CLINICAL INVESTIGATION VENOUS INTERVENTIONS
Transjugular Intrahepatic Portosystemic Shunt for Portal
Hypertension in Hepatocellular Carcinoma with Portal Vein
Received: 10 December 2016 / Accepted: 18 April 2017 / Published online: 9 May 2017
Ó Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2017
Purpose In patients with hepatocellular carcinoma (HCC),
limited therapeutic options are available for portal hyper-
tension resulted from portal vein tumor thrombus (PVTT).
We aimed to determine safety and efﬁcacy of TIPS for
treatment of symptomatic portal hypertension in HCC with
Methods We evaluated clinical characteristics of 95
patients with HCC and PVTT out of 992 patients who
underwent TIPS. The primary endpoints included success
rate, procedural mortality, serious complications, decrease
in portosystemic pressure gradient, and symptom relief.
The secondary endpoints included recurrence of portal
hypertension, overall survival, adverse events related to
treatments for HCC, and quality of life measured by
Karnofsky Performance Status Scale (KPS).
Results Success rate of TIPS was 95.8% (91/95), with
procedural mortality of 1.1%. Serious complications rela-
ted to TIPS procedure occurred in 2.1% (2/95) of patients.
The symptoms of portal hypertension were well relieved.
Variceal bleeding was successfully controlled and termi-
nated in 100% of patients, with a recurrence rate of 39.2%
in 12 months. Refractory ascites/hydrothorax was con-
trolled partially or completely in 92.9% of patients during
1 month after TIPS, with a recurrence rate of 17.9% in
12 months. Survival rate at 6, 12, 24, and 36 months was
75.8, 52.7, 26.4, and 3.3%, respectively. No unexpected
adverse event related to treatments for HCC was observed.
The KPS score was 49 ± 4.5 and 63 ± 4.7 before and
1 month after TIPS, respectively (p \ 0.001).
Conclusions TIPS is a safe and efﬁcacious treatment for
symptomatic portal hypertension in HCC with PVTT.
Keywords Hepatocellular carcinoma Á Transjugular
intrahepatic portosystemic shunt Á Portal vein tumor
thrombus Á Portal hypertension
Hepatocellular carcinoma (HCC) is one of the leading
causes of cancer-related deaths worldwide. Liver cirrhosis
(LC) is present in more than 80% of patients with HCC,
resulting in increased resistance to portal blood ﬂow and
hence portal hypertension [1, 2]. However, the majority of
HCC patients are diagnosed at an advanced stage, when the
tumor has already invaded portal vein and often caused
portal vein tumor thrombus (PVTT) . Notably, PVTT
can obstruct portal venous ﬂow and worsen portal hyper-
tension. Without aggressive intervention, the median sur-
vival time in these patients was found to be only
2.7 months [4, 5]. Given short life expectancy of these
patients, attention must be focused on how to improve
quality of life. In this case, improvement of ascites, hepatic
& Fu-Quan Liu
Department of Interventional Therapy, Beijing Shijitan
Hospital, Capital Medical University, No. 10 Tieyi Rd.,
Yangfangdian, Haidian District, Beijing 100038, China
Department of General Surgery, Beijing Shijitan Hospital,
Capital Medical University, Beijing 100038, China
Section of Gastroenterology, Section of Hematology/
Oncology, Stephenson Cancer Center, Department of Internal
Medicine, College of Medicine, The University of Oklahoma
Health Sciences Center, Oklahoma City, OK, USA
Department of Interventional Therapy, National Cancer
Center/Cancer Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing 100021,
Cardiovasc Intervent Radiol (2017) 40:1372–1382