In Reply to: Re: Case 0100_06 -- Management of Acute Liver Failure in a Patient with Portal and Hepatic Vein Thrombosis posted by LARRY RUFER on January 05, 19100 at 22:05:04:
Presumably the patient's acute hepatic failure was due to the portal venous thrombosis and lack of portal venous flow to the liver? In this scenario creation of a TIPS w/o lysis would not treat the problem. Merely removing thrombus from the main portal vein and/or creating a TIPS will not open peripheral vessels. If the goal is to attempt re-perfusion of the peripheral portal venous system, lysis is requisite.
It would be interesting to know the patients status/ baseline labs prior to the acute decompensation. Would he have survived a TIPS when the portal venous system was patent?