Jorge Enrique Lopera MD, Presenter: Consultant, Boston Scientific Corporation

Venkata S. Katabathina MD, Abstract Co-Author: Nothing to Disclose

Brian T. Bosworth MD, Abstract Co-Author: Nothing to Disclose

Martin Goros, Abstract Co-Author: Nothing to Disclose

Andres Garza, Abstract Co-Author: Nothing to Disclose

Ghazwan M. Faozi Kroma MD, Abstract Co-Author: Nothing to Disclose

Rajeev Suri MD, Abstract Co-Author: Nothing to Disclose

To study the incidence and clinical significance of portal vein thrombosis (PVT) in follow-up imaging after elective transjugular intrahepatic portosystemic shunt (TIPS).

A retrospective review of medical records of patients that underwent elective TIPS was conducted. Contrast enhanced cross sectional images, obtained within 1 year after TIPS, were compared with previous axial images (n=59) or direct portograms (n=3) in order to assess the patency of the main portal vein (PV) and its major branches. The branches analyzed were the right anterior (RAPV), right posterior (RPPV), left (LPV) and main (MPV) portal veins. The presence of associated parenchymal changes was also recorded. Any possible association between PVT and MELD score, and PVT and major adverse events after TIPS, was also studied.

Sixty-two patients (15 female, 47 male, ages: 28-70, mean 54) were included in the study. Follow–up cross sectional images were obtained 1-346 days (mean 92 days) after TIPS. The incidence of PVT was 19 % for RAPV, 51% for the RPPV, 11% for the LPV and 1 % for the MPV. Combined thrombosis of two major branches was observed in 6 and three branches in 4 patients. Associated lobar parenchymal changes were lobar infarcts in 7 and heterogeneous contrast enhancement in 9 patients. The mean MELD score was 12.8 before and 16.8 one month after TIPS. Major adverse events within 6 months included hepatic encephalopathy requiring hospital admission in 18 and death in 8 patients. There was no significant correlation between PVT and the post-TIPS MELD score, or PVT and major adverse events after TIPS.

Thrombosis of major braches of the PV is a very common imaging finding after elective TIPS that can be associated with parenchymal changes. In most patients, branch PVT has no clinical significance.

Thrombosis of major PV branches is a common imaging finding after elective Tips. In most patients, branch  PVT has no clinical significance.

Lopera, J, Katabathina, V, Bosworth, B, Goros, M, Garza, A, Kroma, G, Suri, R, Portal Vein Thrombosis after Elective TIPS. Incidence in Follow-up Imaging and Clinical Significance.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13012870.html