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 InterestThe authors disclose no conflicts.
