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Systematic review with meta‐analysis: portal vein recanalisation and transjugular intrahepatic portosystemic shunt for portal vein thrombosis
Author(s) -
Rodrigues Susana G.,
Sixt Sebastian,
Abraldes Juan G.,
De Gottardi Andrea,
Klinger Christoph,
Bosch Jaime,
Baumgartner Iris,
Berzigotti Annalisa
Publication year - 2019
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.15044
Subject(s) - medicine , transjugular intrahepatic portosystemic shunt , portal vein thrombosis , thrombosis , portal hypertension , radiology , cirrhosis , surgery
Summary Background Transjugular intrahepatic portosystemic shunt has been increasingly used in patients with portal vein thrombosis to obtain patency, but evidenced‐based decisions are challenging. Aim To evaluate published data on efficacy and safety of endovascular therapy in portal vein thrombosis. Methods Systematic search of PubMed, ISI, Scopus, and Embase for studies (in English, until October 2017) reporting feasibility, safety, 12‐month portal vein recanalisation, transjugular intrahepatic portosystemic shunt patency, and survival in patients with benign portal vein thrombosis undergoing endovascular treatment. An independent extraction of articles using predefined data fields and quality indicators was used; pooled analyses based on random‐effects models; heterogeneity assessment by Cochran's Q, I 2 statistic, subgroup analyses, and meta‐regression. Results Thirteen studies including 399 patients (92% cirrhosis; portal vein thrombosis: complete 46%, chronic 87%, cavernous transformation 17%, superior mesenteric vein involvement 55%) were included. Transjugular intrahepatic portosystemic shunt was technically feasible in 95% (95% CI: 89%‐98%) with heterogeneity ( I 2 = 57%, P < 0.001) explained by cavernous transformation. Major complications occurred in 10% (95% CI: 6.0%‐18.0%; I 2 = 52%, P = 0.55). Additional catheter‐directed thrombolysis was associated with more complications compared to transjugular intrahepatic portosystemic shunt alone or plus thrombectomy (17.6% vs 3.3%). Twelve‐month portal vein recanalisation was 79% (95% CI: 67%‐88%; I 2 = 78%, P < 0.01). Shunt patency at 12 months was 84% (95% CI: 76%‐90%; I 2 = 62%, P < 0.01). Overall 12‐month survival rate was 89%, with no heterogeneity. Conclusions Transjugular intrahepatic portosystemic shunt for portal vein thrombosis recanalisation was highly feasible, effective, and safe. Cavernous transformation was the main determinant of technical failure. Additional catheter‐directed thrombolysis was associated with higher risk of severe complications.