Interventional recanalization therapy in patients with non-cirrhotic, non-malignant portal vein thrombosis: comparison between transjugular versus transhepatic access
Purpose To compare the safety and outcome of transjugular versus percutaneous technique in recanalization of non-cirrhotic, non-malignant portal vein thrombosis. Methods We present a retrospective bicentric analysis of 21 patients with non-cirrhotic, non-malignant PVT, who were treated between 2016...
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| Veröffentlicht in: | Abdominal imaging 2022-03, Vol.47 (3), p.1177-1186 |
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| creator | Mansour, Nabeel Öcal, Osman Gerwing, Mirjam Köhler, Michael Deniz, Sinan Heinzow, Hauke Steib, Christian Angele, Martin K. Seidensticker, Max Ricke, Jens Wildgruber, Moritz |
| description | Purpose
To compare the safety and outcome of transjugular versus percutaneous technique in recanalization of non-cirrhotic, non-malignant portal vein thrombosis.
Methods
We present a retrospective bicentric analysis of 21 patients with non-cirrhotic, non-malignant PVT, who were treated between 2016 and 2021 by interventional recanalization via different access routes (percutaneous [PT] vs. transjugular in transhepatic portosystemic shunt [TIPS] technique). Complication rates with a focus on periprocedural bleeding and patency as well as outcome were compared.
Results
Of the 21 patients treated (median age 48 years, range of 19–78), seven (33%) patients had an underlying prothrombotic condition. While 14 (57%) patients were treated for acute PVT, seven (43%) patients had progressive thrombosis with known chronic PVT. Nine patients underwent initial recanalization via PT access and twelve via TIPS technique. There was no significant difference in complete technical success rate according to initial access route (55.5% in PT group vs. 83.3% in TIPS group,
p
= 0.331). However, creation of an actual TIPS was associated with higher technical success in restoring portal venous flow (86.6% vs. 33.3%,
p
= 0.030). 13 (61.9%) patients received thrombolysis. Nine (42.8%) patients experienced hemorrhagic complications. In a multivariate analysis, thrombolysis (
p
= 0.049) and PT access as the first procedure (
p
= 0.045) were significant risk factors for bleeding.
Conclusion
Invasive recanalization of the portal vein in patients with PVT and absence of cirrhosis and malignancy offers a good therapeutic option with high recanalization and patency rates. Bleeding complications result predominantly from a percutaneous access and high amounts of thrombolytics used; therefore, recanalization via TIPS technique should be favored. |
| doi_str_mv | 10.1007/s00261-022-03411-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8863683</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2619212047</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-6ba982dad10932e8dd13ca2452658c11eb3a96c04e43a27fe366bd844ebcf0a33</originalsourceid><addsrcrecordid>eNp9Ustu1TAQjRCIVqU_wAJZYsOCgF95sUCqKgqVKrEBiZ01cebe-Cqxg-3cq_JBfGedplweC1a2z5w545k5Wfac0TeM0uptoJSXLKec51RIxvLDo-yUi7LMKS3qx8e7_HaSnYewo5SysmCMF0-zE1FQnoDqNPt5bSP6PdponIWBeNSQTvMDFoDEHj1Mt8RYMiUk0QI5mNgT62yujfe9i0a_vn-OKW1rwUYyOR-T1h7NouDd2Lpgwjui3TiBNyEJtxgPiCnswYbdvJ0H8CnBhzmsWI9LQU1AawzhWfZkA0PA84fzLPt69eHL5af85vPH68uLm1zLSsa8bKGpeQcdo43gWHcdExq4LHhZ1JoxbAU0paYSpQBebTDNqO1qKbHVGwpCnGXvV91pbkfsdGrYw6Amb0bwt8qBUX9HrOnV1u1VXZeirBeBVw8C3n2fMUQ1mqBxGMCim4NKO2s441RWifryH-rOzT4Nf2EJVsmqrprE4itLexeCx83xM4yqxQlqdYJKTlD3TlCHlPTizzaOKb_2nghiJYQUslv0v2v_R_YO3knFvQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2631747879</pqid></control><display><type>article</type><title>Interventional recanalization therapy in patients with non-cirrhotic, non-malignant portal vein thrombosis: comparison between transjugular versus transhepatic access</title><source>Springer Nature - Complete Springer Journals</source><creator>Mansour, Nabeel ; Öcal, Osman ; Gerwing, Mirjam ; Köhler, Michael ; Deniz, Sinan ; Heinzow, Hauke ; Steib, Christian ; Angele, Martin K. ; Seidensticker, Max ; Ricke, Jens ; Wildgruber, Moritz</creator><creatorcontrib>Mansour, Nabeel ; Öcal, Osman ; Gerwing, Mirjam ; Köhler, Michael ; Deniz, Sinan ; Heinzow, Hauke ; Steib, Christian ; Angele, Martin K. ; Seidensticker, Max ; Ricke, Jens ; Wildgruber, Moritz</creatorcontrib><description>Purpose
To compare the safety and outcome of transjugular versus percutaneous technique in recanalization of non-cirrhotic, non-malignant portal vein thrombosis.
Methods
We present a retrospective bicentric analysis of 21 patients with non-cirrhotic, non-malignant PVT, who were treated between 2016 and 2021 by interventional recanalization via different access routes (percutaneous [PT] vs. transjugular in transhepatic portosystemic shunt [TIPS] technique). Complication rates with a focus on periprocedural bleeding and patency as well as outcome were compared.
Results
Of the 21 patients treated (median age 48 years, range of 19–78), seven (33%) patients had an underlying prothrombotic condition. While 14 (57%) patients were treated for acute PVT, seven (43%) patients had progressive thrombosis with known chronic PVT. Nine patients underwent initial recanalization via PT access and twelve via TIPS technique. There was no significant difference in complete technical success rate according to initial access route (55.5% in PT group vs. 83.3% in TIPS group,
p
= 0.331). However, creation of an actual TIPS was associated with higher technical success in restoring portal venous flow (86.6% vs. 33.3%,
p
= 0.030). 13 (61.9%) patients received thrombolysis. Nine (42.8%) patients experienced hemorrhagic complications. In a multivariate analysis, thrombolysis (
p
= 0.049) and PT access as the first procedure (
p
= 0.045) were significant risk factors for bleeding.
Conclusion
Invasive recanalization of the portal vein in patients with PVT and absence of cirrhosis and malignancy offers a good therapeutic option with high recanalization and patency rates. Bleeding complications result predominantly from a percutaneous access and high amounts of thrombolytics used; therefore, recanalization via TIPS technique should be favored.</description><identifier>ISSN: 2366-004X</identifier><identifier>EISSN: 2366-0058</identifier><identifier>DOI: 10.1007/s00261-022-03411-w</identifier><identifier>PMID: 35020007</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Access routes ; Bleeding ; Cirrhosis ; Complications ; Gastroenterology ; Hemorrhage ; Hepatology ; Imaging ; Interventional Radiology ; Liver cirrhosis ; Malignancy ; Medicine ; Medicine & Public Health ; Multivariate analysis ; Portal vein ; Radiology ; Risk analysis ; Risk factors ; Thromboembolism ; Thrombolysis ; Thrombosis ; Veins & arteries</subject><ispartof>Abdominal imaging, 2022-03, Vol.47 (3), p.1177-1186</ispartof><rights>The Author(s) 2022</rights><rights>2022. The Author(s).</rights><rights>The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-6ba982dad10932e8dd13ca2452658c11eb3a96c04e43a27fe366bd844ebcf0a33</citedby><cites>FETCH-LOGICAL-c474t-6ba982dad10932e8dd13ca2452658c11eb3a96c04e43a27fe366bd844ebcf0a33</cites><orcidid>0000-0002-7228-6963</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00261-022-03411-w$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00261-022-03411-w$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35020007$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mansour, Nabeel</creatorcontrib><creatorcontrib>Öcal, Osman</creatorcontrib><creatorcontrib>Gerwing, Mirjam</creatorcontrib><creatorcontrib>Köhler, Michael</creatorcontrib><creatorcontrib>Deniz, Sinan</creatorcontrib><creatorcontrib>Heinzow, Hauke</creatorcontrib><creatorcontrib>Steib, Christian</creatorcontrib><creatorcontrib>Angele, Martin K.</creatorcontrib><creatorcontrib>Seidensticker, Max</creatorcontrib><creatorcontrib>Ricke, Jens</creatorcontrib><creatorcontrib>Wildgruber, Moritz</creatorcontrib><title>Interventional recanalization therapy in patients with non-cirrhotic, non-malignant portal vein thrombosis: comparison between transjugular versus transhepatic access</title><title>Abdominal imaging</title><addtitle>Abdom Radiol</addtitle><addtitle>Abdom Radiol (NY)</addtitle><description>Purpose
To compare the safety and outcome of transjugular versus percutaneous technique in recanalization of non-cirrhotic, non-malignant portal vein thrombosis.
Methods
We present a retrospective bicentric analysis of 21 patients with non-cirrhotic, non-malignant PVT, who were treated between 2016 and 2021 by interventional recanalization via different access routes (percutaneous [PT] vs. transjugular in transhepatic portosystemic shunt [TIPS] technique). Complication rates with a focus on periprocedural bleeding and patency as well as outcome were compared.
Results
Of the 21 patients treated (median age 48 years, range of 19–78), seven (33%) patients had an underlying prothrombotic condition. While 14 (57%) patients were treated for acute PVT, seven (43%) patients had progressive thrombosis with known chronic PVT. Nine patients underwent initial recanalization via PT access and twelve via TIPS technique. There was no significant difference in complete technical success rate according to initial access route (55.5% in PT group vs. 83.3% in TIPS group,
p
= 0.331). However, creation of an actual TIPS was associated with higher technical success in restoring portal venous flow (86.6% vs. 33.3%,
p
= 0.030). 13 (61.9%) patients received thrombolysis. Nine (42.8%) patients experienced hemorrhagic complications. In a multivariate analysis, thrombolysis (
p
= 0.049) and PT access as the first procedure (
p
= 0.045) were significant risk factors for bleeding.
Conclusion
Invasive recanalization of the portal vein in patients with PVT and absence of cirrhosis and malignancy offers a good therapeutic option with high recanalization and patency rates. Bleeding complications result predominantly from a percutaneous access and high amounts of thrombolytics used; therefore, recanalization via TIPS technique should be favored.</description><subject>Access routes</subject><subject>Bleeding</subject><subject>Cirrhosis</subject><subject>Complications</subject><subject>Gastroenterology</subject><subject>Hemorrhage</subject><subject>Hepatology</subject><subject>Imaging</subject><subject>Interventional Radiology</subject><subject>Liver cirrhosis</subject><subject>Malignancy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Multivariate analysis</subject><subject>Portal vein</subject><subject>Radiology</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Thromboembolism</subject><subject>Thrombolysis</subject><subject>Thrombosis</subject><subject>Veins & arteries</subject><issn>2366-004X</issn><issn>2366-0058</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9Ustu1TAQjRCIVqU_wAJZYsOCgF95sUCqKgqVKrEBiZ01cebe-Cqxg-3cq_JBfGedplweC1a2z5w545k5Wfac0TeM0uptoJSXLKec51RIxvLDo-yUi7LMKS3qx8e7_HaSnYewo5SysmCMF0-zE1FQnoDqNPt5bSP6PdponIWBeNSQTvMDFoDEHj1Mt8RYMiUk0QI5mNgT62yujfe9i0a_vn-OKW1rwUYyOR-T1h7NouDd2Lpgwjui3TiBNyEJtxgPiCnswYbdvJ0H8CnBhzmsWI9LQU1AawzhWfZkA0PA84fzLPt69eHL5af85vPH68uLm1zLSsa8bKGpeQcdo43gWHcdExq4LHhZ1JoxbAU0paYSpQBebTDNqO1qKbHVGwpCnGXvV91pbkfsdGrYw6Amb0bwt8qBUX9HrOnV1u1VXZeirBeBVw8C3n2fMUQ1mqBxGMCim4NKO2s441RWifryH-rOzT4Nf2EJVsmqrprE4itLexeCx83xM4yqxQlqdYJKTlD3TlCHlPTizzaOKb_2nghiJYQUslv0v2v_R_YO3knFvQ</recordid><startdate>20220301</startdate><enddate>20220301</enddate><creator>Mansour, Nabeel</creator><creator>Öcal, Osman</creator><creator>Gerwing, Mirjam</creator><creator>Köhler, Michael</creator><creator>Deniz, Sinan</creator><creator>Heinzow, Hauke</creator><creator>Steib, Christian</creator><creator>Angele, Martin K.</creator><creator>Seidensticker, Max</creator><creator>Ricke, Jens</creator><creator>Wildgruber, Moritz</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>JQ2</scope><scope>K7-</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-7228-6963</orcidid></search><sort><creationdate>20220301</creationdate><title>Interventional recanalization therapy in patients with non-cirrhotic, non-malignant portal vein thrombosis: comparison between transjugular versus transhepatic access</title><author>Mansour, Nabeel ; Öcal, Osman ; Gerwing, Mirjam ; Köhler, Michael ; Deniz, Sinan ; Heinzow, Hauke ; Steib, Christian ; Angele, Martin K. ; Seidensticker, Max ; Ricke, Jens ; Wildgruber, Moritz</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-6ba982dad10932e8dd13ca2452658c11eb3a96c04e43a27fe366bd844ebcf0a33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Access routes</topic><topic>Bleeding</topic><topic>Cirrhosis</topic><topic>Complications</topic><topic>Gastroenterology</topic><topic>Hemorrhage</topic><topic>Hepatology</topic><topic>Imaging</topic><topic>Interventional Radiology</topic><topic>Liver cirrhosis</topic><topic>Malignancy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Multivariate analysis</topic><topic>Portal vein</topic><topic>Radiology</topic><topic>Risk analysis</topic><topic>Risk factors</topic><topic>Thromboembolism</topic><topic>Thrombolysis</topic><topic>Thrombosis</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mansour, Nabeel</creatorcontrib><creatorcontrib>Öcal, Osman</creatorcontrib><creatorcontrib>Gerwing, Mirjam</creatorcontrib><creatorcontrib>Köhler, Michael</creatorcontrib><creatorcontrib>Deniz, Sinan</creatorcontrib><creatorcontrib>Heinzow, Hauke</creatorcontrib><creatorcontrib>Steib, Christian</creatorcontrib><creatorcontrib>Angele, Martin K.</creatorcontrib><creatorcontrib>Seidensticker, Max</creatorcontrib><creatorcontrib>Ricke, Jens</creatorcontrib><creatorcontrib>Wildgruber, Moritz</creatorcontrib><collection>Springer Nature OA Free 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Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Abdominal imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mansour, Nabeel</au><au>Öcal, Osman</au><au>Gerwing, Mirjam</au><au>Köhler, Michael</au><au>Deniz, Sinan</au><au>Heinzow, Hauke</au><au>Steib, Christian</au><au>Angele, Martin K.</au><au>Seidensticker, Max</au><au>Ricke, Jens</au><au>Wildgruber, Moritz</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Interventional recanalization therapy in patients with non-cirrhotic, non-malignant portal vein thrombosis: comparison between transjugular versus transhepatic access</atitle><jtitle>Abdominal imaging</jtitle><stitle>Abdom Radiol</stitle><addtitle>Abdom Radiol (NY)</addtitle><date>2022-03-01</date><risdate>2022</risdate><volume>47</volume><issue>3</issue><spage>1177</spage><epage>1186</epage><pages>1177-1186</pages><issn>2366-004X</issn><eissn>2366-0058</eissn><abstract>Purpose
To compare the safety and outcome of transjugular versus percutaneous technique in recanalization of non-cirrhotic, non-malignant portal vein thrombosis.
Methods
We present a retrospective bicentric analysis of 21 patients with non-cirrhotic, non-malignant PVT, who were treated between 2016 and 2021 by interventional recanalization via different access routes (percutaneous [PT] vs. transjugular in transhepatic portosystemic shunt [TIPS] technique). Complication rates with a focus on periprocedural bleeding and patency as well as outcome were compared.
Results
Of the 21 patients treated (median age 48 years, range of 19–78), seven (33%) patients had an underlying prothrombotic condition. While 14 (57%) patients were treated for acute PVT, seven (43%) patients had progressive thrombosis with known chronic PVT. Nine patients underwent initial recanalization via PT access and twelve via TIPS technique. There was no significant difference in complete technical success rate according to initial access route (55.5% in PT group vs. 83.3% in TIPS group,
p
= 0.331). However, creation of an actual TIPS was associated with higher technical success in restoring portal venous flow (86.6% vs. 33.3%,
p
= 0.030). 13 (61.9%) patients received thrombolysis. Nine (42.8%) patients experienced hemorrhagic complications. In a multivariate analysis, thrombolysis (
p
= 0.049) and PT access as the first procedure (
p
= 0.045) were significant risk factors for bleeding.
Conclusion
Invasive recanalization of the portal vein in patients with PVT and absence of cirrhosis and malignancy offers a good therapeutic option with high recanalization and patency rates. Bleeding complications result predominantly from a percutaneous access and high amounts of thrombolytics used; therefore, recanalization via TIPS technique should be favored.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>35020007</pmid><doi>10.1007/s00261-022-03411-w</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-7228-6963</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Abdominal imaging, 2022-03, Vol.47 (3), p.1177-1186 |
| issn | 2366-004X 2366-0058 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8863683 |
| source | Springer Nature - Complete Springer Journals |
| subjects | Access routes Bleeding Cirrhosis Complications Gastroenterology Hemorrhage Hepatology Imaging Interventional Radiology Liver cirrhosis Malignancy Medicine Medicine & Public Health Multivariate analysis Portal vein Radiology Risk analysis Risk factors Thromboembolism Thrombolysis Thrombosis Veins & arteries |
| title | Interventional recanalization therapy in patients with non-cirrhotic, non-malignant portal vein thrombosis: comparison between transjugular versus transhepatic access |
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