Recanalization of Chronic Noncirrhotic, Nonmalignant Splanchnic Thromboses is Feasible: A Transsplenic Assisted Patient-Tailored Approach

The purpose of this study was to evaluate the feasibility of recanalization of chronic noncirrhotic, nonmalignant splanchnic thromboses with a transsplenic assisted patient-tailored approach with or without transjugular intrahepatic portosystemic shunt (TIPS) creation. In this retrospective study, 10 patients (median age, 48.4 years; interquartile range, 5.1 years) underwent revascularization between November 2016 and August 2020. Portal cavernoma was present in all patients, with complete splenic vein thrombosis in 70%. The technical success rate was 80%. Additional TIPS creation was performed in 5 (50%) patients. At a median follow-up of 19.3 months (interquartile range, 17.9 months), the primary and secondary patency rate was 70% and 100%, respectively. During follow-up, 1 patient died due to recurrent upper gastrointestinal variceal hemorrhage. In conclusion, percutaneous transsplenic assisted recanalization of chronic noncirrhotic, nonmalignant splanchnic thromboses is feasible. However, multiple access points may still be needed. Additional TIPS creation appears to be necessary only in case of insufficient portal venous flow into the liver.