Abstract
Purpose The aim of this study was to evaluate the safety and efficacy of using a trans-splenic
approach for transjugular intrahepatic portosystemic shunt (TIPS) creation in patients
with portal vein thrombosis. (PVT).
Material and Methods A retrospective review was performed on 36 consecutive patients with PVT who underwent
TIPS using a trans-splenic approach from February 2018 to June 2021. Preprocedural
data including demographic information and Model for End-Stage Liver Disease (MELD)
scores were obtained. Outcomes measured included technical success, clinical success,
complications, and survival.
Results Technical success was achieved in 32 of 36 patients (89%). During the follow-up period,
16 of 32 (50%) required secondary TIPS interventions, most of which were planned as
part of a staged procedure. 30/32 (94%) had stent patency on their most recent follow-up,
with a median follow-up of 164 days. No patients had variceal bleeding following TIPS.
12 of 32 (38%) patients underwent successful transplant after TIPS. Anatomical portal
vein end-to-end anastomosis was achieved in 11/12 (92%) patients.
Conclusion The trans-splenic approach to TIPS is a reliable alternative to traditional TIPS
in patients with PVT and provides high technical and clinical success rates. This
technique can also be utilized to improve future liver transplant outcomes by facilitating
anatomic portal vein end-to-end anastomoses.
Keywords
cirrhosis - portal hypertension - TIPS - trans-splenic access - transjugular intrahepatic
portosystemic shunt
