Retrograde transvenous obliteration for the prevention of variceal rebleeding in patients with portal vein thrombosis: a multicenter study

Abstract

Objectives To evaluate the effectiveness of retrograde transvenous obliteration (RTO) for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis (PVT). Methods Consecutive cirrhotic patients with PVT who underwent RTO for the prevention of variceal rebleeding between January 2002 and June 2019 were included in this multicenter retrospective study. The primary outcome measure was rebleeding. The secondary outcome measures were survival, other complications of portal hypertension, liver function, and PVT. Results Forty-five patients (mean age, 66.0 +/- 10.6 years; mean Model for End-Stage Liver Disease (MELD) score, 13.9 +/- 5.5) were included. The 1-year actuarial probability of remaining free of rebleeding was 92.8 +/- 4.0%. The 6-week, 1-year, and 3-year actuarial probabilities of survival were 79.8 +/- 6.0%, 48.8 +/- 7.7%, and 46.1 +/- 7.9%, respectively. MELD score (hazard ratio (HR), 1.09 (95% confidence interval (CI), 1.01-1.17);p = .013) and ascites (HR, 2.84 (95% CI, 1.24-6.55);p = .014) were identified as significant predictors of survival. The 1-year actuarial probabilities of remaining free of new or worsening ascites and esophageal varices were 81.2 +/- 8.7% and 89.2 +/- 6.0%, respectively. No patients had overt hepatic encephalopathy during follow-up. MELD score significantly increased by a mean of 3.8 (95% CI, 1.7-6.0) at 3 months (p = .001). PVT had improved in 32.0%, worsened in 12.0%, and remained unchanged in 56.0% of patients at 3 months. Conclusion RTO may be effective for the prevention of variceal rebleeding in cirrhotic patients with PVT.