Portal Vein Thrombosis

Abstract

Portal vein thrombosis is an important cause of portal hypertension. PVT occurs in association with cirrhosis or as a result of malignant invasion by hepatocellular carcinoma or even in the absence of associated liver disease. With the current research into its genesis, majority now have an underlying prothrombotic state detectable. Endothelial activation and stagnant portal blood flow also contribute to formation of the thrombus. Acute non-cirrhotic PVT, chronic PVT (EHPVO), and portal vein thrombosis in cirrhosis are the three main variants of portal vein thrombosis with varying etiological factors and variability in presentation and management. Procoagulant state should be actively investigated. Anticoagulation is the mainstay of therapy for acute non-cirrhotic PVT, with supporting evidence for its use in cirrhotic population as well. Chronic PVT (EHPVO) on the other hand requires the management of portal hypertension as such and with role for anticoagulation in the setting of underlying prothrombotic state, however data is awaited in those with no underlying prothrombotic states. TIPS and liver transplant may be feasible even in the setting of PVT however proper selection of candidates and type of surgery is warranted. Thrombolysis and thrombectomy have some role. TARE is a new modality for management of HCC with portal vein invasion. ( J CLIN EXP HEPATOL 2015;5:22-40)

Portal vein thrombosis – a primer for the general physician

“…10,14 In patients with PVT caused by concomitant liver disease, portal hypertensive gastropathy is often observed while in those with long-standing PVT, gastric varices are seen in nearly half of the patients. 35 These varices need to be identified because they are important in planning management for the following reasons:…”

Cateterismo de artéria mesentérica para tratamento de trombose de veia porta

“…5 Compensatory mechanisms are activated in response to interruption of this flow, including reflexive vasodilation of the hepatic artery and formation of collateral vessels, allowing blood to bypass the site of obstruction. 15,16 Etiologies of PVT other than those related to cancer and cirrhosis 17 include vascular malformations and hypercoagulable states, 1 such as deficiencies of antithrombin III or deficiencies of protein C and protein S, dysfibrinogenemia, and the G20210A prothrombin gene mutation. 1,5,17,18 Around 60% of patients with mesenteric thrombosis have a history of DVT.…”

Hepatic Venous Outflow Obstruction: Suggestion of a New Classification

“…Diffuse, thickened echoic wall of PV and its branches with occasional thrombosed branches are frequently observed in US/CD examination of patients with HVCS. Whereas HVCS is a common cause of PV thrombosis in Nepal, in India, it was reported only in patients with LC and HCC related to prothrombotic conditions (24).…”