Transjugular intrahepatic portosystemic shunt for portal cavernoma with symptomatic portal hypertension in non-cirrhotic patients.

BACKGROUND: Portal cavernoma is regarded as a contraindication to transjugular intrahepatic portosystemic shunt (TIPS).

AIM: To evaluate the feasibility, safety, and efficacy of TIPS for symptomatic portal hypertension in non-cirrhotic patients with portal cavernoma.

METHODS: Between July 2002 and December 2009, 46 consecutive non-cirrhotic patients with portal cavernoma were admitted to our center. Twenty patients presented with variceal rebleeding (n = 20) and refractory ascites (n = 1), and were treated with TIPS. They were followed until either death or July 2010. Data were compared using the Fisher's exact test or t test.

RESULTS: TIPS were successfully placed in 35% (7/20) of patients via a transjugular approach alone (n = 1), a combined transjugular/transhepatic approach (n = 4), and a combined transjugular/transsplenic approach (n = 2). TIPS were inserted in a large collateral vein in two patients in whom recanalization of the occluded main portal vein was impossible. Procedure-related complication was hepatic capsule perforation in one patient who was cured by medical therapy alone. Shunt dysfunction occurred in two patients, but TIPS revision was failed in one of them. Portosystemic pressure gradient was significantly reduced in TIPS success group (26.3 ± 1.1 vs. 12.4 ± 1.1 mmHg, p < 0.001). The incidence of variceal bleeding in TIPS success group is lower than that in TIPS failure group (14 vs. 69%, p = 0.057). In TIPS success group, two patients died of systemic infection and accident, respectively. In TIPS failure group, two patients died of liver failure.

CONCLUSIONS: TIPS procedures are feasible and safe in selected patients with portal cavernoma. Successful TIPS insertions may decrease the incidence of variceal rebleeding.