Background and aims Portal vein thrombosis (PVT) negatively impacts the prognosis in patients with cirrhosis. The aim of our study was to evaluate the effects of transjugular intrahepatic portosystemic shunt (TIPS) placement in patients with cirrhosis complicated by PVT. Methods Seventy consecutive cirrhotic patients with non-tumoural PVT treated with TIPS for portal hypertension complications from January 2003 to February 2010 in a tertiary-care centre were followed until last clinical evaluation, liver transplantation, or death. Results TIPS was successfully placed without major procedure-related complications. After TIPS, the portal venous system was completely recanalised in 57% of patients, a marked decrease in thrombosis was observed in 30%, and no improvement was seen in 13%. 95% of patients with complete recanalisation after TIPS maintained a patent portal vein. Predictors of complete recanalisation were a less severe and extensive PVT, de novo diagnosis of PVT, and absence of gastro-oesophageal varices. At follow-up, 1 patient had recurrence of bleeding, and 2 had spontaneous bacterial peritonitis. The rate of TIPS dysfunction at 12 and 24 months was 38% and 85% for bare stent and 21% and 29% for covered stent (p=0.001), respectively. Occurrence of encephalopathy at 12 and 24 months was 27% and 32%, respectively. Fifteen patients underwent liver transplantation. Survival at 1, 12 and 24 months was 99%, 89% and 81%, respectively. Conclusion Long-term outcome of non-tumoural PVT in patients with cirrhosis treated with TIPS placement is excellent. Prospective randomised studies should investigate whether TIPS placement is the best therapeutic option in patients with cirrhosis who develops non-tumoural PVT.

To define the natural course of extrahepatic nonmalignant partial portal vein thrombosis (PVT), including the progression from partial to complete PVT, in patients with cirrhosis who had undergone multidetector computed tomography (CT). This study was institutional review board and ethics committee approved. Written informed consent was obtained for each procedure. Forty-two consecutive patients with cirrhosis and untreated extrahepatic, nonmalignant partial PVT were followed up until the final clinical evaluation, liver transplantation, or death. Multidetector CT was used to evaluate the thrombus lumen occlusion, patent lumen area, thrombus area, total lumen area, and diameter of main portal vein, superior mesenteric vein, and splenic vein. Statistical analysis was performed with the Wilcoxon Mann-Whitney U test, χ2 test, Wilcoxon matched-pairs signed-rank test, life-table analysis, Kaplan-Meier method, and log-rank test, as appropriate. After a mean follow-up period of 27 months, partial PVT worsened in 20 (48%) patients, improved in 19 (45%), and was stable in three (7%). The Kaplan-Meier probability of episodes of hepatic decompensation at 1 and 2 years was 41% and 57%; probability of hospital admission for hepatic decompensation, 37% and 54%; and survival rates, 77% and 57%, respectively. There was no clear association between progression or regression of partial PVT and clinical outcome. Multivariate analysis showed that the Child-Pugh score at diagnosis was the only independent predictor of survival (hazard ratio, 1.97; 95% confidence interval: 1.19, 3.23; P=.007) and hepatic decompensation (hazard ratio, 1.51; 95% confidence interval: 1.18, 1.19; P=.001). Extrahepatic nonmalignant partial PVT improved spontaneously in 45% of patients with cirrhosis, and the progression of partial PVT was not associated with clinical outcome, which appeared to be dependent on the severity of cirrhosis.