Management of Portal Hypertension in Oncologic Patients

Portal hypertension significantly impacts the management and prognosis of patients with primary and secondary hepatic malignancies. Its presence may preclude curative surgical or locoregional therapies, increase perioperative risk, and worsen overall survival. Interventional radiology plays a central role in the management of portal hypertensive complications when medical and endoscopic therapies are insufficient. The mainstay intervention, transjugular intrahepatic portosystemic shunt (TIPS), is well-established for variceal bleeding, refractory ascites, and hepatic hydrothorax in cirrhotic patients, and emerging evidence supports its use in selected cancer patients, including those with hepatocellular carcinoma (HCC) and metastatic disease. Splenic artery embolization (SAE) serves as an alternative or adjunctive therapy in patients with contraindications to TIPS, in individuals who have persistent symptoms despite TIPS placement. This document outlines evidence-based management strategies for portal hypertension in cancer patients and discusses technical considerations in TIPS placement and splenic artery embolization.