIPS portal pressure instead of PSG.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">1</span></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.</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Conflicts of Interest</span><p id="p0025" class="elsevierStylePara elsevierViewall">The authors disclose no conflicts.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "s0010" "titulo" => "Dear editor" ] 1 => array:2 [ "identificador" => "s0015" "titulo" => "Conflicts of Interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0010" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0010" "etiqueta" => "1." 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