{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:20:19Z","timestamp":1771928419941,"version":"3.50.1"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Guangxi Medical and Health Appropriate Technology Development and Promotion Project","award":["S2022115"],"award-info":[{"award-number":["S2022115"]}]},{"name":"Self-raised Funds Scientific Research Project of the Health Commission of Guangxi Zhuang Autonomous Region","award":["Z20190664"],"award-info":[{"award-number":["Z20190664"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute esophagogastric variceal bleeding (EGVB) is a lethal complication in patients with hepatocellular carcinoma (HCC) complicated by portal vein tumor thrombus (PVTT). While transjugular intrahepatic portosystemic shunt (TIPS) is a standard treatment for portal hypertension, it is often contraindicated or technically challenging in patients with extensive main portal vein occlusion (Vp4 type) or severe hepatic dysfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>We report the first clinical application of a novel salvage technique, percutaneous portal-central venous bypass (PPCV), in a 56-year-old man with HCC, decompensated cirrhosis, and extensive PVTT. The patient presented with life-threatening EGVB refractory to endoscopic therapy and was deemed ineligible for TIPS due to the extent of the tumor thrombus and critical instability. PPCV was performed by percutaneously puncturing the portal vein under ultrasound guidance and establishing an extracorporeal shunt connected to a pre-existing subclavian central venous catheter.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The procedure was technically successful and achieved immediate hemodynamic improvement. Direct portal venous pressure decreased significantly from 40.6\u202fmmHg pre-connection to 18.8\u202fmmHg post-connection. Clinical hemostasis was achieved within 24\u202fh, and the patient remained stable for 2\u202fweeks until discharge. Although the patient succumbed to tumor progression 2\u202fmonths later, no recurrent bleeding or procedure-related complications were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PPCV is a simple, feasible, and effective salvage therapy for rapidly reducing portal pressure and controlling refractory bleeding. It provides a vital therapeutic option for high-risk HCC patients with PVTT who are contraindicated for TIPS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1731912","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T06:31:31Z","timestamp":1770013891000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Percutaneous portal-central venous bypass: a novel salvage therapy for refractory variceal bleeding in TIPS-ineligible patients with portal vein tumor thrombus"],"prefix":"10.3389","volume":"13","author":[{"given":"Guoyu","family":"Deng","sequence":"first","affiliation":[{"name":"Department of Interventional Radiology, Guangxi Medical University Cancer Hospital","place":["Nanning, Guangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaomei","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Guangxi Medical University Cancer Hospital","place":["Nanning, Guangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meiling","family":"He","sequence":"additional","affiliation":[{"name":"Department of Day Oncology Unit, Guangxi Medical University Cancer Hospital","place":["Nanning, Guangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chaonan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Guangxi Medical University Cancer Hospital","place":["Nanning, Guangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoju","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Guangxi Medical University Cancer Hospital","place":["Nanning, Guangxi, China"]},{"name":"Guangxi Key Laboratory of Extremely Weak Magnetic Field in Cancer Medicine, Guangxi Medical University Cancer Hospital","place":["Nanning, Guangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1038\/s41575-019-0186-y","article-title":"A global view of hepatocellular carcinoma: trends, risk, prevention and management","volume":"16","author":"Yang","year":"2019","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2184","DOI":"10.1007\/s00330-017-5145-9","article-title":"Portal hypertension is associated with poor outcome of transarterial chemoembolization in patients with hepatocellular carcinoma","volume":"28","author":"Choi","year":"2018","journal-title":"Eur Radiol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1159\/000450833","article-title":"Factors influencing surveillance for hepatocellular carcinoma in patients with liver cirrhosis","volume":"6","author":"Ahmed Mohammed","year":"2017","journal-title":"Liver Cancer"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.ijsu.2015.05.009","article-title":"The strategies for treating primary hepatocellular carcinoma with portal vein tumor thrombus","volume":"20","author":"Zhang","year":"2015","journal-title":"Int J Surg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1016\/j.jhep.2018.03.019","article-title":"EASL clinical practice guidelines: management of hepatocellular carcinoma","volume":"69","year":"2018","journal-title":"J Hepatol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.2147\/JHC.S318070","article-title":"Portal vein tumor thrombosis and hepatocellular carcinoma\u2014the changing tides","volume":"8","author":"Khan","year":"2021","journal-title":"J Hepatocell Carcinoma"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"113563","DOI":"10.1016\/j.yexcr.2023.113563","article-title":"Progress on the molecular mechanism of portal vein tumor thrombosis formation in hepatocellular carcinoma","volume":"426","author":"Zhang","year":"2023","journal-title":"Exp Cell Res"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1007\/s00535-024-02097-9","article-title":"Clinical risk factors for portal hypertension-related complications in systemic therapy for hepatocellular carcinoma","volume":"59","author":"Fujiwara","year":"2024","journal-title":"J Gastroenterol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"101305","DOI":"10.1016\/j.jceh.2023.101305","article-title":"Transjugular intrahepatic portosystemic shunt for advanced hepatocellular carcinoma with main portal vein tumor thrombus-related symptomatic portal hypertension","volume":"14","author":"Xie","year":"2024","journal-title":"J Clin Exp Hepatol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/s12885-020-07708-1","article-title":"Variceal bleeding is aggravated by portal venous invasion of hepatocellular carcinoma: a matched nested case-control study","volume":"21","author":"Lim","year":"2021","journal-title":"BMC Cancer"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1016\/S0140-6736(18)30010-2","article-title":"Hepatocellular carcinoma","volume":"391","author":"Forner","year":"2018","journal-title":"Lancet"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1016\/j.mayocp.2018.12.020","article-title":"Portal hypertension and related complications: diagnosis and management","volume":"94","author":"Simonetto","year":"2019","journal-title":"Mayo Clin Proc"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1016\/j.jhep.2021.11.030","article-title":"Updated efficacy and safety data from IMbrave150: atezolizumab plus bevacizumab vs. sorafenib for unresectable hepatocellular carcinoma","volume":"76","author":"Cheng","year":"2022","journal-title":"J Hepatol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1407","DOI":"10.1016\/s1051-0443(07)61699-6","article-title":"Malignant portal venous obstructions treated by stent placement: significant factors affecting patency","volume":"12","author":"Yamakado","year":"2001","journal-title":"J Vasc Interv Radiol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/j.gtc.2014.08.011","article-title":"Nonendoscopic management strategies for acute esophagogastric variceal bleeding","volume":"43","author":"Satapathy","year":"2014","journal-title":"Gastroenterol Clin N Am"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"852","DOI":"10.1111\/jgh.13593","article-title":"Early transjugular intrahepatic portosystemic shunt in US patients hospitalized with acute esophageal variceal bleeding","volume":"32","author":"Njei","year":"2017","journal-title":"J Gastroenterol Hepatol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"6777","DOI":"10.1007\/s00330-022-08705-7","article-title":"TIPS plus sequential systemic therapy of advanced HCC patients with tumour thrombus-related symptomatic portal hypertension","volume":"32","author":"Qiu","year":"2022","journal-title":"Eur Radiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s40644-022-00451-9","article-title":"TIPS improves outcomes in patients with HCC and symptomatic portal hypertension: a multi-institution experience","volume":"22","author":"Yan","year":"2022","journal-title":"Cancer Imaging"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1136\/gutjnl-2019-320221","article-title":"Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension","volume":"69","author":"Tripathi","year":"2020","journal-title":"Gut"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1002\/hep.510290145","article-title":"Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials","volume":"29","author":"Llovet","year":"1999","journal-title":"Hepatology"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"7289","DOI":"10.3748\/wjg.v22.i32.7289","article-title":"Management of hepatocellular carcinoma with portal vein tumor thrombosis: review and update at 2016","volume":"22","author":"Chan","year":"2016","journal-title":"World J Gastroenterol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/S0140-6736(16)32453-9","article-title":"Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial","volume":"389","author":"Bruix","year":"2017","journal-title":"Lancet"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2778","DOI":"10.4240\/wjgs.v16.i9.2778","article-title":"Transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding in patients with hepatocellular carcinoma and portal vein tumor thrombus","volume":"16","author":"Wu","year":"2024","journal-title":"World J Gastrointest Surg"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"29","DOI":"10.2147\/JHC.S491153","article-title":"Fully covered stent-TIPS for advanced HCC patients with portal vein tumor thrombus-related severe symptomatic portal hypertension","volume":"12","author":"Liu","year":"2025","journal-title":"J Hepatocell Carcinoma"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1002\/hep.31411","article-title":"Management of symptomatic portal cavernoma cholangiopathy with transplenic portal vein recanalization and transjugular intrahepatic portosystemic shunt","volume":"73","author":"Abud","year":"2021","journal-title":"Hepatology"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.jhep.2010.08.018","article-title":"Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with symptomatic portal hypertension in liver cirrhosis","volume":"54","author":"Han","year":"2011","journal-title":"J Hepatol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"982","DOI":"10.1097\/MCG.0b013e31819706a4","article-title":"Transjugular intrahepatic portosystemic shunt in patients with chronic portal vein occlusion and cavernous transformation","volume":"43","author":"Wils","year":"2009","journal-title":"J Clin Gastroenterol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1227","DOI":"10.1007\/s12072-024-10656-8","article-title":"Efficacy and safety of precision-guided transjugular extrahepatic portosystemic shunt (TEPS) in the management of cavernous transformation of the portal vein with portal hypertension: a case series","volume":"18","author":"Zhang","year":"2024","journal-title":"Hepatol Int"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1731912\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T09:29:04Z","timestamp":1771925344000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1731912\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,2]]},"references-count":29,"alternative-id":["10.3389\/fmed.2026.1731912"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1731912","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,2]]},"article-number":"1731912"}}