Systematic review and meta-analysis of trans-jugular intrahepatic portosystemic shunt for cirrhotic patients with portal vein thrombosis

doi:10.12998/wjcc.v9.i19.5179

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World Journal of Clinical Cases

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Systematic Reviews

World J Clin Cases. Jul 6, 2021; 9(19): 5179-5190
Published online Jul 6, 2021. doi: 10.12998/wjcc.v9.i19.5179

Systematic review and meta-analysis of trans-jugular intrahepatic portosystemic shunt for cirrhotic patients with portal vein thrombosis

Jian-Bin Zhang, Jie Chen, Jin Zhou, Xu-Ming Wang, Shu Chen, Jian-Guo Chu, Peng Liu, Zhi-Dong Ye

Jian-Bin Zhang, Jie Chen, Jin Zhou, Xu-Ming Wang, Peng Liu, Zhi-Dong Ye, Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing 100029, China

Shu Chen, Department of Interventional Radiology, Affiliated People’s Hospital of Inner Mongolia Medical University, Hohhot 010020, Inner Mongolia Autonomous Region, China

Jian-Guo Chu, Department of Radiology, Air Force Medical Center of PLA, Beijing 100142, China

Author contributions: Zhang JB, Chen J, and Zhou J contributed equally to this work; Zhang JB, Chen J, Zhou J, and Ye ZD designed the research study; Zhang JB, Chen J, Zhou J, Wang XM, and Chen S performed the research; Chu JG and Liu P contributed new reagents and analytic tools; Zhang JB, Chen J, Zhou J, and Chen S analyzed the data and wrote the manuscript; All authors have read and approved the final manuscript.

Conflict-of-interest statement: The authors have no conflicts of interests or financial disclosures relevant to this manuscript.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Zhi-Dong Ye, MD, Chief Doctor, Department of Cardiovascular Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Beijing 100029, China. yezhidong6618@yeah.net

Received: February 13, 2021
Peer-review started: February 13, 2021
First decision: March 14, 2021
Revised: March 21, 2021
Accepted: April 25, 2021
Article in press: April 25, 2021
Published online: July 6, 2021
Processing time: 130 Days and 15.9 Hours

Abstract

BACKGROUND

Portal vein thrombosis (PVT) was previously a contraindication for trans-jugular intrahepatic portosystemic shunt (TIPS).

AIM

To perform a systematic review and meta-analysis of the current available studies investigating outcomes of TIPS for cirrhotic patient with PVT.

METHODS

Multiple databases were systematically searched to identify studies investigating the outcomes of TIPS for cirrhotic patients with PVT. The quality of studies was assessed by Cochrane Collaboration method and Methodological Index for Non-Randomized Studies. The demographic data, outcomes, combined treatment, and anticoagulation strategy were extracted.

RESULTS

Twelve studies were identified with 460 patients enrolled in the analysis. The technical success rate was 98.9% in patients without portal vein cavernous transformation and 92.3% in patients with portal vein cavernous transformation. One-year portal vein recanalization rate was 77.7%, and TIPS patency rate was 84.2%. The cumulative encephalopathy rate was 16.4%. One-year overall survival was 87.4%.

CONCLUSION

TIPS is indicated for portal hypertension related complications and the restoration of pre-transplantation portal vein patency in cirrhotic patients with PVT. Cavernous transformation is an indicator for technical failure. Post-TIPS anticoagulation seems not mandatory. Simultaneous TIPS and percutaneous mechanical thrombectomy device could achieve accelerated portal vein recanalization and decreased thrombolysis-associated complications, but further investigation is still needed.

Keywords: Trans-jugular intrahepatic portosystemic shunt; Portal vein thrombosis; Liver cirrhosis; Systematic review; Meta-analysis

Core Tip: Trans-jugular intrahepatic portosystemic shunt (TIPS) is indicated for portal hypertension related complications and the restoration of pre-transplantation portal vein patency in cirrhotic patients with portal vein thrombosis. Cavernous transformation is an indicator for technical failure. Post-TIPS anticoagulation seems not mandatory. Simultaneous TIPS and percutaneous mechanical thrombectomy device could achieve accelerated portal vein recanalization and decreased thrombolysis-associated complications, but further investigation is still needed.