Effects of restoring portal flow with anticoagulation and partial splenorenal shunt embolization

Intagliata, Nicolas M.; Saad, Wael E.A.; Caldwell, Stephen H.

doi:10.1002/hep.27241

Cited by 11 publications

(6 citation statements)

References 12 publications

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“…In support of our results, it has been reported that the thrombus resolution achieved by anticoagulation can prevent the deterioration of liver function by ameliorating PV hemodynamics. 21,22 Although our study failed to determine whether anticoagulation just prevents the aggravation of liver function or can further improve it (Supporting Figure S1A), stratified analyses of ΔALBI scores led us to the assumption that the benefit of anticoagulation on liver function can be more apparent in pre-mALBI grade 2b-3 than in grade 1-2a cases.…”

Section: Discussionmentioning

confidence: 90%

Anticoagulation against portal vein thrombosis reduces mortality and liver cirrhosis‐related complications: A propensity score‐matched study

Sato

Watanabe

Iseki

et al. 2023

Hepatology Research

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AimPortal vein thrombosis (PVT) is one of the common complications of liver cirrhosis. Although anticoagulation contributes to thrombus resolution and is considered the first‐choice treatment, its impact on patients' prognosis is still controversial. This study aimed to clarify the benefit of anticoagulation on mortality, liver function, and the incidence of liver cirrhosis‐related complications in cirrhotic PVT patients.MethodsWe conducted a multicenter retrospective review in which we included 78 eligible patients with PVT out of 439. After propensity score matching, 21 cirrhotic PVT patients were included in each one of the untreated control and anticoagulation groups.ResultsOverall survival was significantly improved in the anticoagulation group compared with the control group (p = 0.041), along with PVT size reduction (53.3% vs. 108.2%, p = 0.009). At the time of CT follow‐up, the anticoagulation group showed a lower ALBI score (p = 0.037) and its prevalence of massive ascites was significantly lower (p = 0.043) compared with the control group. The incidence of overt encephalopathy was also lower in the anticoagulation group (p = 0.041). The cumulative incidence of bleeding events did not differ significantly between the two groups.ConclusionsAnticoagulation improves the survival of patients with cirrhotic PVT. Preserved liver function and reduced risks of cirrhosis‐related complications under the treatment may have contributed to a better prognosis. Given its efficacy and safety, anticoagulation is worth initiating in patients with PVT.

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Section: Discussionmentioning

confidence: 90%

Anticoagulation against portal vein thrombosis reduces mortality and liver cirrhosis‐related complications: A propensity score‐matched study

Sato

Watanabe

Iseki

et al. 2023

Hepatology Research

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“…Presence of PVT has been considered a relative contraindication for shunt embolization in the past. A recent report highlights a case of successful partial recanalization of a PVT with anticoagulation followed by partial embolization of a portosystemic shunt to improve portal vein flow and maintain patency [72]. As redirection of blood flow back through the portal vein can significantly exacerbate portal hypertension, caution is needed and further study is indicated to determine the long-term effects of this procedure on portal vein patency and liver function.…”

Section: Mechanical Therapymentioning

confidence: 96%

Portal Vein Thrombosis in Patients with Cirrhosis—Etiology, Diagnosis, and Management

Intagliata

Henry

2015

Curr Hepatology Rep

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“…Refractory HE is treated by closure of PSS but it a relative contraindication in patients with EHPVO [69] . Deliberate partial embolization of these shunts using coils [69] or balloon occluded trans-venous obliteration of the larger shunts in presence of multiple PSS [70] (Figure 11) using sclerosants and other inventories have been reported to be successful in treating recurrent HE in patients with PVT.…”

Section: Pargewar Ss Et Al Imaging and Interventions In Ehpvomentioning

confidence: 99%

Imaging and radiological interventions in extra-hepatic portal vein obstruction

Pargewar¹,

Desai²,

Rajesh³

et al. 2016

WJR

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Extrahepatic portal vein obstruction (EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension (PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt (PSS) and revision of PSS. Core tip: The present review describes the etiopathogenesis and role of imaging modalities in Extrahepatic portal vein obstruction and role of various radiological interventional procedures in its management. Pargewar SS et al . Imaging and interventions in EHPVOThe advantages and potential limitations of each imaging modality namely endoscopic retrograde cholangiography, ultrasonography and Doppler, multidetector computed tomography, magnetic resonance cholangiography and portovenography, endoscopic ultrasound and ultrasound transient elastography are discussed. Also, the concepts behind the use of interventional procedures like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, splenic artery aneurysmal embolization, balloon occluded retrograde obliteration of portosystemic shunt, etc. , are described.

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Effects of restoring portal flow with anticoagulation and partial splenorenal shunt embolization

Cited by 11 publications

References 12 publications

Anticoagulation against portal vein thrombosis reduces mortality and liver cirrhosis‐related complications: A propensity score‐matched study

Anticoagulation against portal vein thrombosis reduces mortality and liver cirrhosis‐related complications: A propensity score‐matched study

Portal Vein Thrombosis in Patients with Cirrhosis—Etiology, Diagnosis, and Management

Imaging and radiological interventions in extra-hepatic portal vein obstruction

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