Portal Vein Thrombosis in Neonates with Umbilical Vein Catheterization: Incidence and Risk Factors

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Tarek A Abd El Gawad ◽  
Lerine Bahy El Din ◽  
Amel A.M El Faramawy ◽  
Asmaa Wafeeq ◽  
Hebatallah A Shaaban ◽  
...  
Keyword(s):  
Risk Factors ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Neonatal Intensive Care ◽  
Umbilical Vein ◽  
Venous Catheter ◽  
Tertiary Referral Centre ◽  
Children's Hospital ◽  
Vein Thrombosis ◽  
Children’S Hospital

Abstract Background and aim of the work Umbilical venous catheter(UVC) placement is thought to be a cause of portal vein thrombosis(PVT).Our study aimed to identify the incidence of PVT and potential risk factors predisposing neonates with UVC to develop PVT and the prevalence of hereditary prothrombotic mutations among the affected group. Methods A prospective observational study was conducted in the Neonatal intensive care unit (NICU) of Ain Shams university(ASU) Children's Hospital on 100 neonates.They were subjected to abdominal X-ray initially and duplex on their portal veins initially and at 1,6 and 12 months post insertion.We studied the correlation between length of NICU stay, UVC duration, technique, birth weight(BW),gestational age (GA) and the development of PVT. Results There was 46 males and 54 females.The mean BW was 1.87±0.72 Kg, the mean GA was 33.71±2.41weeks.Mean stay in NICU was 18.22±9.78 days, with mean UVC insertion duration 6.88 ±2.55 days,75%of inserted UVC were central in position,77% of the studied neonates were premature,1 patient had NEC(Necrotizing EnteroColitis),18% had sepsis,4% had blood products transfusion through the UVC.The one year follow up of the study group showed no incidence of UVC related PVT. Conclusion Although PVT is related to UVC in the literature and in our experience in the ASU Children's Hospital Hepatology Clinic as a tertiary referral centre, yet in this study, the sole placement of UVC does not appear to increase risk of PVT if properly inserted and cared.

scholarly journals Extrahepatic Portal Vein Thrombosis, an Important Cause of Portal Hypertension in Children

2021 ◽  
Vol 10 (12) ◽  
pp. 2703
Author(s):  
Alina Grama ◽  
Alexandru Pîrvan ◽  
Claudia Sîrbe ◽  
Lucia Burac ◽  
Horia Ştefănescu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Portal Hypertension ◽  
Gastrointestinal Bleeding ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Bacterial Infections ◽  
Umbilical Vein ◽  
Clinical Manifestations ◽  
Vein Thrombosis ◽  
Vein Catheterization

One of the most important causes of portal hypertension among children is extrahepatic portal vein thrombosis (EHPVT). The most common risk factors for EHPVT are neonatal umbilical vein catheterization, transfusions, bacterial infections, dehydration, and thrombophilia. Our study aimed to describe the clinical manifestations, treatment, evolution, and risk factors of children with EHPVT. Methods: We analyzed retrospectively all children admitted and followed in our hospital with EHPVT between January 2011–December 2020. The diagnosis was made by ultrasound or contrast magnetic resonance imaging. We evaluated the onset symptoms, complications, therapeutic methods, and risk factors. Results: A total of 63 children, mean age 5.14 ± 4.90 (33 boys, 52.38%), were evaluated for EHPVT during the study period. The first symptoms were upper gastrointestinal bleeding (31 children, 49.21%) and splenomegaly (22 children, 34.92%). Thrombocytopenia was present in 44 children (69.84%). The most frequent risk factors were umbilical vein catheterization (46 children, 73.02%) and bacterial infections during the neonatal period (30 children, 47.62%). Protein C, protein S, antithrombin III levels were decreased in 44 of the 48 patients tested. In 42 of these cases, mutations for thrombophilia were tested, and 37 were positive. Upper digestive endoscopy was performed in all cases, revealing esophageal varices in 56 children (88.89%). All children with gastrointestinal bleeding received an octreotide infusion. In 26 children (41.27%), variceal ligation was performed, and in 5 children (7.94%), sclerotherapy. Porto-systemic shunt was performed in 11 children (17.46%), and Meso-Rex shunt was done in 4 children (6.35%). The evolution was favorable in 62 cases (98.41%). Only one child died secondary to severe sepsis. Conclusions: EHPVT is frequently diagnosed in the last period in our region due to the increased use of umbilical vein catheterization. Furthermore, genetic predisposition, neonatal bacterial infections, and prematurity certainly play an important role in this condition. A proactive ultrasound assessment of children with risk factors for EHPVT should be encouraged for early diagnosis and treatment.

scholarly journals Risk factors and impact of portal vein thrombosis in liver transplantation

2019 ◽  
Vol 111 ◽  
Author(s):  
Lorena Reyes ◽  
José Ignacio Herrero ◽  
Fernando Rotellar Sastre ◽  
José Antonio Páramo
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Vein Thrombosis

scholarly journals A226 INCIDENTAL FINDING OF A LARGE GASTRIC VARIX ASSOCIATED WITH NEONATAL UMBILICAL VEIN CANALIZATION

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 261-263
Author(s):  
L Tsang ◽  
J Abraldes ◽  
E Wiebe ◽  
G S Sandha ◽  
S van Zanten
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Umbilical Vein ◽  
Gastroesophageal Junction ◽  
Splenic Vein ◽  
Gastric Varix ◽  
Vein Thrombosis ◽  
Inferior Aspect ◽  
Upper Abdomen

Abstract Results A 41-year old Asian male, who immigrated to Canada many years ago, and who had previously been successfully treated for Helicobacter pylori infection underwent gastroscopy for investigation of dyspepsia. His gastroscopy was normal except for a large subepithelial abnormality that was noted close to the gastroesophageal junction. Routine gastric biopsies from the antrum and body were normal. Subsequent endoscopic ultrasound revealed flow through the anechoic tortuous lesion and confirmed it was a very large isolated gastric varix type 1. Abdominal CT scan revealed chronic occlusion of the portal vein, splenic vein, and the portal confluence with extensive collateralization in the upper abdomen. There was complete cavernous transformation of the portal vein. Of the numerous varices in the upper abdomen, a very large varix drained into the left renal vein and indented into the posterior wall of the fundus of the stomach which accounted for the endoscopic finding. Multiple mesenteric veins were identified that connected to varices adjacent to the inferior aspect of the pancreas and duodenum. Notably, there was no evidence of cirrhosis or chronic pancreatitis. Liver enzymes, albumin, and INR were normal. Further collateral history revealed that he was hospitalized as a neonate for pneumonia with catheterization of the umbilical vein, which is known to be associated with thrombosis of the portal vein. Conclusions Detection of congenital absence of the portal vein (CAPV) is recognized more often due to advances in diagnostic imaging. Radiologically, the absence of the portal vein in CAPV is distinguished from portal vein thrombosis by the lack of venous collaterals or sequalae of portal hypertension, such as ascites or splenomegaly. A more gradual thrombosis of the portal vein may permit collaterals to develop without acute changes and is not equivalent to portal vein aplasia or agenesis as intrahepatic bile ducts are normal. The gold standard for diagnosis of CAPV is histologic absence of the portal vein in the liver on catheter angiography. CAPV is associated with abnormal embryologic development of the portal vein and frequently presents with complications of portal hypertension or portosystemic encephalopathy or the sequalae of venous shunts, hepatic or cardiac abnormalities found on imaging. Our case is an incidentally discovered absence of the portal venous system due to chronic thrombosis with extensive collateralization and an enlarged gastric varix protruding into the proximal stomach. It is well documented that canalization of the umbilical vein in infancy is associated with portal vein thrombosis, with incidences up to 68%. This case highlights the importance of eliciting a childhood hospitalization history in cases of non-cirrhotic portal hypertension. Funding Agencies None

scholarly journals Hematemesis in an eight-year-old female as a presenting symptom of portal vein thrombosis following neonatal umbilical vein catheterization

2020 ◽  
Vol 61 (6) ◽  
pp. 663-664
Author(s):  
Anne Louise van Els ◽  
Joël Israëls ◽  
Marianne Alice van Houten ◽  
Timotheüs Gualtherus Jacob de Meij
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Umbilical Vein ◽  
Vein Thrombosis ◽  
Vein Catheterization

scholarly journals Successful Thrombectomy via a Surgically Reopened Umbilical Vein for Extended Portal Vein Thrombosis Caused by Portal Vein Embolization prior to Extended Liver Resection

2020 ◽  
Vol 14 (2) ◽  
pp. 320-328
Author(s):  
Wouter J.M. Derksen ◽  
Iris E.M. de Jong ◽  
Carlijn I. Buis ◽  
Koen M.E.M. Reyntjens ◽  
G. Matthijs Kater ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Portal Vein Embolization ◽  
Liver Surgery ◽  
Umbilical Vein ◽  
Future Liver Remnant ◽  
Main Stem ◽  
Liver Remnant ◽  
Vein Thrombosis ◽  
The Future

Selective portal vein embolization (PVE) before extended liver surgery is an accepted method to stimulate growth of the future liver remnant. Portal vein thrombosis (PVT) of the main stem and the non-targeted branches to the future liver remnant is a rare but major complication of PVE, requiring immediate revascularization. Without revascularization, curative liver surgery is not possible, resulting in a potentially life-threatening situation. We here present a new surgical technique to revascularize the portal vein after PVT by combining a surgical thrombectomy with catheter-based thrombolysis via the surgically reopened umbilical vein. This technique was successfully applied in a patient who developed thrombosis of the portal vein main stem, as well as the left portal vein and its branches to the left lateral segments after selective right-sided PVE in preparation for an extended right hemihepatectomy. The advantage of this technique is the avoidance of an exploration of hepatoduodenal ligament and a venotomy of the portal vein. The minimal surgical trauma facilitates additional intravascular thrombolytic therapy as well as the future right extended hemihepatectomy. We recommend this technique in patients with extensive PVT in which percutaneous less invasive therapies have been proven unsuccessful.

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