Retrograde Transvenous Obliteration for Variceal Rebleeding in Patients with Portal Vein Thrombosis: A Multicenter Study

Purpose: To evaluate the effectiveness of retrograde transvenous obliteration (RTO) for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis (PVT).

Material and Methods: Consecutive cirrhotic patients with PVT who underwent RTO for the prevention of variceal rebleeding between January 2002 and June 2019 were included in this multicenter retrospective study. The primary outcome measure was variceal rebleeding. The secondary outcome measures were survival, other complications of portal hypertension, liver function, and PVT.

Results: A total of 45 patients [mean age, 66.0 ± 10.6 years; mean Model for End-Stage Liver Disease (MELD) score, 9.9 ± 5.5] were included (Table 1). The median follow-up time was 5.4 (range, 0.1–149.0) months. The 1-year actuarial probability of remaining free of variceal rebleeding was 92.8 ± 4.0% (Figure 1). The 6-week and 1-year actuarial probabilities of survival were 79.8 ± 6.0% and 48.8 ± 7.7%, respectively. MELD score [HR, 1.07 (95% CI, .99–1.15); P = .013] and ascites [HR, 3.09 (95% CI, 1.31–7.28); P = .014] were identified to be significant predictors of survival. The 1-year actuarial probabilities of remaining free of new or worsening ascites and esophageal varices were 81.2 ± 8.7% and 89.2 ± 6.0%, respectively. No patients had overt hepatic encephalopathy (HE) during follow-up. MELD score significantly increased by a mean of 3.8 (95% CI, 1.7–6.0) at 3 months (P = .001). PVT had improved in 32.0%, worsened in 12.0%, and remained unchanged in 56.0% of patients at 3 months.

Conclusions: RTO may be effective for the prevention of variceal rebleeding in cirrhotic patients with PVT.