Background/Aims
Transjugular Intrahepatic Portosystemic Shunt (TIPS) is commonly used in patients
with variceal bleeding. However, this procedure is contraindicated in hepatocellular carcinoma patients with
portal vein thrombosis. This study was done to evaluate the effect of TIPS in those patients with variceal
bleeding. Methods: Between 1997 and 2004, six hepatocellular carcinoma (HCC) patients with portal vein
thrombosis were enrolled in this study due to their variceal bleeding. All the patients underwent TIPS
placement to treat the variceal bleeding that had not responded to endoscopic treatment. Effective shunt
creation was assessed by the decrease of the portal pressure gradient (less than 12 mmHg) or if good
patency and flow were seen on a doppler examination. Results: Shunts were successfully created in all the
patients and the bleeding was immediately controlled in the active bleeding cases. The bleeding was caused by
esophageal varices in one patient and, by gastric varices in five patients. The HCC types were diffuse or
massive in five patients, and a single nodule was present in one patient. All the patients had portal vein
thrombosis. Rebleeding was noted in two patients at 10 days and 3 months, respectively, due to the shunt
occlusion. Hepatic encephalopathy was noted in two patients. The causes of death were hepatorenal syndrome
after 2 weeks in one patient, bleeding due to portal hypertensive gastropathy after 3 weeks in another, and
cancer progression after 4 months in third patient. Conclusions: For HCC patients with portal vein thrombosis,
TIPS can be an effective treatment modality if uncontrolled variceal bleeding presents when using endoscopic
hemostasis or pharmacologic therapy. However, further studies are needed. (Korean J Hepatol 2005;11:
157-163)
