Advanced Endovascular Management of Portal Vein Thrombosis Using Combined Rotational Morcellation and Large-Bore Aspiration Techniques: Treating Thrombosed TIPS Shunts

Portal vein thrombosis (PVT) is a challenging clinical condition characterized by thrombotic obstruction of the portal venous system, significantly impacting patient outcomes due to its potential complications including portal hypertension and liver dysfunction. Traditional management, primarily anticoagulation, frequently falls short in achieving complete thrombus resolution. Here, we present an analysis of five cases utilizing an innovative endovascular approach employing an 18 French thrombo-aspiration catheter combined with rotational morcellation. In five patients presenting with acute and sub-acute portal vein thrombosis (PVT), involving critical venous structures such as the main portal vein, superior mesenteric vein (SMV), and splenic vein, mechanical thrombo-aspiration with rotational morcellation was effectively performed. Across all cases, the procedure successfully achieved significant thrombus reduction, consistently decreasing the extent of occlusion from near-total (95%-100%) to minimal residual thrombus levels (0%-15%). Post-procedure imaging confirmed substantial restoration of venous patency, and all patients experienced symptomatic relief. Importantly, the procedures were completed without immediate device-related complications or major adverse events, underscoring the safety and efficacy of mechanical thrombo-aspiration with rotational morcellation as a possible therapeutic approach for extensive acute and sub-acute PVT. These findings highlight the potential efficacy and safety of combining large-bore thrombo-aspiration and rotational morcellation in managing portal venous thrombosis, suggesting possible clinical benefits over conventional anticoagulation therapy alone. Further prospective studies and long-term follow-up are required to validate these outcomes and establish this technique as a standardized approach in the interventional management of portal vein thrombosis.