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

 Jiaywei Tsauo  ;  Seung Yeon Noh  ;  Ji Hoon Shin  ;  Dong Il Gwon  ;  Kichang Han  ;  Jae Myeong Lee  ;  Ung Bae Jeon  ;  Young Hwan Kim 
 EUROPEAN RADIOLOGY, Vol.31(1) : 559-566, 2021-01 
Journal Title
Issue Date
Aged ; End Stage Liver Disease* ; Esophageal and Gastric Varices* / complications ; Esophageal and Gastric Varices* / therapy ; Gastrointestinal Hemorrhage / prevention & control ; Humans ; Middle Aged ; Portal Vein ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome
Embolization, therapeutic ; Esophageal and gastric varices ; Hypertension, portal ; Liver diseases
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.

Key points: • Retrograde transvenous obliteration may prevent variceal rebleeding in cirrhotic patients with portal vein thrombosis. • The risks of other complications of portal hypertension may not be high after retrograde transvenous obliteration in cirrhotic patients with portal vein thrombosis. • Portal vein thrombosis may improve in approximately one-third of cirrhotic patients within 3 months after retrograde transvenous obliteration.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Han, Ki Chang(한기창) ORCID logo
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