Interventional recanalization therapy in patients with non-cirrhotic, non-malignant portal vein thrombosis: comparison between transjugular versus transhepatic access

Purpose To compare the safety and outcome of transjugular versus percutaneous technique in recanalization of non-cirrhotic, non-malignant portal vein thrombosis. Methods We present a retrospective bicentric analysis of 21 patients with non-cirrhotic, non-malignant PVT, who were treated between 2016 and 2021 by interventional recanalization via different access routes (percutaneous [PT] vs. transjugular in transhepatic portosystemic shunt [TIPS] technique). Complication rates with a focus on periprocedural bleeding and patency as well as outcome were compared. Results Of the 21 patients treated (median age 48 years, range of 19–78), seven (33%) patients had an underlying prothrombotic condition. While 14 (57%) patients were treated for acute PVT, seven (43%) patients had progressive thrombosis with known chronic PVT. Nine patients underwent initial recanalization via PT access and twelve via TIPS technique. There was no significant difference in complete technical success rate according to initial access route (55.5% in PT group vs. 83.3% in TIPS group, p = 0.331). However, creation of an actual TIPS was associated with higher technical success in restoring portal venous flow (86.6% vs. 33.3%, p = 0.030). 13 (61.9%) patients received thrombolysis. Nine (42.8%) patients experienced hemorrhagic complications. In a multivariate analysis, thrombolysis (p = 0.049) and PT access as the first procedure (p = 0.045) were significant risk factors for bleeding. Conclusion Invasive recanalization of the portal vein in patients with PVT and absence of cirrhosis and malignancy offers a good therapeutic option with high recanalization and patency rates. Bleeding complications result predominantly from a percutaneous access and high amounts of thrombolytics used; therefore, recanalization via TIPS technique should be favored.

Hybrid Management of Acute Portal Vein Thrombosis Complicated by Mesenteric Ischemia

Treatment for portal vein thrombosis complicated by mesenteric ischemia can be treated in the operating room following a hybrid approach. This allows for efficient care of the patient, avoids the need for transhepatic cannulation for obtaining a venogram and placing a thrombolysis catheter, and obviates the need to obtain percutaneous venous access.

Cognitive Impairement in Non-Cirrhotic Portal Hypertension: Highlights on Physiopathology, Diagnosis and Management

Hepatic encephalopathy (HE) is one of the most frequent complications of cirrhosis. Several studies and case reports have shown that cognitive impairment may also be a tangible complication of portal hypertension secondary to chronic portal vein thrombosis and to porto-sinusoidal vascular disease (PSVD). In these conditions, representing the main causes of non-cirrhotic portal hypertension (NCPH) in the Western world, both overt and minimal/covert HE occurs in a non-neglectable proportion of patients, even lower than in cirrhosis, and it is mainly sustained by the presence of large porto-systemic shunt. In these patients, the liver function is usually preserved or only mildly altered, and the development of porto-systemic shunt is either spontaneous or iatrogenically frequent; HE is an example of type-B HE. To date, in the absence of strong evidence and large cooperative studies, for the diagnosis and the management of HE in NCPH, the same approach used for HE occurring in cirrhosis is applied. The aim of this paper is to provide an overview of type B hepatic encephalopathy, focusing on its pathophysiology, diagnostic tools and management in patients affected by porto-sinusoidal vascular disease and chronic portal vein thrombosis.

Đánh giá đáp ứng điều trị ung thư biểu mô tế bào gan sau nút mạch hóa chất (TACE) theo mRECIST

TÓM TẮT Mục tiêu: Đánh giá đáp ứng điều trị ung thư biểu mô tế bào gan (UTBMTBG) sau nút mạch hoá chất (TACE) theo tiêu chuẩn mRECIST. Phương pháp: Nghiên cứu tiến cứu.Chẩn đoán UTBMTBG theo EASL 2018. Đánh giá đáp ứng sau TACE theo thang điểm mRECIST tại các thời điểm < 3 tháng, 3 - 6 tháng, 6 - 12 tháng, > 12 tháng. Kết quả: 46 bệnh nhân (nam/nữ: 39/7), tuổi trung bình 61,5 ± 11,2 tuổi thỏa mãn tiêu chuẩn chọn bệnh. Thời gian theo dõi trung bình: 223 ngày (42 - 723 ngày). Đường kính lớn nhất trung bình của u: 62 mm (10 - 153 mm). 23,9% bệnh nhân có huyết khối tĩnh mạch cửa (HKTMC). Tỉ lệ đáp ứng hoàn toàn đối với tổn thương đích tại các thời điểm < 3 tháng, 3 - 6 tháng, 6 - 12 tháng, > 12 tháng lần lượt là 33,3%; 33,3%; 35,3% và 33,3%. Có 16,7% u tiến triển sau lần TACE thứ nhất. U thâm nhiễm, kích thước > 10cm, ở cả 2 thùy và có HKTMC là những yếu tố dự báo tái phát sau TACE. Kết luận: TACE có hiệu quả kiểm soát u ngắn hạn khi đánh giá bằng mRECIST. ABSTRACT EVALUATION OF TREATMENT RESPONSE OF HEPATOCELLULAR CARCINOMA AFTER TRANSARTERIAL CHEMOEMBOLIZATION USING mRECIST CRITERIA Nguyen Thi Thuy Linh1, Hoang Anh Dung1, Huyen Ton Nu Hong Hanh2, Ngo Dac Hong An1, Le Minh Tuan1, Dang Quang Hung2, Le Hoang Huy2, Le Trong Binh1* Purpose: To evaluate the treatment response of hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) using mRECIST. Methods: Diagnosis of HCC was based on EASL 2018, and an indication of TACE was based on SIR practice guideline. Treatment responses were evaluated at < 3 - month, 3 - 6 - month, 6 - 12 - month and > 12 - month intervals. Results: Forty - sixpatients (male/female 39/7) with the mean age 61.5 ± 11.2 years were enrolled in the present study. The mean follow - up duration was 223 days (range, 42 - 723 days). The mean of maximal HCC diameter was 62mm (range, 10 - 153mm). 23.9% of patients had portal vein thrombosis (PVT). The rates of complete response of the target lesions at the < 3 - month, 3 - 6 - month, 6 - 12 - month and > 12 - month were 33.3%; 33.3%; 35.3% and 33.3%, respectively. Progression disease was seen in 16.7%. Infiltrative type, diameter > 10cm, bilobar HCC, and portal vein thrombosis were predictors for recurrence. Conclusion: TACE offered short - term therapeutic control of HCC when using mRECIST. Keywords: Hepatocellular carcinoma, transarterial chemoembolization, mRECIST.

Determination of Platelets Parameters among People Vaccinated with Oxford-AstraZeneca Vaccine - COVID Vaccine at Khartoum State -Sudan

Background: The global SARS-CoV-2 vaccination program has been hampered by the rare-and initially inexplicable emergence of vaccine-associated thrombosis, particularly venous territory strokes or other venous obstructions, including portal vein thrombosis, which has been dubbed Vaccine-Induced Thrombotic Thrombocytopenia (VITT). So, this study was conducted to determine platelets parameters among people vaccinated with the AstraZeneca vaccine at Khartoum state. Materials & Methods: A total of 50 AstraZeneca vaccinated participants (22 male and 26 female) were utilized as a case and 50 healthy non-vaccinated participants (21 male and 29 female) were used as control. The age of both groups ranged between (20-62) years with a mean of 34.6 ± 11.9. Platelets parameters were assayed for all patients using Sysmex KX-21. Results: The statistical analysis was performed by using SPSS. The results of the study showed that there was no significant difference in platelets count and platelets indices when compared according to vaccine intake and gender. Also, the most frequent symptoms among vaccinated people were: muscle pain at the site of puncture (56%), fatigue (54%), fever (34%), headache (22%), nausea (16%), and diarrhea (6%) respectively and developed no symptoms (30%). Conclusions: The study concludes that the side effects of the COVID-19 AstraZeneca vaccine in Khartoum state, Sudan was consistent with the manufacturers’ data. Healthcare providers and recipients of vaccines can be more confident about the safety of Oxford-AstraZeneca COVID-19 vaccines.

Portal Vein Thrombosis Might Develop by COVID-19 Infection or Vaccination: A Systematic Review of Case-Report Studies

Background and Objective: Infection by the novel coronavirus disease 2019 (COVID-19) has been associated with different types of thrombotic complications same as portal vein thrombosis (PVT). However, by emerging vaccines of COVID, the thrombosis did not seem to be concerning anymore. Until new findings showed that, the vaccine of COVID itself can cause PVT.Method: We performed an electronic search in PubMed, Scopus, and Web of Sciences to evaluate the possibility of occurring PVT due to infection and vaccination of COVID-19. The results were reported in a narrative method and categorized into tables.Result: Overall, 40 cases of PVT from 34 studies were reviewed in this article. The prevalence of PVT following COVID-19 was more remarkable in males. However, it was more common in females after vaccinations of COVID-19 in the reviewed cases. Regardless of etiology, 20 of PVT cases reviewed in this article had at least one comorbidity. The most common clinical presentation was abdominal pain (AP). After anticoagulant therapies, most of the patients improved or discharged.Conclusion: As long as the laboratory findings are not appropriate enough to predict PVT, the diagnosis of this complication with whatever underlying reason is challengeable, while rapid diagnosis and treatment of that are vital. Therefore, by providing available data in an organized way, we aimed to prepare the information of infected patients for better and easier future diagnosis of PVT in new cases.