Incidence, risk factors, and management options for portal vein thrombosis after hepatectomy: a 14-year, single-center experience

Kuboki, Satoshi; Shimizu, Hiroaki; Ohtsuka, Masayuki; Kato, Atsushi; Yoshitomi, Hideyuki; Furukawa, Katsunori; Takayashiki, Tsukasa; Takano, Shigetsugu; Okamura, Daiki; Suzuki, Daisuke; Sakai, Nozomu; Kagawa, Shingo; Miyazaki, Masaru

doi:10.1016/j.amjsurg.2014.11.021

Cited by 40 publications

(62 citation statements)

References 27 publications

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“…Portal vein thrombosis (PVT) is a common complication after the hepatobiliary-pancreatic surgery, such as splenectomy (Sx) and hepatectomy (Hx); and its incidence was reported to be 2.6% to 16.9% 1,2 after Sx, 2.1% to 9.1% 3,4 after Hx, respectively. According to the definition of PVT and frequency of computed tomography (CT) scan after operation, however, the incidences of PVT markedly differ.…”

Section: Introductionmentioning

confidence: 99%

Platelet Activation Assessed by Glycoprotein VI/Platelet Ratio Is Associated With Portal Vein Thrombosis After Hepatectomy and Splenectomy in Patients With Liver Cirrhosis

Matsui

Usui

Wada

et al. 2017

Clin Appl Thromb Hemost

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Portal vein thrombosis (PVT) is a serious complication after hepatobiliary-pancreatic surgery. Portal vein thrombosis often develops in patients with liver cirrhosis (LC) postoperatively, although they have low platelet counts. Platelet activation is one of the causes of thrombosis formation, and soluble form of glycoprotein VI (sGPVI) has received attention as a platelet activation marker. We had prospectively enrolled the 81 consecutive patients who underwent splenectomy (Sx) and/or hepatectomy: these patients were divided as Sx (n = 38) and hepatectomy (Hx, n = 46) groups. The 3 patients who underwent both procedures were added to both groups. Each group was subdivided into patients with non-LC and LC: non-LC-Sx (n = 22) and LC-Sx (n = 16), non-LC-Hx (n = 40) and LC-Hx (n = 6). The presence of PVT was diagnosed by using enhanced computed tomography (CT) scan. Platelet counts were significantly lower in LC-Sx than in non-LC-Sx, and incidence of PVT was significantly higher in LC-Sx than in non-LC-Sx (68.8% vs 31.8%, P = .024). Soluble form of glycoprotein VI /platelet ratios on preoperative day and postoperative day 1 were significantly higher in LC-Sx than in non-LC-Sx. Incidence of PVT was significantly higher in LC-Hx than in non-LC-Hx (50.0% vs 7.5%, P < .01). Soluble form of glycoprotein VI /platelet ratios were significantly higher in LC-Hx before and after Hx, compared to non-LC-Hx. Patients with LC stay in hypercoagulable state together with platelet activation before and after surgery. Under this circumstance, alteration of portal venous blood flow after Sx or Hx is likely to cause PVT in patients with LC.

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Section: Introductionmentioning

confidence: 99%

Platelet Activation Assessed by Glycoprotein VI/Platelet Ratio Is Associated With Portal Vein Thrombosis After Hepatectomy and Splenectomy in Patients With Liver Cirrhosis

Matsui

Usui

Wada

et al. 2017

Clin Appl Thromb Hemost

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“…The most common clinical presentations of SVT reported in included studies were nausea/ vomiting (5 studies), 18,30,34,39,56 fever (10 studies), malaise 18,39,52,56 (4 studies), abdominal pain (15 studies), and ascites (4 studies). 19,28,40,41 Some of the complications experienced by patients with SVT include cavernous malformation of the portal vein, 48 small bowel ischemia, 18,27 pulmonary embolism, 18 thrombotic stroke, 56 gastrointestinal bleeding, 37,49,61 and liver failure. 41 Cause of death was provided by 13 studies (55 patients).…”

Section: Clinical Presentation and Mortalitymentioning

confidence: 99%

“…19,28,40,41 Some of the complications experienced by patients with SVT include cavernous malformation of the portal vein, 48 small bowel ischemia, 18,27 pulmonary embolism, 18 thrombotic stroke, 56 gastrointestinal bleeding, 37,49,61 and liver failure. 41 Cause of death was provided by 13 studies (55 patients). He et al 34 reported 41 cases of mortality of 184 patients sampled, which account for most of the reported patient mortality.…”

Section: Clinical Presentation and Mortalitymentioning

confidence: 99%

“…He et al 34 reported 41 cases of mortality of 184 patients sampled, which account for most of the reported patient mortality. Most studies did not report cause of mortality, but the four studies that did, the reported causes were esophageal or gastrointestinal bleed (n ¼ 3), 45 liver failure (n ¼ 2), 18,41 and bowel ischemia (n ¼ 1). 18 The mortality rate of patients with SVT was 16% (9/57) and it was reported on five studies.…”

Section: Clinical Presentation and Mortalitymentioning

confidence: 99%

“…18 The mortality rate of patients with SVT was 16% (9/57) and it was reported on five studies. 28,38,41,56,62…”

Section: Clinical Presentation and Mortalitymentioning

confidence: 99%

See 2 more Smart Citations

Incidence of Splanchnic Vein Thrombosis After Abdominal Surgery: A Systematic Review and Meta-analysis

Zhang

Kim

Griffiths

et al. 2020

Journal of Surgical Research

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New classification‐oriented treatment strategy for portal vein thrombosis after hepatectomy

Onda

Furukawa

Shirai

et al. 2020

Annals of Gastroent Surgery

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Aim This study sought to evaluate the incidence, risk factors, and clinical outcomes of portal vein thrombosis after hepatectomy. Furthermore, we proposed a novel classification and treatment strategy for portal vein thrombosis after hepatectomy. Methods We retrospectively analyzed 398 patients who underwent hepatectomy and enhanced computed tomography imaging within 14 days after surgery in our hospital from 2009 to 2019. Portal vein thrombosis was classified into three categories according to the location of the thrombus – main, hilar, and peripheral – with main portal vein thrombosis further subclassified into three grades. Each patient's treatment strategy was determined based on their portal vein thrombosis classification and grading. From 2015, enhanced computed tomography imaging was performed routinely on patients who underwent anatomical hepatectomy on postoperative day 7. Results Portal vein thrombosis was diagnosed in 57 patients (14.3%) during the study period. Multivariate analysis revealed that a Pringle maneuver time of 75 minutes or longer was a significant predictor of portal vein thrombosis ( P = .012). In total, 52 patients (91%) with portal vein thrombosis recovered by surgery, anticoagulant therapy, or without specific treatment. There was no instance of mortality recorded. Conclusions Patients who undergo hepatectomy are at high risk for portal vein thrombosis, especially when the Pringle maneuver time is long. The proposed classification and treatment strategy may be useful for clinical management of patients with portal vein thrombosis after hepatectomy.

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Incidence, risk factors, and management options for portal vein thrombosis after hepatectomy: a 14-year, single-center experience

Cited by 40 publications

References 27 publications

Platelet Activation Assessed by Glycoprotein VI/Platelet Ratio Is Associated With Portal Vein Thrombosis After Hepatectomy and Splenectomy in Patients With Liver Cirrhosis

Platelet Activation Assessed by Glycoprotein VI/Platelet Ratio Is Associated With Portal Vein Thrombosis After Hepatectomy and Splenectomy in Patients With Liver Cirrhosis

Incidence of Splanchnic Vein Thrombosis After Abdominal Surgery: A Systematic Review and Meta-analysis

New classification‐oriented treatment strategy for portal vein thrombosis after hepatectomy

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