Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: a randomised controlled trial

Gut ◽  
2017 ◽  
Vol 67 (12) ◽  
pp. 2156-2168 ◽  
Author(s):  
Yong Lv ◽  
Xingshun Qi ◽  
Chuangye He ◽  
Zhengyu Wang ◽  
Zhanxin Yin ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Adverse Events ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Decompensated Cirrhosis ◽  
Covered Stents ◽  
Band Ligation ◽  
Vein Thrombosis ◽  
Cirrhotic Patients ◽  
Endoscopic Band Ligation

ObjectiveLimited data are available on the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis (PVT). This study aimed to compare transjugular intrahepatic portosystemic shunt (TIPS) with covered stents versus endoscopic band ligation (EBL) plus propranolol for the prevention of variceal rebleeding among patients with cirrhosis and PVT.DesignConsecutive cirrhotic patients (94% Child-Pugh class A or B) with PVT who had variceal bleeding in the past 6 weeks were randomly assigned to TIPS group (n=24) or EBL plus propranolol group (EBL+drug, n=25), respectively. Primary endpoint was variceal rebleeding. Secondary endpoints included survival, overt hepatic encephalopathy (OHE), portal vein recanalisation and rethrombosis, other complications of portal hypertension and adverse events.ResultsDuring a median follow-up of 30 months in both groups, variceal rebleeding was significantly less frequent in the TIPS group (15% vs 45% at 1 year and 25% vs 50% at 2 years, respectively; HR=0.28, 95% CI 0.10 to 0.76, p=0.008), with a significantly higher portal vein recanalisation rate (95% vs 70%; p=0.03) and a relatively lower rethrombosis rate (5% vs 33%; p=0.06) compared with the EBL+drug group. There were no statistically significant differences in survival (67% vs 84%; p=0.152), OHE (25% vs 16%; p=0.440), other complications of portal hypertension and adverse events between groups.ConclusionCovered TIPS placement in patients with PVT and moderately decompensated cirrhosis was more effective than EBL combined with propranolol for the prevention of rebleeding, with a higher probability of PVT resolution without increasing the risk of OHE and adverse effects, but this benefit did not translate into improved survival.Trial registration numberClinicalTrials.gov: NCT01326949.

Clinical case of chronic portal vein thrombosis

2020 ◽  
pp. 27-41
Author(s):  
L. Zaklyakova ◽  
B. Levitan ◽  
M. Bolgova ◽  
V. Skvortsov ◽  
I. Zaklyakov
Keyword(s):  
Blood Flow ◽  
Portal Hypertension ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Oral Anticoagulant ◽  
Clinical Case ◽  
Standard Treatment ◽  
Decompensated Cirrhosis ◽  
Mechanical Trauma ◽  
Vein Thrombosis

Portal vein thrombosis (PVT) is a form of venous thrombosis that causes impaired or terminated blood flow in the portal vein. PVT is the main reason for the development of extrahepatic portal hypertension. The article presents a clinical case of chronic PVT with signs of severe portal hypertension and ascites. A feature of the case is that in a patient with suspected decompensated cirrhosis of the liver with the ineffectiveness of standard treatment, PVT was detected. The cause of PVT was mechanical trauma of the portal vein and hemocoagulation thrombophilia. For health reasons, the patient was prescribed rivaroxaban. Rivaroxaban is an oral anticoagulant from the group of Xa inhibitors. Against the background of treatment, recanalization of PVT was noted in the patient. Our experiment has shown that rivaroxaban is a promising drug for treatment of PVT.

scholarly journals Portal vein thrombosis associated with high 14-day and 6-week rebleeding in patients after oesophageal variceal band ligation: A retrospective, multicentre, nested case–control study

2021 ◽  
Author(s):  
Zhanjuan Gao ◽  
Jingrun Zhao ◽  
Xiaofeng Liu ◽  
Senlin Li ◽  
Minghui Wang ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Risk Factor ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Variceal Bleeding ◽  
Protective Factor ◽  
Independent Factor ◽  
Band Ligation ◽  
Vein Thrombosis ◽  
Cirrhotic Patients

Abstract Background and Aims: The association between prognosis of variceal bleeding and portal vein thrombosis (PVT) is unclear. In this multicentre study, we determined the effect of PVT on rebleeding and mortality in patients with acute variceal bleeding (AVB) after oesophageal variceal band ligation (EVL).Methods: Cirrhotic patients with AVB who had undergone EVL were included. The patients were allocated to either the PVT group or the control cirrhotic group (CCG) based on the presence or absence of PVT. One-year rebleeding episodes and mortality after EVL were recorded.Results: A total of 218 cirrhotic patients with AVB from 3 centres were included. Patients with PVT had a higher rate of 14-day and 6-week rebleeding than those without PVT (14-day: 8.26% vs. 1.83%, p = 0.03; 6-week: 11.92% vs. 1.83%, p = 0.003). The rates of 5-day failure (3.67% vs. 0.92%, p = 0.175), 1-year rebleeding (21.10% vs. 20.18%, p = 0.867), and 14-day, 6-week, and 1-year mortality were similar between the groups (14-day: 3.67% vs. 0.92%, p = 0.175; 6-week: 3.67% vs. 0.92%, p = 0.175; 1-year: 3.67% vs. 1.83%, p = 0.408). The Child-Pugh class [p = 0.022, hazard ratio (HR): 1.453; 95% confidence interval (CI): 1.056–1.998], PVT (p = 0.050, HR: 4.622, 95% CI: 0.999–21.395), albumin < 30 g/L (p = 0.023, HR: 5.886, 95% CI: 1.272–27.245), and number of bands (p = 0.010, HR: 1.207, 95% CI: 1.046–1.393) were identified as the predictors for 14-day rebleeding; the multivariate analysis revealed only the number of bands (p = 0.009, HR: 1.247, 95% CI: 1.056–1.473) as the independent factor. PVT (p = 0.012, HR: 6.732, 95% CI: 1.519–29.835) and albumin < 30 g/L (p = 0.027, HR: 3.643, 95% CI: 1.160–11.441) were identified as predictors for 6-week rebleeding; however, only PVT (p = 0.015, HR: 6.380, 95% CI: 1.427–28.515) was found to be the independent factor in the multivariate analysis. Further analysis showed that superior mesenteric vein (SMV) thrombosis is the only risk factor predicting 6-week rebleeding in patients with PVT (p = 0.032, HR: 3.405, 95% CI: 1.112–10.429). Conclusions: PVT was associated with high 14-day and 6-week rebleeding in patients after EVL. SMV thrombosis was the only risk factor for 6-week rebleeding in patients with PVT. High albumin levels may serve as a protective factor for the 14-day and 6-week rebleeding risk. PVT was not responsible for mortality after EVL during 1-year follow-up.

scholarly journals Measurement of Exhaled Nitric Oxide in Cirrhotic Patients with Esophageal and Gastric Varices

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Xiaoquan Huang ◽  
Souksavanh Thansamay ◽  
Kaiqi Yang ◽  
Tiancheng Luo ◽  
Shiyao Chen
Keyword(s):  
Nitric Oxide ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Gastric Varices ◽  
Exhaled Nitric Oxide ◽  
Decompensated Cirrhosis ◽  
Vein Thrombosis ◽  
Esophageal And Gastric Varices ◽  
Red Color ◽  
Cirrhotic Patients

Background and aims. This study aimed to detect exhaled nitric oxide (eNO) level in cirrhotic patients and explore the correlation between eNO levels and the severity of cirrhosis. Methods. Patients were enrolled to analyze the relationship of eNO with noncirrhosis, cirrhosis, and complications of decompensated cirrhosis. We explored the potential predictive values of eNO in different states of cirrhosis. Results. The eNO levels were significantly increased in cirrhotic patients compared with noncirrhotic patients (14 (10–18) vs 8 (6–13) ppb, P<0.001). The eNO level was increased in those with ascites (15 (14–22) vs 13 (10–18) ppb, P=0.026), with portal vein thrombosis (19.5 (11.75–22) vs 13.5 (10–17) ppb, P=0.032), or with the mucosal red-color sign of esophageal and gastric varices (EGV) (16.5 (10–21.75) vs 13 (10–14.75) ppb, P=0.041). Among cirrhotic patients undergoing hepatic venous pressure gradient (HVPG) measurement, the eNO level was significantly increased in the high-HVPG group (HVPG >12 mm Hg) compared with the low-HVPG group (6 mm Hg ≤ HVPG ≤ 12 mm Hg) (15 (11.75–19.25) vs 10 (8–14) ppb, P=0.011). Conclusions. The eNO level was increased in cirrhotic patients, especially in those complicated with ascites, portal vein thrombosis, mucosal red-color sign of varices, and high HVPG.

scholarly journals Portal vein thrombosis in cirrhotic patients - it is always the small pieces that make the big picture

2018 ◽  
Vol 24 (39) ◽  
pp. 4419-4427 ◽  
Author(s):  
Irina Gîrleanu ◽  
Anca Trifan ◽  
Carol Stanciu ◽  
Cătălin Sfarti
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Vein Thrombosis ◽  
Big Picture ◽  
Cirrhotic Patients

scholarly journals MesoTIPS: Combined Approach for the Treatment of Portal Hypertension Secondary to Portal Vein Thrombosis – A Brief Report

2017 ◽  
Vol 01 (01) ◽  
pp. 20-26
Author(s):  
Abbas Chamsuddin ◽  
Lama Nazzal ◽  
Thomas Heffron ◽  
Osama Gaber ◽  
Raja Achou ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Vein Thrombosis ◽  
Intrahepatic Portosystemic Shunt ◽  
The Right ◽  
Minilaparotomy Approach ◽  
Mean Time

AbstractIntroduction: We describe a technique we call “Meso-transjugular intrahepatic portosystemic shunt (MTIPS)” for relief of portal hypertension secondary to portal vein thrombosis (PVT) using combined surgical and endovascular technique. Materials and Methods: Nine adult patients with PVT underwent transjugular intrahepatic portosystemic shunt through a combined transjugular and mesenteric approach (MTIPS), in which a peripheral mesenteric vein was exposed through a minilaparotomy approach. The right hepatic vein was accessed through a transjugular approach. Mechanical thrombectomy, thrombolysis, and angioplasty were performed when feasible to clear PVT. Results: All patients had technically successful procedures. Patients were followed up for a mean time of 13.3 months (range: 8 days to 3 years). All patients are still alive and asymptomatic. Conclusion: We conclude that MTIPS is effective for the relief of portal hypertension secondary to PVT.

Portal vein thrombosis in hepatitis C virus-related cirrhotic patients: Prevalence and clinical characteristics in an Egyptian cohort

2021 ◽  
pp. 004947552199850
Author(s):  
Omkolsoum Alhaddad ◽  
Maha Elsabaawy ◽  
Omar Elshaaraawy ◽  
Mohamed Elhalawany ◽  
Mohamed Mohamed Houseni ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Clinical Characteristics ◽  
Abdominal Ultrasound ◽  
Focal Lesion ◽  
Vein Thrombosis ◽  
Doppler Study ◽  
Cirrhotic Patients

Portal vein thrombosis is a catastrophe not uncommonly complicating hepatitis C virus-related liver cirrhosis. To estimate its prevalence and clinical characteristics, we investigated 1000 cirrhotic patients by abdominal ultrasound or Doppler study at least. Portal vein thrombosis was found in 21.6%, of whom 157 (72.7%) had malignancy. Complete portal vein thrombosis was found in 70.4%. Half of all these patients had at least one episode of portal hypertensive bleeding, a third had abdominal pain and a quarter presented with jaundice. Portal bilopathy was diagnosed in two cases (0.9%). There was significant association between severity of liver disease, ascites, male gender and site of segmental focal lesion and portal vein thrombosis.

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