Jiang TT, et al. - Researchers compared the clinical outcomes of transcatheter superior mesenteric artery (SMA) urokinase infusion therapy and transjugular intrahepatic portosystemic shunt (TIPS) in patients with cirrhosis and acute portal vein thrombosis (PVT). For acute symptomatic PVT in cirrhosis, transcatheter selective SMA urokinase infusion and TIPS are safe and effective.

Methods

• The researchers randomly assigned patients with liver cirrhosis and acute symptomatic PVT who met the inclusion criteria to either an SMA group or a TIPS group from January 2013 to December 2014.
• The 2 groups accepted transcatheter selective SMA urokinase infusion therapy and TIPS, respectively.
• For this study, the total follow-up time was 24 mo.
• The change in portal vein patency status which was evaluated by angio-computed tomography or Doppler ultrasound was the primary outcome measure.
• Rebleeding and hepatic encephalopathy were included as secondary outcomes.

Results

• The researchers enrolled 40 patients.
• Twenty were assigned to the SMA group and 20 to the TIPS group.
• In the 2 groups, the symptoms of all patients improved within 48 h.
• In the SMA group, PVT was improved in 17 (85%) patients and 14 (70%) patients in the TIPS group.
• In both groups, the main portal vein (MPV) thrombosis was significantly reduced (P < 0.001), and no significant difference was observed (P=0.304).
• Superior mesenteric vein (SMV) thrombosis and splenic vein (SV) thrombosis were significantly reduced (P=0.048 and P=0.02) in the SMA group, which did not occur in the TIPS group.
• In the SMA group and the TIPS group, at 6-, 12-, and 24-mo follow-up, the cumulative rates free of the first episode of rebleeding were 80%, 65%, and 45% vs 90%, 80%, and 60%, respectively (P=0.320).
• At 6-, 12-, and 24-mo follow-up, the cumulative rates free of the first episode of hepatic encephalopathy were 85%, 80%, and 65% vs 50%, 40%, and 35% in the SMA group and the TIPS group, respectively (P=0.022).