scholarly journals Comparison of Non-Tumoral Portal Vein Thrombosis Management in Cirrhotic Patients: TIPS Versus Anticoagulation Versus No Treatment

2021 ◽  
Vol 10 (11) ◽  
pp. 2316
Author(s):  
Chenyang Zhan ◽  
Vinay Prabhu ◽  
Stella K. Kang ◽  
Clayton Li ◽  
Yuli Zhu ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Liver Function Tests ◽  
Bleeding Complications ◽  
Imaging Data ◽  
Vein Thrombosis ◽  
Intrahepatic Portosystemic Shunt ◽  
Cirrhotic Patients ◽  
Anticoagulated Patients

Background: There is a lack of consensus in optimal management of portal vein thrombosis (PVT) in patients with cirrhosis. The purpose of this study is to compare the safety and thrombosis burden change for cirrhotic patients with non-tumoral PVT managed by transjugular intrahepatic portosystemic shunt (TIPS) only, anticoagulation only, or no treatment. Methods: This single-center retrospective study evaluated 52 patients with cirrhosis and non-tumoral PVT managed by TIPS only (14), anticoagulation only (11), or no treatment (27). The demographic, clinical, and imaging data for patients were collected. The portomesenteric thrombosis burden and liver function tests at early follow-up (6–9 months) and late follow-up (9–16 months) were compared to the baseline. Adverse events including bleeding and encephalopathy were recorded. Results: The overall portomesenteric thrombosis burden improved in eight (72%) TIPS patients, three (27%) anticoagulated patients, and two (10%) untreated patients at early follow-up (p = 0.001) and in seven (78%) TIPS patients, two (29%) anticoagulated patients, and three (17%) untreated patients in late follow-up (p = 0.007). No bleeding complications attributable to anticoagulation were observed. Conclusion: TIPS decreased portomesenteric thrombus burden compared to anticoagulation or no treatment for cirrhotic patients with PVT. Both TIPS and anticoagulation were safe therapies.

Transjugular portal vein recanalization with creation of intrahepatic portosystemic shunt (PVR-TIPS) in patients with chronic non-cirrhotic, non-malignant portal vein thrombosis

2017 ◽  
Vol 56 (03) ◽  
pp. 221-237 ◽  
Author(s):  
Christoph Klinger ◽  
Bettina Riecken ◽  
Arthur Schmidt ◽  
Andrea De Gottardi ◽  
Benjamin Meier ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Portosystemic Shunt ◽  
Refractory Ascites ◽  
Bleeding Complications ◽  
Vein Thrombosis ◽  
Cavernous Transformation ◽  
Intrahepatic Portosystemic Shunt ◽  
Intraperitoneal Bleeding

Abstract Purpose To determine safety and efficacy of transjugular portal vein recanalization with creation of intrahepatic portosystemic shunt (PVR-TIPS) in patients with chronic non-cirrhotic, non-malignant portal vein thrombosis (PVT). Methods This retrospective study includes 17 consecutive patients with chronic non-cirrhotic PVT (cavernous transformation n = 15). PVR-TIPS was indicated because of variceal bleeding (n = 13), refractory ascites (n = 2), portal biliopathy with recurrent cholangitis (n = 1), or abdominal pain (n = 1). Treatment consisted of a combination of transjugular balloon angioplasty, mechanical thrombectomy, and—depending on extent of residual thrombosis—transjugular intrahepatic portosystemic shunt and additional stenting of the portal venous system. Results Recanalization was successful in 76.5 % of patients despite cavernous transformation in 88.2 %. Both 1- and 2-year secondary PV and TIPS patency rates were 69.5 %. Procedure-related bleeding complications occurred in 2 patients (intraperitoneal bleeding due to capsule perforation, n = 1; liver hematoma, n = 1) and resolved spontaneously. However, 1 patient died due to subsequent nosocomial pneumonia. During follow-up, 3 patients with TIPS occlusion and PVT recurrence experienced portal hypertensive complications. Conclusions PVR-TIPS is safe and effective in selected patients with chronic non-cirrhotic PVT. Due to technical complexity and possible complications, it should be performed only in specialized centers with high experience in TIPS procedures.

scholarly journals A221 CLINICAL CHARACTERISITICS OF PORTAL VEIN THROMBOSIS AMONG AN INPATIENT COHORT WITH CIRRHOSIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 254-255
Author(s):  
K Dadgar ◽  
E M Kelly
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Bleeding Complications ◽  
P Value ◽  
Optimal Management ◽  
Bacterial Peritonitis ◽  
Vein Thrombosis ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Cirrhotic Patients

Abstract Background Portal vein thrombosis (PVT) has a reported prevalence ranging from 0.6 to 26% in cirrhotic patients and yet optimal management in these patients remains unclear [1]. PVT can lead to poor outcomes including increased risk of bleeding, intestinal injury, and deterioration in liver function. Conversely, treatment of PVT in cirrhotic patients increases their risk of bleeding complications, particularly in patients with known varices. Aims The aim of this study is to better characterize the prevalence and impact of PVT in cirrhotic inpatients. Methods We conducted a retrospective cohort study based on data collected on adult patients admitted to the Ottawa Hospital between January 1, 2011 and December 31, 2015. We included patients with a diagnosis of cirrhosis either before or during index admission. Patients with a radiology report indicating a PVT were compared to those without PVT. Non-Ontario residents were excluded and where there were multiple admissions per patient one admission was randomly selected to be used. Ethics approval was obtained from the Research Ethics Board at the University of Ottawa. Results This study found 34 patients with cirrhosis diagnosed with PVT during their hospitalization (3.73%). Of the patients with PVT, 23 were acute and 11 were chronic based on radiologic appearance. Mean age was similar between groups (PVT: 61.7, SD=9.8; No PVT: 62.3, SD=12.3). The mean Na-MELD was also similar (PVT: 17.6, no PVT: 17.3, p=0.82). Among patients with PVT, 11 patients presented with ascites, 10 with hepatic encephalopathy (HE), 5 with abdominal pain and 5 with an upper GI bleed. Spontaneous bacterial peritonitis (SBP) occurred in 11.76% of patients with PVT as compared to 3% of patients without PVT (p value= 0.006). There also seemed to be a trend towards more HE in the cohort with PVT (20.6% vs 10.7%, p value= 0.07). With regards to screening for varices, 2 patients had an EGD in the 6 months prior to admission, 11 had an EGD on admission, 1 after anticoagulation due to bleeding, and 18 had no screening in the 6 months prior to admission. Twelve patients were treated for PVT, 17 were untreated and 5 did not have documentation about treatment. Of the patients that were not treated, 9 were due to palliative goals of care, 1 due to bleeding, 1 due to thrombocytopenia, 2 due to chronicity on imaging and 4 did not have reasons documented. Conclusions PVT is a known complication of cirrhosis, however the clinical significance and optimal management of patients with PVT is poorly understood. Although prevalence of PVT was low in this cohort, our data suggests some possible association between liver related complications and PVT, including SBP and HE. Further research is needed to determine how to best manage patients with PVT. 1. Garcia-Pagan JC, Valla DC. Portal vein thrombosis: a predictable milestone in cirrhosis? Journal of hepatology. 2009 Oct 1;51(4):632–4. Funding Agencies None

Imaging and radiological interventions of portal vein thrombosis

2005 ◽  
Vol 46 (4) ◽  
pp. 336-343 ◽  
Author(s):  
N. Hidajat ◽  
H. Stobbe ◽  
V. Griesshaber ◽  
R. Felix ◽  
R‐J. Schroder
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Portal Pressure ◽  
Alternative Methods ◽  
Vein Thrombosis ◽  
Contrast Enhanced ◽  
Local Methods ◽  
Intrahepatic Portosystemic Shunt ◽  
Cirrhotic Patients ◽  
Enhanced Computed Tomography

Portal vein thrombosis (PVT) is diagnosed by imaging methods. Once diagnosed by means of ultrasound, Doppler ultrasound can be performed to distinguish between a benign and malignant thrombus. If further information is required, magnetic resonance angiography or contrast‐enhanced computed tomography is the next step, and if these tests are unsatisfactory, digital subtraction angiography should be performed. Many papers have been published dealing with alternative methods of treating PVT, but the material is fairly heterogeneous. In symptomatic non‐cavernomatous PVT, recanalization using local methods is recommended by many authors. Implantation of transjugular intrahepatic portosystemic shunt is helpful in cirrhotic patients with non‐cavernomatous PVT in reducing portal pressure and in diminishing the risk of re‐thrombosis. In non‐cirrhotic patients with recent PVT, some authors recommend anticoagulation alone. In chronic thrombotic occlusion of the portal vein, local measures may be implemented if refractory symptoms of portal hypertension are evident.

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