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Inicio Annals of Hepatology Could TIPS be Applied in All Kinds of Portal Vein Thrombosis: We are not Sure!
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Vol. 16. Issue 6.
Pages 979 (November - December 2017)
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Vol. 16. Issue 6.
Pages 979 (November - December 2017)
DOI: 10.5604/01.3001.0010.5291
Open Access
Could TIPS be Applied in All Kinds of Portal Vein Thrombosis: We are not Sure!
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Xuefeng Luo, Li Yang
Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
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Dear editor

We read with interest the recent article by Chinchilla-Lopez, et al. regarding the role of transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory as-cites and portal vein thrombosis (PVT).1 We should applaud their work for the extend of TIPS indication in this population, since high-quality clinical trials has demonstrated that patients with refractory ascites and/or PVT could benefit from this procedure.2,3 However, several issues need further clarification.

A reduced portal flow velocity has shown to be an important underlying mechanism of PVT formation in patients with cirrhosis.4 TIPS creation could restore portal vein flow, recanalize portal venous system and relieve the complications of portal hypertension. However, the intra-hepatic PVT (such as the case presented by Chinchilla-Lopez) couldn’t resolve because the intrahepatic portal branch flow was further decreased after TIPS.1 The TIPS indication in patients with intrahepatic PVT need further evaluated.

A post-TIPS portosystemic pressure gradient (PSG) below than 12 mmHg was usually considered the target threshold of de nova TIPS creation.5 It is uncommon for the authors to report pre- and post-TIPS portal pressure instead of PSG.1 In addition, a significant low post-TIPS PSG may lead to deprivation of portal perfusion, aggravated liver function and increased incidence of hepatic en-cephalopathy.

Conflicts of Interest

The authors disclose no conflicts.

References
[1.]
Chinchilla-López P., Hamdan-Pérez N., Guerrero-Ixtlahuac J., Barranco-Fragoso B., Méndez-Sánchez N..
The Role of TIPS in patients with Refractory Ascites and Portal Vein Thrombosis.
Ann Hepatol, 16 (2017), pp. 619-620
[2.]
Bureau C., Thabut D., Oberti F., Dharancy S., Carbonell N., Bou-vier A., Mathurin P., et al.
Transjugular Intrahepatic Portosys-temic Shunts With Covered Stents Increase Transplant-free Survival of Patients With Cirrhosis and Recurrent Ascites.
Gastroenterology, 152 (2017), pp. 157-163
[3.]
Luo X., Wang Z., Tsauo J., Zhou B., Zhang H., Li X..
Advanced Cirrhosis Combined with Portal Vein Thrombosis: A Randomized Trial of TIPS versus Endoscopic Band Ligation Plus Propranolol for the Prevention of Recurrent Esophageal Variceal Bleeding.
Radiology, 276 (2015), pp. 286-293
[4.]
Zocco M.A., Di Stasio E., De Cristofaro R., Novi M., Ainora M.E., Ponziani F., Riccardi L., et al.
Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development.
J Hepatol, 51 (2009), pp. 682-689
[5.]
Boyer T.D., Haskal Z.J..
The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension: update 2009.
Hepatology, 51 (2010), pp. 306
Copyright © 2017. Fundación Clínica Médica Sur, A.C.
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