Management and conduct of vascular diseases of the portal system

Aneurysms and thromboses of the portal vein are rare pathologies of the portal system that commonly follow an asymptomatic course. The vast majority of cases are diagnosed as incidental findings during imaging studies. Symptoms of aneurysms are the result of mass effects, while thrombosis symptoms are a function of the liver's ability to form a collateral circulation network in the thrombosis. The scant experience with such cases poses a dilemma for patient management and so the vast majority of authors choose an expectant approach with rigorous patient surveillance and only intervene in symptomatic patients. We report one case of an aneurysm of the portal vein and one case of portal vein thrombosis and discuss management and observation of these patients.

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Characteristics of ascitic fluid and flow of the portal system in cirrotic patients with diagnosis of portal vein thrombosis

Annals of Hepatology ◽

10.1016/j.aohep.2020.08.032 ◽

2020 ◽

Vol 19 ◽

pp. 15

Author(s):

C.A. Campoverde-Espinoza ◽

F. Higuera de la Tijera ◽

J.A. Meléndez-Andrade ◽

A. Servín-Caamaño

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Ascitic Fluid ◽

Portal System ◽

Vein Thrombosis

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Portal Venous Thrombosis in a Special Operations Paratrooper: A Case Report

Military Medicine ◽

10.1093/milmed/usab387 ◽

2021 ◽

Author(s):

Rachel E Bridwell ◽

Sean Clerkin ◽

Nathaniel R Walker ◽

Brit Long ◽

Sarah Goss

Keyword(s):

Risk Factors ◽

Abdominal Pain ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Portal System ◽

Thrombotic Occlusion ◽

Special Operations ◽

Vein Thrombosis ◽

Portal Venous Thrombosis ◽

Abdominal Infections

ABSTRACT Portal vein thrombosis is the thrombotic occlusion of the extrahepatic portal system, which can propagate towards the vena caval system. Although rare, it occurs primarily in those with cirrhosis, intra-abdominal infections, malignancy, or hypercoagulable disorders. This report describes the first reported case of a soldier within special operations without identifiable risk factors who was found to have a completely occlusive portal vein thrombosis after approximately 10 days of insidious abdominal pain. This case emphasizes the importance of considering this rare but dangerous pathology among this highly screened and capable special operations population.

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Risk Factors Regarding Portal Vein Thrombosis in Chronic Liver Disease

Acta Medica Transilvanica ◽

10.2478/amtsb-2020-0068 ◽

2020 ◽

Vol 25 (4) ◽

pp. 38-41

Author(s):

Liliana Vecerzan ◽

Romeo Gabriel Mihăilă

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Hepatic Cirrhosis ◽

Vascular Diseases ◽

High Rate ◽

Imaging Method ◽

Vein Thrombosis ◽

Common Causes ◽

Portosystemic Collateral ◽

Collateral Vessels

Abstract The portal vein thrombosis (PVT) is one of the most frequent vascular diseases of the liver, with a high rate of morbidity and mortality. The most common causes of the PVT are hepatic cirrhosis, hepatobiliary neoplasms, inflammatory and infectious abdominal diseases, and myeloproliferative syndromes.(1,2) The natural progress of the PVT has as a result portal hypertension which leads to splenomegaly and the formation of portosystemic collateral vessels, as well as gastroesophageal, duodenal and jejunal varices. Ultrasonography, especially Doppler ultrasound, is the most widely used imaging method to asses, supervise and diagnose PVT in patients with hepatopathies. The purpose of acute PVT treatment is to re-permeabilize the obstructed vessels; the endoscopic ligature of the varices in the eventuality of their rupture is safe and extremely efficient in chronic PVT. To conclude, PVT is the most common hepatic vascular disorder, and its prevalence has increased particularly among the patients with chronic hepatopathies.(3)

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TIPS Placement via Combined Transjugular and Transhepatic Approach for Cavernous Portal Vein Occlusion: Targeted Approach

Case Reports in Radiology ◽

10.1155/2013/635391 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Natanel Jourabchi ◽

Justin Pryce McWilliams ◽

Edward Wolfgang Lee ◽

Steven Sauk ◽

Stephen Thomas Kee

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Portal System ◽

Main Portal Vein ◽

Vein Thrombosis ◽

Cavernous Transformation ◽

Vein Access ◽

Portal Decompression ◽

Intrahepatic Portosystemic Shunt

Purpose. We report a novel technique which aided recanalization of an occluded portal vein for transjugular intrahepatic portosystemic shunt (TIPS) creation in a patient with symptomatic portal vein thrombosis with cavernous transformation. Some have previously considered cavernous transformation a contraindication to TIPS.Case Presentation. 62-year-old man with chronic pancreatitis, portal vein thrombosis, portal hypertension and recurrent variceal bleeding presents with melena and hematemesis. The patient was severely anemic, hemodynamically unstable, and required emergent portal decompression. Attempts to recanalize the main portal vein using traditional transjugular access were unsuccessful. After percutaneous transhepatic right portal vein access and navigation of a wire through the occluded main portal vein, an angioplasty balloon was inflated at the desired site of shunt takeoff. The balloon was targeted and punctured from the transjugular approach, and a wire was passed into the portal system. TIPS placement then proceeded routinely.Conclusion. Although occlusion of the portal vein increases difficulty of performing TIPS, it should not be considered an absolute contraindication. We have described a method for recanalizing an occluded portal vein using a combined transhepatic and transjugular approach for TIPS. This approach may be useful to relieve portal hypertension in patients who fail endoscopic and/or surgical therapies.

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Combined Piggyback Technique and Cavoportal Hemitransposition for Liver Transplant

Case Reports in Medicine ◽

10.1155/2010/595289 ◽

2010 ◽

Vol 2010 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Jeffrey Campsen ◽

Igal Kam

Keyword(s):

Portal Vein ◽

Liver Transplant ◽

Portal Vein Thrombosis ◽

Vena Cava ◽

Portal System ◽

Absolute Contraindication ◽

Donor Liver ◽

Vein Thrombosis ◽

Collateral Vein ◽

Hepatic Vein Reconstruction

Portal Vein thrombosis (PVT) increases the difficulty of liver transplant; however, it is not an absolute contraindication. Cavoportal hemitransposition (CPH) is an option for patients with complete PVT and no alternative collateral vein. Our center often performs the piggyback technique for the hepatic vein reconstruction, which allows for great access to the recipient vena cava in patients with known complete PVT that may need a CPH preformed to successfully restore flow to the portal system of the donor liver. We describe the use of the piggy-back technique to prepare the vena cava for possible CPH in patients with known complete PVT.

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