Comparison of Bleeding Complications between Transplenic versus Transhepatic Access of the Portal Venous System

To evaluate the incidence of bleeding complications between transplenic (TS) and transhepatic (TH) access in portal venous interventions.

Retrospective review of patients who underwent TS or TH access for portal venous system interventions from January 2000 to August 2017. Only procedures with clinical and laboratory follow-up were included (n = 148). Twenty-four TS procedures were performed in 22 patients, and 124 TH procedures were performed in 114 patients. The main indications were for angioplasty/stent, embolization of varices/shunt, or portal vein embolization, with no difference between the groups. Mean patient age and sex were not significantly different between the groups (P values .445 and .682, respectively). Mean follow up was 2.3 years (range 0.1-14.2). There was no significant difference between the international normalized ratio (P = .300) and platelets (P = .234) before the procedure between the 2 cohorts.

Technical success of vascular access and procedural success was achieved in 22/24 (91.6%) TS procedures and 120/124 (96.8%) TH procedures (P = .238). There was no significant difference in bleeding complications between the 2 groups (3/24 [12.5%] TS vs 10/124 [8.1%] TH; P = .44). There was no significant difference in major bleeding complications (SIR classification ≥ C; 1/24 [4.2%] TS vs 4/124 [3.2%] TH; P = .789).There was no significant difference in the hemoglobin before or after the procedure (g/dL), with average change -1.1 g/dL (range -3.4 to +1.0) in the TS group and 1.0 g/dL (range -4.5 to +1.9) in the TH group (P = .540). Finally, there was no significant difference in proportion of patients requiring blood transfusion after the procedure (P = .520), with 2 (8.3%) in the TS group requiring an average of 4 units (range 2-6) and 17 (13.7%) in the TH group requiring an average of 3.5 units (range 1-26).

These data suggest no significant difference in bleeding complications between TS and TH access for portal venous interventions.