[Efficacy of percutaneous mechanical thrombectomy combined with transjugular intrahepatic portosystemic shunt for acute non-cirrhotic portal vein thrombosis].

Abstract

Objective: To evaluate the efficacy of percutaneous mechanical thrombectomy combined with transjugular intrahepatic portosystemic shunt (PMT-TIPS) in patients with acute non-cirrhotic portal vein thrombosis (NCPVT). Methods: This is a retrospective case series study. The clinical data of 61 patients with acute NCPVT who underwent PMT combined with TIPS at Department of Endovascular Surgery, the First Affiliated Hospital of Zhengzhou University between June 2017 and June 2023 were retrospectively analyzed. There were 39 males and 22 females, with an age (M(IQR) of 49.0(24.5)years (range:21 to 73 years). Paired sample t-test or Wilcoxon signed-rank test were used to compare liver volume and biochemical parameters before treatment and at 1 year after treatment. Independent sample t-test was used to compare changes in liver volume between patients with different stent patency statuses. Kaplan-Meier analysis was used to estimate stent patency and symptom recurrence. Univariate and multivariate Cox proportional hazards regression models were used to analyze the factors associated with stent occlusion. Results: Among the 61 patients, 7 (11.5%) died during hospitalization and 5 (8.2%) died within 30 days after discharge, most commonly due to bowel necrosis. The remaining 49 patients were followed up for 43(34) months (range:4 to 94 months). During follow-up, stent occlusion occurred in 35 patients (71.4%), with a median primary patency of 13.0 months (95%CI: 7.3 to 18.7). Among the 35 patients with primary stent occlusion, 21 developed symptom recurrence, whereas symptom recurrence occurred in 4 of the 14 patients with sustained patency. Ten patients with stent occlusion underwent stent recanalization, with a median secondary patency of 21.0 months (95%CI: 16.8 to 25.2 months). Univariate Cox regression analysis showed that myeloproliferative neoplasms (HR=3.08, 95%CI: 1.48 to 6.42, P=0.003) and dual-stent implantation (HR=2.26, 95%CI: 1.09 to 4.70, P=0.036) were associated with an increased risk of stent occlusion (both P<0.05); multivariate Cox regression further revealed that only myeloproliferative neoplasms (HR=2.75, 95%CI: 1.31 to 5.78, P=0.008) was an independent risk factor. At one year post-procedure, inflammatory and coagulation markers improved, total liver volume decreased compared with baseline (P=0.005), and the reduction in liver volume was greater in patients with patent stents than in those with stent occlusion ((-215.6±205.5)cm³ vs.(-3.5±236.5) cm³,t=-3.505,P=0.001). Conclusions: In patients with acute NCPVT, the PMT-TIPS technique is feasible, but long-term stent patency is limited. This technique can be used as a rescue strategy rather than a definitive treatment.