Combined TIPS and TACE for patients with hepatocellular carcinoma and variceal bleeding secondary to portal vein tumor thrombus

The study aimed to assess the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with transarterial chemoembolization (TACE) for treating hepatocellular carcinoma (HCC) patients who have portal vein tumor thrombus (PVTT) and variceal bleeding secondary to portal hypertension. This retrospective study analysed 39 patients with HCC and PVTT who experienced variceal bleeding and were treated with TIPS and TACE from June 2018 to April 2025. The evaluated outcomes included the technical success, clinical success and overall survival (OS). The technical success rate was 100%. Variceal bleeding was successfully controlled in all patients. Among these patients, 13 (33.3%) developed overt hepatic encephalopathy (HE) after TIPS. There were no other significant procedure-related complications. The recurrence rate of variceal bleeding was 25.6% at 1 year. After TACE, all patients exhibited a reduction in tumor size, with 26 (66.7%) patients achieving partial response (PR) and 13 (33.3%) patients achieving stable disease (SD). The median OS was 12.2 (95% CI: 10.9–13.5) months and OS rates were 89.7% at 1 month, 76.9% at 3 months, 56.4% at 6 months, and 46.2% at 12 months. TIPS combined with TACE appears to be safe and effective for patients who had HCC and PVTT complicated with variceal bleeding secondary to portal hypertension. This study found that the combination of TIPS and TACE is a safe and effective treatment for patients with HCC and PVTT. The treatment successfully stopped the bleeding in all patients, helped shrink the tumors in most, and improved overall survival. This approach not only manages the life-threatening bleeding but also allows for further treatment of the liver cancer itself.