Portal Vein Thrombosis: Transjugular Intrahepatic Portosystemic Shunt (TIPS) or Thrombolysis?

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Last updated: February 7, 2025 • View editorial policy

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From the Guidelines

TIPS is recommended over thrombolysis for portal vein thrombosis in cirrhotic patients with portal hypertension complications.

Key Points

  • In cirrhotic patients with portal vein thrombosis, TIPS creation is recommended if portal hypertension complications persist despite well-managed anticoagulant therapy 1.
  • TIPS placement has been shown to achieve portal trunk recanalization and improve outcomes in patients with cirrhosis and portal vein thrombosis 1.
  • The procedure is technically feasible in most cases, with a high rate of portal vein patency and TIPS patency at one year post-procedure 1.
  • However, TIPS creation is associated with a risk of major complications, including hepatic encephalopathy, which occurs in around 25% of patients at one year post-procedure 1.
  • Anticoagulation therapy is often used as first-line treatment, but TIPS placement may be considered if anticoagulation fails or is not effective 1.

Indications for TIPS

  • Portal hypertension complications, such as ascites or recurrent variceal bleeding, that persist despite well-managed anticoagulant therapy 1.
  • Cirrhotic patients with portal vein thrombosis who are awaiting liver transplantation 1.

Important Considerations

  • TIPS creation should be performed by an experienced interventional radiologist or hepatologist 1.
  • Patients should be fully informed of the potential complications and risks associated with the procedure 1.
  • Regular follow-up and monitoring are necessary to minimize the risk of complications and ensure optimal outcomes 1.

From the Research

Portal Vein Thrombosis Treatment Options

  • Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a viable treatment option for patients with portal vein thrombosis (PVT) 2, 3, 4, 5
  • TIPS can reduce portal hypertensive complications such as variceal bleeding and facilitate liver transplantation 2, 5
  • The presence of PVT is no longer considered a contraindication to TIPS, although the procedure may be more technically difficult and should be performed in expert high-volume centers 2, 4

TIPS Placement Techniques

  • Three strategies for TIPS placement have been reported:
    • Portal recanalization and conventional implantation of the TIPS through the jugular vein
    • Portal recanalization through percutaneous transhepatic/transsplenic access
    • Insertion of the TIPS between the suprahepatic vein and a periportal collateral vessel without portal recanalization 4
  • Different materials can be used as fluoroscopic targets for the TIPS needle and for portal recanalization 4

Outcomes and Complications

  • TIPS has been reported with high levels of technical success, short-term portal vein recanalization, and long-term PV patency and TIPS patency outcomes 2
  • Comparative studies have shown favorable outcomes of TIPS compared with non-TIPS treatment of PVT complications 2, 5
  • Major procedure-related complications are rare, but can include hemorrhage and contrast extravasation 6
  • Ascites, white blood cell count, and degree of portal vein tumor thrombosis are independent predictors of survival after TIPS creation 6

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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