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Shalaby S, Miraglia R, Senzolo M. Transjugular Intrahepatic Portosystemic Shunt in Nonmalignant Noncirrhotic Portal Vein Thrombosis and Portosinusoidal Vascular Disorder. J Clin Med 2024; 13:1412. [PMID: 38592220 PMCID: PMC10931999 DOI: 10.3390/jcm13051412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) emerges as a key treatment for portal hypertension (PH) complications. While international guidelines provide clear indications for its use in cirrhosis, empirical knowledge is notably scarcer in non-cirrhotic PH, particularly in nonmalignant noncirrhotic portal vein thrombosis (NNPVT) and in patients with portosinusoidal vascular disorder (PSVD). Patients afflicted by these rare diseases exhibit distinct clinical profiles compared to their cirrhotic counterparts, often characterized by a younger age, predominantly preserved hepatic functionality even in cases of severe PH, and a higher propensity for extensive splanchnic thrombosis, which intricately complicates TIPS placement, posing unique challenges for its creation. The objective of this review is to synthesize existing literature on the effectiveness, safety, specific indications, and clinical outcomes of TIPS in adult patients with NNPVT or PSVD, focusing also on the technical challenges of TIPS insertion in the presence of portal cavernoma.
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Affiliation(s)
- Sarah Shalaby
- Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy;
| | - Roberto Miraglia
- Radiology Service, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), 90127 Palermo, Italy;
| | - Marco Senzolo
- Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy;
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Rao K, Aswani Y, Bindner H, Patel A, Averill S, Davis T, Amarneh M. Intra-abdominal Venous Thromboses and Their Management. Acad Radiol 2024:S1076-6332(23)00693-1. [PMID: 38184416 DOI: 10.1016/j.acra.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 01/08/2024]
Abstract
While a plethora of articles discuss management of deep venous thromboses in extremities, there is a relative scarcity of literature comprehensively describing intra-abdominal venous thromboses, and their management. Intra-abdominal venous thromboses include iliocaval venous obstruction (ICVO), hepatic venous thrombosis (HVT), portal venous thrombosis (PVT), renal vein thrombosis (RVT), splenic vein thrombosis (SVT), and gonadal vein thrombosis (GVT); each of which provides unique microenvironmental challenges to management. Doppler ultrasound is the first line imaging modality for diagnosis, and computed tomography and magnetic resonance imaging can help define the extent of thrombus burden and aid with interventional planning. Systemic anticoagulation remains the common medical treatment for intra-abdominal venous thrombosis, however, catheter directed thrombolysis and thrombectomy show positive outcomes in ICVO, HVT, PVT, and RVT, with transjugular intrahepatic portosystemic shunt (TIPS) creation especially beneficial in HVT and PVT. In this review article, we describe pathophysiology, clinical features, imaging findings, and current management options for intra-abdominal venous thromboses.
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Affiliation(s)
- Karan Rao
- Department of Vascular and Interventional Radiology, University of Iowa, lowa city, lowa, USA (K.R., Y.A., H.B., A.P.)
| | - Yashant Aswani
- Department of Vascular and Interventional Radiology, University of Iowa, lowa city, lowa, USA (K.R., Y.A., H.B., A.P.)
| | - Hans Bindner
- Department of Vascular and Interventional Radiology, University of Iowa, lowa city, lowa, USA (K.R., Y.A., H.B., A.P.)
| | - Aditi Patel
- Department of Vascular and Interventional Radiology, University of Iowa, lowa city, lowa, USA (K.R., Y.A., H.B., A.P.)
| | - Sarah Averill
- Roswell Park Comprehensive Cancer Institute, Buffalo, New York, USA (S.A.)
| | - Trent Davis
- Dignity Health St. Joseph's Radiology, Phoenix, Arizona, USA (T.D.)
| | - Mohammad Amarneh
- Department of Pediatric Interventional Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, Massachusetts 02115, USA (M.A.).
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