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. 2022 Apr 20;32(10):6777–6787. doi: 10.1007/s00330-022-08705-7

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© The Author(s) 2022

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 2 — A 55-year-old male patient with hepatocellular carcinoma (HCC) and tumour thrombus-related symptomatic portal hypertension underwent a transjugular intrahepatic portosystemic shunt (TIPS) procedure for severe variceal bleeding and received sequential systemic therapy with lenvatinib (8 mg/qd). A Contrast-enhanced computed tomography showed advanced HCC with extensive portal vein tumour thrombus (PVTT) before treatment (black arrowhead). B Superior mesenteric venography showed the disappearance of the portal vein and branches that were replaced by disordered collateral veins. The portal venous pressure gradient (PPG) was 28.2 mmHg before TIPS creation. C Angiography showed gastroesophageal varices (GOV2). D After TIPS creation, angiography showed that the stent was smooth, and the collateral circulation veins were significantly reduced. The portal venous PPG was 11.5 mmHg after TIPS creation. The gastroesophageal varices were embolised with coils, and the varices disappeared on angiography. E After 6 months of sequential systemic therapy, the viable lesions of the tumour and PVTT were significantly decreased (black arrowhead), and the TIPS patency was satisfactory. The overall survival period after TIPS placement was 10.8 months without variceal rebleeding