2017, Number 6
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Ann Hepatol 2017; 16 (6)
Could TIPS be Applied in All Kinds of Portal Vein Thrombosis: We are not Sure!
Reply
Luo X, Yang L
Language: English
References: 13
Page: 979-980
PDF size: 98.16 Kb.
Text Extraction
Dear editor:
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 ascites
and portal vein thrombosis (PVT). 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. 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. TIPS creation could restore portal
vein flow, recanalize portal venous system and relieve the
complications of portal hypertension. However, the intrahepatic
PVT (such as the case presented by Chinchilla-
Lopez) couldn’t resolve because the intrahepatic portal
branch flow was further decreased after TIPS. The TIPS
indication in patients with intrahepatic PVT need further
evaluated.
REFERENCES
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 2017; 16: 619-20.
Bureau C, Thabut D, Oberti F, Dharancy S, Carbonell N, Bouvier A, Mathurin P, et al. Transjugular Intrahepatic Portosystemic Shunts With Covered Stents Increase Transplant-free Survival of Patients With Cirrhosis and Recurrent Ascites. Gastroenterology 2017; 152: 157-63.
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 2015; 276: 286-93.
Zocco MA, Di Stasio E, De Cristofaro R, Novi M, Ainora ME, 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 2009; 51: 682-9.
Boyer TD, Haskal ZJ. The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension: update 2009. Hepatology 2010; 51: 306.
European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010; 3: 397-417.
Boyer T, Haskal Z, AASLD Practice Guidelines: The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension. Hepatology 2010; 1: 1-16.
Rössle M. TIPS: 25 years later. J Hepatol 2013; 59: 1081-93.
Tsochatzis EA, Gerbes AL. Diagnosis and treatment of ascites. J Hepatol 2017; (67) 184-5.
Wong F. The use of TIPS in chronic liver disease. Annals of Hepatology 2006; 1: 5-15.
García-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal Hypertensive Bleeding in Cirrhosis: Risk Stratification, Diagnosis and Management: 2016 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2017; 1: 310-35.
Moreno A, Meneu JC, Moreno E, Fraile M, Garcia I, Loinaz C, Abradelo M, et al. Liver transplantation and transjugular intrahepatic portosystemic shunt. Transplant Proc 2003; 35: 1869-70.
Gonzales P, Dhanasekaran R, West J, Subramanian R, Parekh S, Spivey JR, PreetiReshamwala, et al. Influence of transjugular intrahepatic portosystemic shunt in patients awaiting orthotopic liver transplant on post-transplant outcome. Gastrointestinal Intervention 2012; 1: 69-73.