scholarly journals Portal Vein Thrombosis: Diagnosis and Endovascular Management

Author(s):  
Connie Ju ◽  
Xin Li ◽  
Sameer Gadani ◽  
Baljendra Kapoor ◽  
Sasan Partovi

Background Portal vein thrombosis (PVT) is a rare but severe entity that can cause clinically significant sequela such as worsening portal hypertension or mesenteric ischemia. Those cases refractory to medical management may be referred for endovascular intervention. Several technical considerations have been described in the literature, but a cohesive comparison of these multiple techniques is lacking. Methods The purpose of this article is to review the diagnosis and endovascular management of PVT, including areas in which further research is warranted. Results Cases of PVT can be readily diagnosed using ultrasound, computed tomography, or magnetic resonance imaging. Treatment often begins with systemic anticoagulation and endovascular interventions may be used in selected cases. Determining the optimal approach to accessing the portal venous system depends on the underlying disease and chronicity of the thrombus and the degree of occlusion. Once access to the portal venous system is established, catheter-directed therapy may be performed to achieve recanalization. Conclusion Despite the heterogeneity in patient presentation, cases of PVT can be readily diagnosed across several imaging modalities. Strategizing interventional approaches involves evaluation of the underlying disease and the chronicity of the thrombus. Key Points:  Citation Format

2020 ◽  
Vol 53 (6) ◽  
pp. 424-429
Author(s):  
Alexandre Makoto Minoda ◽  
Raissa Brito Fernandes Cadete ◽  
Sara Reis Teixeira ◽  
Valdair Francisco Muglia ◽  
Jorge Elias Junior ◽  
...  

Abstract Portal vein thrombosis refers to complete or partial obstruction of the portal venous system, in the intrahepatic or extrahepatic venous tract or even in the splenic or superior mesenteric veins. This common and potentially fatal condition can develop in various clinical contexts, especially those of liver cirrhosis, hepatocellular carcinoma, and other solid tumors. Certain characteristics, such as the time since the onset of the thrombus (acute or chronic), its biology (hematic or tumoral), the presence of collateral vessels, and the magnetic resonance imaging aspects, are important components of a thorough, careful analysis, as well as informing decisions regarding the appropriate therapeutic strategy. Here, we present a brief review of the anatomy of the portal venous system and a systematic approach to analyzing the condition, using a mnemonic (ABCD, for age, biology, collaterals, and diffusion). We discuss the various imaging methods and illustrate our discussion with images selected from the case files archived at our facility.


2021 ◽  
Vol 27 ◽  
pp. 107602962110109
Author(s):  
Le Wang ◽  
Xiaozhong Guo ◽  
Xiangbo Xu ◽  
Shixue Xu ◽  
Juqiang Han ◽  
...  

Portal venous system thrombosis (PVST), a common complication of liver cirrhosis, is closely associated with thrombophilia. To explore the association of homocysteine (Hcy), anticardiolipin antibody (aCL), and anti-β2 glycoprotein I antibody (aβ2GPI), which are possible thrombophilic factors, with PVST in liver cirrhosis. Overall, 654 non-malignant patients (219 with and 435 without liver cirrhosis) admitted between January 2016 and June 2020 were retrospectively evaluated. Presence of PVST, degree of main portal vein (MPV) thrombosis, and clinically significant PVST were identified. Hcy level, hyperhomocysteinemia (HHcy), aCL positivity, and aβ2GPI positivity were compared according to the presence of liver cirrhosis and PVST. Positive aβ2GPI was significantly more frequent in patients with liver cirrhosis than those without, but Hcy level and proportions of HHcy and positive aCL were not significantly different between them. PVST could be evaluated in 136 cirrhotic patients. Hcy level [10.57 μmol/L (2.71-56.82) versus 9.97 μmol/L (2.05-53.44); P = 0.796] and proportions of HHcy [4/44 (9.1%) versus 13/81 (16.0%); P = 0.413] and positive aCL [1/23 (4.3%) versus 10/52 (19.2%); P = 0.185] and aβ2GPI [9/23 (39.1%) versus 21/52 (40.4%); P = 0.919] were not significantly different between cirrhotic patients with and without PVST. There was still no significant association of Hcy level, HHcy, aCL, or aβ2GPI with PVST based on Child-Pugh classification, MPV thrombosis >50%, and clinically significant PVST. Hcy, aCL, and aβ2GPI may not be associated with PVST in liver cirrhosis, suggesting that routine screening for Hcy, aCL, and aβ2GPI should be unnecessary in such patients.


2008 ◽  
Vol 22 (5) ◽  
pp. 668-671 ◽  
Author(s):  
Bon Yong Koo ◽  
Hee Chul Yu ◽  
Min Cheol So ◽  
Guang Yu Jin ◽  
Hyo Sung Kwak ◽  
...  

2018 ◽  
Vol 6 (26) ◽  
pp. 10-16
Author(s):  
Logan Adams ◽  
Somedeb Ball

Portal vein thrombosis (PVT) is an occlusion of the portal venous system and is a common complication of liver cirrhosis. It can present as either an acute or chronic complication. Acute PVT can present with abdominal pain, diarrhea, ileus, and bleeding. Chronic PVT is often asymptomatic; however, it can be discovered in cases of worsening portal hypertension. Portal vein thrombosis is diagnosed by imaging modalities, such as ultrasound and computed tomography. Contrast-enhanced imaging can be used in cases with difficult visualization. Despite the hemostatic imbalance in cirrhosis, anticoagulants can be safely used to recanalize the vein. Transjugular intrahepatic portosystemic shunt procedures are also an effective method for recanalization.


Author(s):  
Giovanna Bertolini

This article offers an overview of congenital and acquired vascular anomalies involving the portal venous system in dogs and cats, as determined by multidetector-row computed tomography angiography. Congenital absence of the portal vein, portal vein hypoplasia, portal vein thrombosis and portal collaterals are described. Portal collaterals are further discussed as high- and low-flow connections, and categorized in hepatic arterioportal malformation, arteriovenous fistula, end-to-side and side-to-side congenital portosystemic shunts, acquired portosystemic shunts, cavoportal and porto-portal collaterals. Knowledge of different portal system anomalies helps understand the underlying physiopathological mechanism and is essential for surgical and interventional approaches.


2019 ◽  
Vol 6 (1) ◽  
pp. 10 ◽  
Author(s):  
Giovanna Bertolini

This article offers an overview of congenital and acquired vascular anomalies involving the portal venous system in dogs and cats, as determined by multidetector-row computed tomography angiography. Congenital absence of the portal vein, portal vein hypoplasia, portal vein thrombosis and portal collaterals are described. Portal collaterals are further discussed as high- and low-flow connections and categorized in hepatic arterioportal malformation, arteriovenous fistula, end-to-side and side-to-side congenital portosystemic shunts, acquired portosystemic shunts, cavoportal and porto-portal collaterals. Knowledge of different portal system anomalies helps understand the underlying physiopathological mechanism and is essential for surgical and interventional approaches.


2018 ◽  
Vol 35 (03) ◽  
pp. 198-202 ◽  
Author(s):  
Stephen Seedial ◽  
Samdeep Mouli ◽  
Kush Desai

AbstractAcute portal vein thrombosis (PVT) is a relatively rare diagnosis with a nonspecific clinical presentation. Imaging plays an important role in establishing the diagnosis as well as the etiology and complications of acute PVT. Prompt diagnosis is essential to prevent catastrophic short-term complications including bowel infarction, sepsis, and possible death; missed diagnosis can also result in the long-term sequelae of portal hypertension. Differentiation of acute from chronic PVT is crucial as management strategies differ. Currently, guidelines for treating acute PVT recommend immediate initiation of systemic anticoagulation. Catheter-directed therapy may be used in combination with systemic anticoagulation in the setting of bowel ischemia or as an adjunct in patients with a contraindication to systemic anticoagulation. In this review article, we discuss the diagnosis and clinical features of acute PVT, focusing on current medical and endovascular management strategies including mechanical thrombectomy and fibrinolytic therapy.


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