Transjugular intrahepatic portosystemic shunt for portal vein thrombosis in the context of complicated portal hypertension of cirrhotic origin

Aim. To analyze the effectiveness of transjugular intrahepatic portosystemic shunt in complicated portal hypertension of cirrhotic origin aggravated by portal vein thrombosis, and to assess the portal decompression achieved through the reduction in the portosystemic pressure gradient.

Materials and methods. In the period of 2017–2024, transjugular intrahepatic portosystemic shunt was performed on 26 patients with liver cirrhosis and portal hypertension complicated by portal vein thrombosis. Mortality, recurrence rate of variceal bleeding, shunt thrombosis, rethrombosis of the portal vein, and overall survival were analyzed.

Results. All patients exhibited a decrease in portal vein pressure from 36.0 ± 3.4 mmHg to 21.9 ± 1.5 mmHg (t = 3.77, p < 0.001) and in the portosystemic pressure gradient from 28.5 ± 3.1 mmHg to 11.5 ± 1.1 mmHg (t = 5.17, p < 0.001). The maximum duration of follow-up accounted for 78 months. The six-week mortality rate comprised 7.7%, 8 patients (30.8%) died within one year. All patients underwent surgery due to a high risk of bleeding. 14 patients remain under observation.

Conclusion. Achievable portal decompression is considered effective in terms of reducing mortality and prolonging the non-transplantation period. Long-term anticoagulant therapy is found mandatory. The shunting procedure should be complemented by selective embolization of the inflow pathways to the esophagogastric varices.

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