*UPDATE* New Non-surgical Procedure for PVT (PVR-TIPS)

PLEASE NOTE:  Since my original post (March 13/20) I would like to reiterate that this relatively new procedure is indeed helping people with the right physical criteria and it not always suitable for everyone.  The results for those who have had the procedure are quite astounding though as you can read from the comments I have received so far.  On my post called “My Portal Hypertension Journey” a friend (Greg) who I met since I started this blog, just posted his own personal success story after suffering for 40 years with the condition.  I have reposted his comments at the end of this post as it was through Dr. Salem and his team that Greg’s condition has been reversed.  October 27/20

With great optimism I share this news with you today.  Dr. Riad Salem at Northwestern University in Chicago Illinois, and a team of over a dozen doctors have recently developed and tested a new non-surgical procedure for the treatment of portal vein thrombosis (PVT).

A few days ago Dr. Salem reached out to me via this blog with the results of the clinical study.   His words below encapsulate this new technique.   

“At Northwestern, we have pioneered a new, non-surgical approach for the treatment of portal vein thrombosis with or without cavernomatous transformation.  It involves creating a new channel in the clotted portal vein, and placing a transjugular intrahepatic portosystemic shunt (TIPS) stent. We do this using ultrasound and X-ray guidance. Our first series of 61 patients has already been published with excellent success, and many of these patients have gone on to liver transplantation since they had cirrhosis of the liver. We are now performing this on adults without cirrhosis with cavernoma. Some of these patients have varices that have bled. This is a procedure you should be evaluated for if you are considering a Rex shunt or any other interventianal operation since this is a less evasive alternative”.

Contact Information

Riad Salem MD MBA
Professor of Radiology, Medicine and Surgery
Chief, Section of Vascular and Interventional Radiology
Vice-Chairman, Image-Guided Therapy
Department of Radiology
Northwestern University
676 N St Clair, Suite 800
Chicago, IL USA 60611
1-312-695-6371 office

Dr. Salem is glad to answer questions for patients and has asked that you contact him directly at rsalem1@nm.org 

If you have a story to share about your personal journey with portal hypertension or have had the procedure please feel free to post it. 

Addendum comment posted October 26/20 as mentioned above: 

“Thank you, Clint for providing a valuable conduit for information regarding PVT for patients and their families with PVT.

I have had PVT since birth, and as a consequence, have experienced 2 major bleeds from my esophageal varicies when I was in high school. As a lifesaving measure to decompress my esophageal varicies, I had a Splenorenal shunt created to prevent future bleeds. I was blessed to have been put under the care of two distinguished physicians and exemplary individuals: Gastroenterologist, Dr. William Baldus, and surgeon, Dr. Martin Adson, both doctors at the Mayo Clinic.

I began to experience the gradual onset of hepatic encephalopathy in my mid 30’s. As I have aged (now 57) I have had a growing list of health issues tied to PVT. Although I have not had any banding of my varicies done for few years now, I still have esophageal and gastric varicies.

I am writing this entry because I now feel a sense of hope for me and my family. I am grateful to Dr. Riad Salem, another distinguished physician and exemplary person who is an interventional radiologist at Northwestern University Medical Center in Chicago. Dr. Salem was able to place a stent in and through what was the cavernous transformation of my portal vein and and connect my atrophied liver with an entirely new supply of blood from the nexus of my Inferior vena cava and splenic vein. The initial transformation was very significant, and I continue to do well. It is my understanding that improvement in the symptoms of PVT and hepatic encephalopathy as my body adjusts to this welcome change.


Dr. Salem, his colleagues and staff at Northwestern University are among the best of the best. After surgeons attempted a REX shunt on me at another institution in 1979, albeit unsuccessfully because of the atrophied condition of my liver, I was resigned to the prospect that I would never experience the benefit of an open portal vein. Dr. Salem and his colleagues have helped me and many others realize the many benefits of an open portal vein”.

“If you can’t fly then run, if you can’t run then walk, if you can’t walk then crawl, but whatever you do you have to keep moving forward”.  – Martin Luther King Jr.

 

37 thoughts on “*UPDATE* New Non-surgical Procedure for PVT (PVR-TIPS)

  1. IFTIKHAR ALAM

    Hello. My uncle is diagnosed with extensive portal vein tumor thrombosis. He just had jaundice few days ago his eyes are yellow.. Here in pakistan they are saying there is no any treatment and patient should be on palliative care.
    Can you please guide me on this? What are the best available options.

    Reply
    1. Clint Post author

      Hello,

      I am very sorry to hear about your uncle. At this time, I have no contacts within your country for you to consider. From time to time I have had people get jn touch with me from India, but I do not have anyone with the expertise who I can refer you to in that country. You can try contacting doctors from this list, especially in Italy, Australia, and see if they can refer you to a liver specialist in your country or close by. This is the best I can do at this time. Please let me know if you are able to reach someone. My thoughts and prayers are with your uncle and family at this time. https://www.portal-hypertension.com/rex-shunt-specialist-list/

      Reply
  2. Tenzin

    Helo client
    My son has been diagnosed portal vein thrombosis last year in the month of October and he is on warfarin.doctor asked to review after 6 months and due to lockdown we could not do the review and after 7 months we did ultrasound but his thrombosis is not resolved.he is a symptomatic but doctor told me to do his endoscopy but no hurry.

    Reply
    1. Clint Post author

      Sorry to hear about your son. Your doctor has given you good advice. They need to scope your son to examine the condition of the varices that may be in the esophagus and upper part of the stomach assuming there is an actual clot in the portal vein. I am not a doctor, but depending on where you live and other physical factors, there may be a few options that may work to alleviate the underlying issue? There are a few options, one being relatively new, and the other has proven to also work in most cases. There are big obstacles if you need to travel anywhere especially now, and because your son is considered high risk, that may play into going elsewhere for treatment. Once your son has been scoped this should determine what the next steps should be. Here are the 2 options currently being used.

      https://www.portal-hypertension.com/2020/03/non-surgical-procedure-portal-vein-thrombosis/

      https://www.portal-hypertension.com/the-rex-shunt-procedure-for-portal-hypertension/

      Your questions and comments are most welcome.

      Clint

      Reply
      1. Anil

        Hii
        I have History of Pvt have abdominal pain in right side discomfort migraine shortness of breath.
        Liver kidney spleen gall bladder are normal
        Please suggest me permanent solution for Pvt
        Thanks
        Anil

        Reply
        1. Clint Post author

          Hi Anil,

          In my latest post you can read where a doctor in Chicago called Dr. Riad Salem has developed a nonevasive procedure that may possible work for you. He is based in Chicago Illinois, and he may be able to refer to doctors elsewhere who may be able to help you. Dr. Salem’s contact information is included with the post. See: https://www.portal-hypertension.com/2020/03/non-surgical-procedure-portal-vein-thrombosis/ Hope this helps? Another procedure that might work, is called the Rex Shunt procedure, performed my another doctor in the Chicago area (Dr.Richardo Superina), and many parts of the world. See the following: https://www.portal-hypertension.com/the-rex-shunt-procedure-for-portal-hypertension/ Also: https://www.portal-hypertension.com/rex-shunt-specialist-list/ If you are able to contact these doctors I am sure they will be able to assist you. Best regards, Clint

          Reply
      1. Clint Post author

        In my latest post you can read where a doctor in Chicago called Dr. Riad Salem has developed a nonevasive procedure that may possible work for you. He is based in Chicago Illinois, and he may be able to refer to doctors elsewhere who may be able to help you. Dr. Salem’s contact information is included with the post. See: https://www.portal-hypertension.com/2020/03/non-surgical-procedure-portal-vein-thrombosis/ Hope this helps? Another procedure that might work, is called the Rex Shunt procedure, performed my another doctor in the Chicago area (Dr.Richardo Superina), and many parts of the world. See the following: https://www.portal-hypertension.com/the-rex-shunt-procedure-for-portal-hypertension/ Also: https://www.portal-hypertension.com/rex-shunt-specialist-list/ If you are able to contact these doctors I am sure they will be able to assist you. Best regards, Clint

        Reply
  3. Isa

    Hi Clint! Isn’t this the same procedure you described on the page called “TIPS Procedure explained in a video”?

    Reply
    1. Clint Post author

      Hi Isa,

      Thanks for your question. I’m sorry for the delay in responding. In answer to your question I will quote directly from an email Dr. Salem sent me initially to inform me of this new procedure. “For the last 10 years, I have been actively researching novel treatments for PVT using TIPS. As you know, there are many cases where TIPS is deemed impossible because of cavernoma and/or chronicity of the clot. We have developed a new transsplenic approach. I am enclosing our recent paper of 61 patients”.

      Here is a link to the actual study: https://www.dropbox.com/s/a3e32zmh8lbbfei/Final%20JVIR%20PVR%20TIPS.pdf?dl=0

      I hope you are able to open the link, I can resend it directly to your email if you wish.

      Hope this helps?

      Best regards,

      Clint

      Reply
  4. Kelly

    Hi, my gi said I probably have portal hypertension because I developed acites, I have to do an upper gi tomorrow to see if I have varices or not.
    The acites has gone down a lot just with taking diuretics. Im hoping I get lucky with the varices, im not passing blood or vomiting it. Just feel like an idiot for drinking myself to this state. I have quit alcohol and my liver levels have improved to almost normal. Can i possibly get lucky? Or am I screwed?

    Reply
    1. Clint Post author

      Wow, thanks for your note! So sorry to hear about your condition. I have no way of predicting your outcome, but can only tell you that people can and do live a long time and even after a bleed or two. There is a very short period of time for intervention if a bleed were to occur, but many I know have survived. When they do an upper GI scope, they should be able to tell what grade the varices are in your esphogas and sometimes they will band them at the same time. If its any consolation I have lived 18 years beyond my diagnosis although in my case it was caused by a unknown genetic clotting disorder (noncirrhotic portal hypertension). Nowadays I would say that along with the standard treatment protocol, and the development of new procedures the outlook seems more positive. What part of the world are you from? I pray all goes well with you tomorrow and that doctors will have a clearer picture of treatment options for you. Please let me know what transpires. Take care, Clint

      Reply
      1. Kelly

        Thank you Clint, I am In Kansas. Its all so overwhelming so many variables with liver disease. Im 54 so I guess if I am as lucky as you ill take 18 years. I feel like such an ass for treating my body so poorly. Oh well, I guess you reap what you sew.

        Reply
        1. Clint Post author

          Still young enough to start over and begin to adjust to new health habits. I just turned 60 and have a few other health issues, I just keep going. Try to eat right, and get some exercise in, plus I believe prayer has really helped me overcome these obstacles. Take care and give me an update if you wish. God bless, Clint

          Reply
  5. Kely

    Well the lord was watching over me. I have no varices, the doctor wants to see me in three months. Maybe we caught this in time. Doctor was a bit suprised since i have acites and muscle wasting. Thanks fo r your prayers. They work.

    Reply
  6. Kelly

    Thanks, ill pray for you as well. Thank you for your site. As you know, when talking to people about issues with the liver its hard for most people to even grasp all that can be involved.

    Reply
    1. Clint Post author

      Thank you! It is a hard thing to grasp and sometimes only those going through a specific illness themselves have the most empathy.

      Reply

Leave a Reply

Your email address will not be published. Required fields are marked *