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Aim: Purpose of this retrospective study was to evaluate and to compare the treatment of patients with acute portal vein thrombosis (PVT) in a group with liver cirrhosis and in group without cirrhosis. Methods: Patients with PVT were selected from the group of patients treated with TIPS procedure between years 2000 and 2019. Patients with chronic PVT and portal cavernoma and patients with tumorous thrombosis were excluded. Patients with acute PVT were divided into two groups - group with liver cirrhosis (LC) and group without cirrhosis. We evaluated size and localization of thrombus. In a group of patients who underwent thrombolysis (TL) for the portal vein (PV) recanalisation we evaluated amount and severity of hemorrhagic complications. We also evaluated primary patency, primary assisted patency and secondary patency of shunt. Thirty-day and 1-year mortality was observed in the group with the LC and without LC and survival was assessed in the whole group and separately in both subgroups. We used the same technique to gain access to PV in all patients. Shunt in the liver parenchyma was created using bare metal stent or stentgraft. Results: The whole group with acute PVT treated with TIPS consisted of 74 patients. In the group A were 60 patients, 64% of them had partial thrombosis of PV trunk. Majority of this group consisted of men with mean age 58 years. The indications for TIPS were complications of PH (variceal bleeding in 60% and refractory ascites or fluidothorax in 35%). Thrombus was in 32% covered with the stent and in 38% dissolved after treatment with low molecular weight heparin (LMWH). In the group B was 14 patients without LC. They suffered from procoagulation disease such as hepatic veins thrombosis associated with PVT (22%) and polycytaemia vera (22%). There were more women in this group, mean age was 43 years. These patients had complete thrombosis (86%). In 10 patients from the whole group we had to use the local TL with mechanical thrombectomy to restore the flow in the PV. In this group we observed higher hemorrhagic complication rate comparing to group without TL. All these complications were treated conservatively or endovascularly. Patients in the group with TL had similar rate of 30-day mortality. Conclusion: Patients with portal vein thrombosis without liver cirrhosis are more frequently younger women with large PV thrombosis presenting with abdominal pain as a main symptom. In these patients using local thrombolysis for recanalisation of PV was more successful. On contrary the patients with PVT and liver cirrhosis were older men with thrombus on the wall of PV trunk. Indication for TIPS was gastrointestinal bleeding and the thrombus was dissolved after TIPS procedure. [ABSTRACT FROM AUTHOR]

Aim: Purpose of this study was to assess current practice in the Transjugular Intrahepatic Portosystemic Shunts (TIPS) creation in the Czech Republic. Methods: Questionnaire was sent to all university hospitals and regional hospitals. Numbers of procedures were requested in the last three years (2015-2017). There was also question about indications for TIPS during the last year and availability of urgent TIPS. We monitored 30day mortality and number of TIPS revisions in the last year (2017). Proportion of dedicated stentgrafts versus bare stents used was evaluated as well. Results: All hospitals answered. TIPS is being performed in 6 centres. There were performed 70 procedures in 2015, 87 procedures in 2016, and 96 in 2017. All centres declared availability for urgent TIPS creation. There were 57% procedures done for ascites (including patients with Budd-Chiari syndrome) and 43% for bleeding (including patients with portal vein thrombosis) in 2017. There were 3 centres where TIPS was indicated also for other indications beside bleeding or refractory ascites (8% of patients). These indications were portal vein thrombosis, Budd Chiari syndrome, and TIPS creation in a pediatric patient. The TIPS revisions were performed by all centres. Reported thirty day mortality was in range from 10 to 33%. TIPS dedicated stentgrafts were commonly centres also selfexpandable bare stents were used in 59% and 19% of cases. Conclusion: The Czech Republic has homogeneous geographical availibility of centres providing TIPS procedures on urgent basis. Half of these centres provide even technically more difficult procedures for the portal vein or hepatic vein thrombosis, or TIPS in children. Patients are followed after TIPS procedure in all centres. [ABSTRACT FROM AUTHOR]