Transjugular Intrahepatic Portosystemic Shunt for Non-malignant Portal Vein Thrombosis

Portal vein thrombosis (PVT) is characterised by the presence of thrombus in the main portal vein, with or without intra-hepatic or mesenteric extension. PVT can arise in a non-cirrhotic liver, or on a background of cirrhosis. The etiologies, natural history, prognosis and therapeutic implications differ in both groups accordingly. Currently, anticoagulation is primarily recommended for those with acute PVT but is fraught with a theoretical risk of bleeding. Surgical therapy in these patients might be over-aggressive. In the past, transjugular intrahepatic portosystemic shunt (TIPS) placement was considered a relative contraindication in patients with PVT but now has been shown to be safe and efficacious in these patients, both with and without cirrhosis, with some caveats and modifications. What remains to be explored is the stage at which TIPS should be offered and whether it should be preferred over therapeutic anticoagulation. Randomized controlled trials are needed to answer this question.