Clinical Outcomes Of Transcatheter Selective Superior Mesenteric Artery Urokinase Infusion Therapy Vs Transjugular Intrahepatic Portosystemic Shunt In Patients With Cirrhosis And Acute Portal Vein Thrombosis

Objective:Portal vein thrombosis(PVT)is one of the most common complications of cirrhosis.Occlusive portal vein thrombosis may affect the prognosis of patients with cirrhosis.At present,anticoagulant therapy is regarded as a first-line treatment scheme,and its research evidence is relatively abundant,and the anticoagulant effect has been effectively confirmed.However,local thrombolytic therapy and transjugular intrahepatic portosystemic shunt(TIPS)were rarely studied,and their safety and effectiveness need to be verified.To evaluate the efficacy and safety of transcatheter selective superior mesenteric artery(SMA)thrombolysis and TIPS in the treatment of acute portal vein thrombosis in cirrhotic patients.Methods:Based on the exclusion criteria,we retrospectively analyzed all the patients with cirrhosis and acute portal vein thrombosis who were admitted to our hospital from January 2013 to December 2014.They received transcatheter selective mesenteric artery thrombolysis.We also selected the same number of cirrhosis patients with acute portal vein thrombosis treated with TIPS and matched the baseline features(age,sex,etiology,liver function,splenectomy,portal vein patency status)between the two groups.The total follow-up time was 24 months.The primary outcome measure was the change in portal vein patency status which was evaluated by angio-computed tomography or Doppler ultrasound.Secondary outcomes were bleeding and hepatic encephalopathy.Results:A total of 40 patients were enrolled,with 20 in the SMA group and 20 in the TIPS group.The symptoms of all patients in the two groups improved within 48 h.Portal vein thrombosis was improved in 17(85%)patients in the SMA group and 14(70%)patients in the TIPS group.The main portal vein(MPV)thrombosis was significantly reduced in both groups(P<0.001),and there was no significant difference between them(P=0.304).In the SMA group,superior mesenteric vein(SMV)thrombosis and splenic vein(SV)thrombosis were significantly reduced(P= 0.048 and P= 0.02),which did not occur in the TIPS group.At 6-mo,12-mo,and 24-mo follow-up,in the SMA group and the TIPS group,the cumulative rates free of the first episode of bleeding were 80%,65%,and45% vs 90%,80%,and 60%,respectively(P=0.320);the cumulative rates free of the first episode of hepatic encephalopathy were85%,80%,and65%vs50%,40%,and35%,respectively(P=0.022).Conclusions:Transcatheter selective superior mesenteric artery thrombolysis and transjugular intrahepatic portosystemic shunt are both safe and effective for acute symptomatic portal vein thrombosis in cirrhosis.