Multidisciplinary diagnosis and treatment strategies and research progress of cavernous transformation of the portal vein_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

Liu Dongfang , Fan Zhenhua , Yue Zhendong ,  Wang Lei

Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P. R. China;

Corresponding?author：

Wang Lei, Email: wanglei800212@126.com

Keywords：

cavernous transformation of the portal vein; portal hypertension; transjugular intrahepatic portosystemic shunt; surgically assisted transjugular intrahepatic portosystemic shunt

DOI：

10.7507/1007-9424.202510043

Video：

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[Abstract] Cavernous transformation of the portal vein (CTPV) is a complex pathological condition characterized by the formation of cavernous venous collaterals secondary to portal vein obstruction caused by various etiologies, which often leads to portal hypertension and its associated complications. This disease features diverse causes, intricate pathological mechanisms, multidisciplinary involvement in clinical management, and considerable challenges in diagnosis and treatment. In recent years, the rapid advancement of imaging techniques and the widespread adoption of the multidisciplinary team model have markedly improved the early diagnostic rate and treatment accuracy of CTPV. However, numerous controversies remain regarding its surgical indications, therapeutic strategies, and long-term management to date. This review focuses on the etiology, clinical manifestations, imaging features, and recent therapeutic advances of CTPV, with particular emphasis on the optimization of multidisciplinary diagnostic and therapeutic strategies as well as the latest research findings. It aims to provide a systematic and practical reference for clinical practice, promote individualized comprehensive treatment, and ultimately improve the prognosis and quality of life of patients.

1.	Attanasi ML, Bou Daher H, Rockey DC. Natural history and outcomes of cavernous transformation of the portal vein in cirrhosis. Dig Dis Sci, 2023, 68(8): 3458-3466.
2.	Wu YF, Yue ZD, Fan ZH, et al. Clinical efficacy of surgically assisted transjugular intrahepatic portosystemic shunt for cavernous transformation of portal vein. World J Gastroenterol, 2025, 31(27): 108483. doi: 10.3748/wjg.v31.i27.108483.
3.	Zhang L, Zhu YJ, Wang XQ, et al. Efficacy and safety of precision-guided transjugular extrahepatic portosystemic shunt (TEPS) in the management of cavernous transformation of the portal vein with portal hypertension: a case series. Hepatol Int, 2024, 18(4): 1227-1237.
4.	Jiang H, He S, Wang H. A rare complication of people with inflammatory bowel disease after ileostomy: a case report. Medicine (Baltimore), 2023, 102(37): e35098. doi: 10.1097/MD.0000000000035098.
5.	Niu XK, Das SK, Wu HL, et al. Computed tomography-based score model/nomogram for predicting technical and midterm outcomes in transjugular intrahepatic portosystemic shunt treatment for symptomatic portal cavernoma. World J Clin Cases, 2020, 8(5): 887-899.
6.	Wei B, Huang Z, Tang C. Optimal treatment for patients with cavernous transformation of the portal vein. Front Med (Lausanne), 2022, 9: 853138. doi: 10.3389/fmed.2022.853138.
7.	Sethi SK, Dewan P, Faridi MM, et al. Liver abscess, portal vein thrombosis and cavernoma formation following umbilical vein catherisation in two neonates. Trop Gastroenterol, 2007, 28(2): 79-80.
8.	Denys A, Artru F. Noncirrhotic portal vein cavernous transformation: to TIPS, or not to TIPS, that is the question. J Vasc Interv Radiol, 2023, 34(2): 195-196.
9.	Du S, Luo X, Yang L, et al. Clinical significance of portal vein thrombosis in patients with decompensated cirrhosis: A still matter of debate. J Transl Int Med, 2025, 13(2): 100-103.
10.	Zhou Y, Zhuang Z, Yu T, et al. Long-term efficacy and safety of anticoagulant for cavernous transformation of the portal vein cirrhotic patient with extrahepatic portal vein obstruction. Thromb J, 2023, 21(1): 6. doi: 10.1186/s12959-023-00449-8.
11.	Marot A, Barbosa JV, Duran R, et al. Percutaneous portal vein recanalization using self-expandable nitinol stents in patients with non-cirrhotic non-tumoral portal vein occlusion. Diagn Interv Imaging, 2019, 100(3): 147-156.
12.	Luo X, Nie L, Zhou B, et al. Transjugular intrahepatic portosystemic shunt for the treatment of portal hypertension in noncirrhotic patients with portal cavernoma. Gastroenterol Res Pract, 2014, 2014: 659726. doi: 10.1155/2014/659726.
13.	Wang L, He F, Yue Z, et al. Techniques and long-term effects of transjugular intrahepatic portosystemic shunt on liver cirrhosis-related thrombotic total occlusion of main portal vein. Sci Rep, 2017, 7(1): 10868.
14.	Li W, Cui M, Li Q, et al. Application of transmesenteric vein extrahepatic portosystemic shunt in treatment of symptomatic portal hypertension with cavernous transformation of portal vein. J Interv Med, 2023, 6(2): 90-95.
15.	Prakash S, Bies J, Hassan M, et al. Portal vein thrombosis in cirrhosis: a literature review. Front Med (Lausanne), 2023, 10: 1134801. doi: 10.3389/fmed.2023.1134801.
16.	Kiladjian JJ, Cassinat B. Myeloproliferative neoplasms and splanchnic vein thrombosis: contemporary diagnostic and therapeutic strategies. Am J Hematol, 2023, 98(5): 794-800.
17.	Chang X, Liu L, Wang J, et al. Effectiveness of preoperative intrahepatic portal venous classification system in guiding preoperative surgical decisions and predicting hypotensive effects after Meso-Rex bypass for children with EHPVO. J Pediatr Surg, 2025, 60(2): 161990. doi: 10.1016/j.jpedsurg.2024.161990.
18.	Zhu WH, Chen J, Huang RK, et al. Erythroid-transdifferentiated myeloid cells promote portal vein tumor thrombus in hepatocellular carcinoma. Theranostics, 2023, 13(13): 4316-4332.
19.	Zhang M, Ding Q, Bian C, et al. Progress on the molecular mechanism of portal vein tumor thrombosis formation in hepatocellular carcinoma. Exp Cell Res, 2023, 426(1): 113563. doi: 10.1016/j.yexcr.2023.113563.
20.	Massironi S, Gervaso L, Fanizzi F, et al. Venous thromboembolism in patients with neuroendocrine neoplasms: a systematic review of incidence, types, and clinical outcomes. Cancers (Basel), 2025, 17(2): 212. doi: 10.3390/cancers17020212.
21.	Wada H, Shiraki K, Shimpo H, et al. Thrombotic mechanism involving platelet activation, hypercoagulability and hypofibrinolysis in coronavirus disease 2019. Int J Mol Sci, 2023, 24(9): 7975. doi: 10.3390/ijms24097975.
22.	Specchi S, Bertolini G. CT angiography identifies collaterals in dogs with splenic vein obstruction and presumed regional splenic vein hypertension. Vet Radiol Ultrasound, 2020, 61(6): 636-640.
23.	Fusaro L, Di Bella S, Martingano P, et al. Pylephlebitis: a Systematic review on etiology, diagnosis, and treatment of infective portal vein thrombosis. Diagnostics (Basel), 2023, 13(3): 429. doi: 10.3390/diagnostics13030429.
24.	Anand S, Umeh CA, Giberson C, et al. Septic portal vein thrombosis, clinical presentation, and management. Cureus, 2021, 13(11): e19840. doi: 10.7759/cureus.19840.
25.	Steib C, Guba M, Seidensticker M. Portal vein thrombosis-treatment options. Gastroenterologe, 2021, 16(2): 79-89.
26.	Costache RS, Dragomiric? AS, Dumitra? EA, et al. Portal vein thrombosis: a concise review (Review). Exp Ther Med, 2021, 22(1): 759. doi: 10.3892/etm.2021.10191.
27.	Karahan F, Atay A, Dilek FH, et al. Disasters that develop in the liver due to hydatid cyst: a case report. Cir Cir, 2024, 92(2): 267-270.
28.	Seedahmed AMK, Gasmalla KAD, Ahmed HYM, et al. Portal hypertension unmasked-cavernous transformation of the portal vein following portal vein thrombosis in a 9-year-old female: a case report. Clin Case Rep, 2025, 13(1): e70058. doi: 10.1002/ccr3.70058.
29.	Chen Z, Liu H, Li W, et al. Management of pediatric portal vein cavernous transformation: a seven-case single-center study. Front Pediatr, 2025, 13: 1627388. doi: 10.3389/fped.2025.1627388.
30.	Arkorful J, Adu-Bredu TK, Otoo O. Detection of cavernous transformation of the portal vein in a 22-year-old male with upper gastrointestinal bleeding by abdominal duplex ultrasonography: a Case Report. Ultrasound, 2023, 31(1): 56-60.
31.	Bhandari K, Mishra S, Sen K, et al. A rare case of esophageal variceal bleeding as a result of portal hypertension due to extra-hepatic portal vein obstruction and its management in a 7-year-old. Int J Surg Case Rep, 2024, 116: 109362. doi: 10.1016/j.ijscr.2024.109362.
32.	Miller A, Bernshteyn M, Achakzai B, et al. Closure of a distal splenorenal shunt as a therapy for refractory hyperammonaemia in setting of neuropsychiatric symptoms. BMJ Case Rep, 2023, 16(8): e255610. doi: 10.1136/bcr-2023-255610.
33.	Elkrief L, Denecheau-Girard C, Magaz M, et al. Abdominal surgery in patients with chronic noncirrhotic extrahepatic portal vein obstruction: a multicenter retrospective study. Hepatology, 2025, 81(1): 152-167.
34.	Meier B, Caca K. Gastrointestinal bleeding. Dtsch Med Wochenschr, 2023, 148(3): 116-127.
35.	Han SK, Baik SK, Kim MY. Pulmonary complications in patients with liver cirrhosis. Korean J Gastroenterol, 2023, 82(5): 213-223.
36.	Tamiru R, Hailemariam T, Wakjira E, et al. Congenital extrahepatic portosystemic shunt masquerading as chronic portal vein thrombosis: a case report. Int J Surg Case Rep, 2023, 109: 108553. doi: 10.1016/j.ijscr.2023.108553.
37.	Wei B, Huang Z, Wu H, et al. Portal vein recanalization for noncirrhotic portal vein cavernous transformation: transjugular intrahepatic portosystemic shunt creation versus portal vein stent placement. J Vasc Interv Radiol, 2023, 34(2): 187-194.
38.	Ueno N, Sasaki A, Tomiyama T, et al. Color Doppler ultrasonography in the diagnosis of cavernous transformation of the portal vein. J Clin Ultrasound, 1997, 25(5): 227-233.
39.	Han G, Qi X, He C, et al. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with symptomatic portal hypertension in liver cirrhosis. J Hepatol, 2011, 54(1): 78-88.
40.	Nery F, Correia S, Macedo C, et al. Nonselective beta-blockers and the risk of portal vein thrombosis in patients with cirrhosis: results of a prospective longitudinal study. Aliment Pharmacol Ther, 2019, 49(5): 582-588.
41.	Xu X, Guo X, De Stefano V, et al. Nonselective beta-blockers and development of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis. Hepatol Int, 2019, 13(4): 468-481.
42.	Davis JPE, Lim JK, Francis FF, et al. AGA clinical practice update on management of portal vein thrombosis in patients with cirrhosis: expert review. Gastroenterology, 2025, 168(2): 396-404.
43.	Stancu B, Chira A, Coman HF, et al. Intestinal obstruction as initial presentation of idiopathic portal and mesenteric venous thrombosis: diagnosis, management, and literature review. Diagnostics (Basel), 2024, 14(3): 304. doi: 10.3390/diagnostics14030304.
44.	Singh S, Chandan S, Vinayek R, et al. Comprehensive approach to esophageal variceal bleeding: From prevention to treatment. World J Gastroenterol, 2024, 30(43): 4602-4608.
45.	Garcia-Tsao G, Abraldes JG, Rich NE, et al. AGA clinical practice update on the use of vasoactive drugs and intravenous albumin in cirrhosis: expert review. Gastroenterology, 2024, 166(1): 202-210.
46.	Gralnek IM, Camus Duboc M, Garcia-Pagan JC, et al. Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy, 2022, 54(11): 1094-1120.
47.	Boyer TD, Haskal ZJ,. The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension. Hepatology, 2005, 41(2): 386-400.
48.	Zhang JB, Chen J, Zhou J, et al. Systematic review and meta-analysis of trans-jugular intrahepatic portosystemic shunt for cirrhotic patients with portal vein thrombosis. World J Clin Cases, 2021, 9(19): 5179-5190.
49.	Fanelli F, Angeloni S, Salvatori FM, et al. Transjugular intrahepatic portosystemic shunt with expanded-polytetrafuoroethylene-covered stents in non-cirrhotic patients with portal cavernoma. Dig Liver Dis, 2011, 43(1): 78-84.
50.	Salem R, Vouche M, Baker T, et al. Pretransplant portal vein recanalization-transjugular intrahepatic portosystemic shunt in patients with complete obliterative portal vein thrombosis. Transplantation, 2015, 99(11): 2347-2355.
51.	Entezari P, Riaz A, Thornburg B, et al. Percutaneous ultrasound-guided superior and inferior mesenteric vein access for portal vein recanalization-transjugular intrahepatic portosystemic shunt: a case series. Cardiovasc Intervent Radiol, 2021, 44(3): 496-499.
52.	Haruta I, Isobe Y, Ueno E, et al. Balloon-occluded retrograde transvenous obliteration (BRTO), a promising nonsurgical therapy for ectopic varices: a case report of successful treatment of duodenal varices by BRTO. Am J Gastroenterol, 1996, 91(12): 2594-2597.
53.	Mizutani T, Nirei K, Kanda T, et al. Left gastric vein width is an important risk factor for exacerbation of esophageal varices post balloon-occluded retrograde transvenous obliteration for gastric varices in cirrhotic patients. Medicina (Kaunas), 2022, 58(2): 205. doi: 10.3390/medicina58020205.
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1. Attanasi ML, Bou Daher H, Rockey DC. Natural history and outcomes of cavernous transformation of the portal vein in cirrhosis. Dig Dis Sci, 2023, 68(8): 3458-3466.
2. Wu YF, Yue ZD, Fan ZH, et al. Clinical efficacy of surgically assisted transjugular intrahepatic portosystemic shunt for cavernous transformation of portal vein. World J Gastroenterol, 2025, 31(27): 108483. doi: 10.3748/wjg.v31.i27.108483.
3. Zhang L, Zhu YJ, Wang XQ, et al. Efficacy and safety of precision-guided transjugular extrahepatic portosystemic shunt (TEPS) in the management of cavernous transformation of the portal vein with portal hypertension: a case series. Hepatol Int, 2024, 18(4): 1227-1237.
4. Jiang H, He S, Wang H. A rare complication of people with inflammatory bowel disease after ileostomy: a case report. Medicine (Baltimore), 2023, 102(37): e35098. doi: 10.1097/MD.0000000000035098.
5. Niu XK, Das SK, Wu HL, et al. Computed tomography-based score model/nomogram for predicting technical and midterm outcomes in transjugular intrahepatic portosystemic shunt treatment for symptomatic portal cavernoma. World J Clin Cases, 2020, 8(5): 887-899.
6. Wei B, Huang Z, Tang C. Optimal treatment for patients with cavernous transformation of the portal vein. Front Med (Lausanne), 2022, 9: 853138. doi: 10.3389/fmed.2022.853138.
7. Sethi SK, Dewan P, Faridi MM, et al. Liver abscess, portal vein thrombosis and cavernoma formation following umbilical vein catherisation in two neonates. Trop Gastroenterol, 2007, 28(2): 79-80.
8. Denys A, Artru F. Noncirrhotic portal vein cavernous transformation: to TIPS, or not to TIPS, that is the question. J Vasc Interv Radiol, 2023, 34(2): 195-196.
9. Du S, Luo X, Yang L, et al. Clinical significance of portal vein thrombosis in patients with decompensated cirrhosis: A still matter of debate. J Transl Int Med, 2025, 13(2): 100-103.
10. Zhou Y, Zhuang Z, Yu T, et al. Long-term efficacy and safety of anticoagulant for cavernous transformation of the portal vein cirrhotic patient with extrahepatic portal vein obstruction. Thromb J, 2023, 21(1): 6. doi: 10.1186/s12959-023-00449-8.
11. Marot A, Barbosa JV, Duran R, et al. Percutaneous portal vein recanalization using self-expandable nitinol stents in patients with non-cirrhotic non-tumoral portal vein occlusion. Diagn Interv Imaging, 2019, 100(3): 147-156.
12. Luo X, Nie L, Zhou B, et al. Transjugular intrahepatic portosystemic shunt for the treatment of portal hypertension in noncirrhotic patients with portal cavernoma. Gastroenterol Res Pract, 2014, 2014: 659726. doi: 10.1155/2014/659726.
13. Wang L, He F, Yue Z, et al. Techniques and long-term effects of transjugular intrahepatic portosystemic shunt on liver cirrhosis-related thrombotic total occlusion of main portal vein. Sci Rep, 2017, 7(1): 10868.
14. Li W, Cui M, Li Q, et al. Application of transmesenteric vein extrahepatic portosystemic shunt in treatment of symptomatic portal hypertension with cavernous transformation of portal vein. J Interv Med, 2023, 6(2): 90-95.
15. Prakash S, Bies J, Hassan M, et al. Portal vein thrombosis in cirrhosis: a literature review. Front Med (Lausanne), 2023, 10: 1134801. doi: 10.3389/fmed.2023.1134801.
16. Kiladjian JJ, Cassinat B. Myeloproliferative neoplasms and splanchnic vein thrombosis: contemporary diagnostic and therapeutic strategies. Am J Hematol, 2023, 98(5): 794-800.
17. Chang X, Liu L, Wang J, et al. Effectiveness of preoperative intrahepatic portal venous classification system in guiding preoperative surgical decisions and predicting hypotensive effects after Meso-Rex bypass for children with EHPVO. J Pediatr Surg, 2025, 60(2): 161990. doi: 10.1016/j.jpedsurg.2024.161990.
18. Zhu WH, Chen J, Huang RK, et al. Erythroid-transdifferentiated myeloid cells promote portal vein tumor thrombus in hepatocellular carcinoma. Theranostics, 2023, 13(13): 4316-4332.
19. Zhang M, Ding Q, Bian C, et al. Progress on the molecular mechanism of portal vein tumor thrombosis formation in hepatocellular carcinoma. Exp Cell Res, 2023, 426(1): 113563. doi: 10.1016/j.yexcr.2023.113563.
20. Massironi S, Gervaso L, Fanizzi F, et al. Venous thromboembolism in patients with neuroendocrine neoplasms: a systematic review of incidence, types, and clinical outcomes. Cancers (Basel), 2025, 17(2): 212. doi: 10.3390/cancers17020212.
21. Wada H, Shiraki K, Shimpo H, et al. Thrombotic mechanism involving platelet activation, hypercoagulability and hypofibrinolysis in coronavirus disease 2019. Int J Mol Sci, 2023, 24(9): 7975. doi: 10.3390/ijms24097975.
22. Specchi S, Bertolini G. CT angiography identifies collaterals in dogs with splenic vein obstruction and presumed regional splenic vein hypertension. Vet Radiol Ultrasound, 2020, 61(6): 636-640.
23. Fusaro L, Di Bella S, Martingano P, et al. Pylephlebitis: a Systematic review on etiology, diagnosis, and treatment of infective portal vein thrombosis. Diagnostics (Basel), 2023, 13(3): 429. doi: 10.3390/diagnostics13030429.
24. Anand S, Umeh CA, Giberson C, et al. Septic portal vein thrombosis, clinical presentation, and management. Cureus, 2021, 13(11): e19840. doi: 10.7759/cureus.19840.
25. Steib C, Guba M, Seidensticker M. Portal vein thrombosis-treatment options. Gastroenterologe, 2021, 16(2): 79-89.
26. Costache RS, Dragomiric? AS, Dumitra? EA, et al. Portal vein thrombosis: a concise review (Review). Exp Ther Med, 2021, 22(1): 759. doi: 10.3892/etm.2021.10191.
27. Karahan F, Atay A, Dilek FH, et al. Disasters that develop in the liver due to hydatid cyst: a case report. Cir Cir, 2024, 92(2): 267-270.
28. Seedahmed AMK, Gasmalla KAD, Ahmed HYM, et al. Portal hypertension unmasked-cavernous transformation of the portal vein following portal vein thrombosis in a 9-year-old female: a case report. Clin Case Rep, 2025, 13(1): e70058. doi: 10.1002/ccr3.70058.
29. Chen Z, Liu H, Li W, et al. Management of pediatric portal vein cavernous transformation: a seven-case single-center study. Front Pediatr, 2025, 13: 1627388. doi: 10.3389/fped.2025.1627388.
30. Arkorful J, Adu-Bredu TK, Otoo O. Detection of cavernous transformation of the portal vein in a 22-year-old male with upper gastrointestinal bleeding by abdominal duplex ultrasonography: a Case Report. Ultrasound, 2023, 31(1): 56-60.
31. Bhandari K, Mishra S, Sen K, et al. A rare case of esophageal variceal bleeding as a result of portal hypertension due to extra-hepatic portal vein obstruction and its management in a 7-year-old. Int J Surg Case Rep, 2024, 116: 109362. doi: 10.1016/j.ijscr.2024.109362.
32. Miller A, Bernshteyn M, Achakzai B, et al. Closure of a distal splenorenal shunt as a therapy for refractory hyperammonaemia in setting of neuropsychiatric symptoms. BMJ Case Rep, 2023, 16(8): e255610. doi: 10.1136/bcr-2023-255610.
33. Elkrief L, Denecheau-Girard C, Magaz M, et al. Abdominal surgery in patients with chronic noncirrhotic extrahepatic portal vein obstruction: a multicenter retrospective study. Hepatology, 2025, 81(1): 152-167.
34. Meier B, Caca K. Gastrointestinal bleeding. Dtsch Med Wochenschr, 2023, 148(3): 116-127.
35. Han SK, Baik SK, Kim MY. Pulmonary complications in patients with liver cirrhosis. Korean J Gastroenterol, 2023, 82(5): 213-223.
36. Tamiru R, Hailemariam T, Wakjira E, et al. Congenital extrahepatic portosystemic shunt masquerading as chronic portal vein thrombosis: a case report. Int J Surg Case Rep, 2023, 109: 108553. doi: 10.1016/j.ijscr.2023.108553.
37. Wei B, Huang Z, Wu H, et al. Portal vein recanalization for noncirrhotic portal vein cavernous transformation: transjugular intrahepatic portosystemic shunt creation versus portal vein stent placement. J Vasc Interv Radiol, 2023, 34(2): 187-194.
38. Ueno N, Sasaki A, Tomiyama T, et al. Color Doppler ultrasonography in the diagnosis of cavernous transformation of the portal vein. J Clin Ultrasound, 1997, 25(5): 227-233.
39. Han G, Qi X, He C, et al. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with symptomatic portal hypertension in liver cirrhosis. J Hepatol, 2011, 54(1): 78-88.
40. Nery F, Correia S, Macedo C, et al. Nonselective beta-blockers and the risk of portal vein thrombosis in patients with cirrhosis: results of a prospective longitudinal study. Aliment Pharmacol Ther, 2019, 49(5): 582-588.
41. Xu X, Guo X, De Stefano V, et al. Nonselective beta-blockers and development of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis. Hepatol Int, 2019, 13(4): 468-481.
42. Davis JPE, Lim JK, Francis FF, et al. AGA clinical practice update on management of portal vein thrombosis in patients with cirrhosis: expert review. Gastroenterology, 2025, 168(2): 396-404.
43. Stancu B, Chira A, Coman HF, et al. Intestinal obstruction as initial presentation of idiopathic portal and mesenteric venous thrombosis: diagnosis, management, and literature review. Diagnostics (Basel), 2024, 14(3): 304. doi: 10.3390/diagnostics14030304.
44. Singh S, Chandan S, Vinayek R, et al. Comprehensive approach to esophageal variceal bleeding: From prevention to treatment. World J Gastroenterol, 2024, 30(43): 4602-4608.
45. Garcia-Tsao G, Abraldes JG, Rich NE, et al. AGA clinical practice update on the use of vasoactive drugs and intravenous albumin in cirrhosis: expert review. Gastroenterology, 2024, 166(1): 202-210.
46. Gralnek IM, Camus Duboc M, Garcia-Pagan JC, et al. Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy, 2022, 54(11): 1094-1120.
47. Boyer TD, Haskal ZJ,. The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension. Hepatology, 2005, 41(2): 386-400.
48. Zhang JB, Chen J, Zhou J, et al. Systematic review and meta-analysis of trans-jugular intrahepatic portosystemic shunt for cirrhotic patients with portal vein thrombosis. World J Clin Cases, 2021, 9(19): 5179-5190.
49. Fanelli F, Angeloni S, Salvatori FM, et al. Transjugular intrahepatic portosystemic shunt with expanded-polytetrafuoroethylene-covered stents in non-cirrhotic patients with portal cavernoma. Dig Liver Dis, 2011, 43(1): 78-84.
50. Salem R, Vouche M, Baker T, et al. Pretransplant portal vein recanalization-transjugular intrahepatic portosystemic shunt in patients with complete obliterative portal vein thrombosis. Transplantation, 2015, 99(11): 2347-2355.
51. Entezari P, Riaz A, Thornburg B, et al. Percutaneous ultrasound-guided superior and inferior mesenteric vein access for portal vein recanalization-transjugular intrahepatic portosystemic shunt: a case series. Cardiovasc Intervent Radiol, 2021, 44(3): 496-499.
52. Haruta I, Isobe Y, Ueno E, et al. Balloon-occluded retrograde transvenous obliteration (BRTO), a promising nonsurgical therapy for ectopic varices: a case report of successful treatment of duodenal varices by BRTO. Am J Gastroenterol, 1996, 91(12): 2594-2597.
53. Mizutani T, Nirei K, Kanda T, et al. Left gastric vein width is an important risk factor for exacerbation of esophageal varices post balloon-occluded retrograde transvenous obliteration for gastric varices in cirrhotic patients. Medicina (Kaunas), 2022, 58(2): 205. doi: 10.3390/medicina58020205.
54. Ohs Z, Jones M, Sharma N, et al. Percutaneous transhepatic embolization of ectopic varices in a patient with portal hypertension presenting with hemorrhagic shock. Cureus, 2021, 13(9): e18209. doi: 10.7759/cureus.18209.
55. Hirose S, Hasegawa N, Mori K, et al. Percutaneous transhepatic obliteration-related procedures for isolated gastric varices: experience of three cases. Clin J Gastroenterol, 2022, 15(1): 192-198.
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