Portal vein thrombosis: Insight into physiopathology, diagnosis, and treatment

Ponziani, Francesca Romana; Zocco, Maria Assunta; Campanale, Chiara; Rinninella, Emanuele; Tortora, Annalisa; Maurizio, Luca Di; Bombardieri, G.; Cristofaro, Raimondo De; Gaetano, Anna Maria De; Landolfi, Raffaele; Gasbarrini, Antonio

doi:10.3748/wjg.v16.i2.143

Cited by 272 publications

(330 citation statements)

References 136 publications

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“…The medium-term results with or without PVT appear roughly comparable if the early mortality is excluded. 79,87 CONCLUSIONS PVT is a common problem in cirrhosis, mostly in individuals with advanced liver disease. PVT is an important prognostic factor of cirrhosis and also bears significance in individuals undergoing liver transplantation.…”

Section: Outcomes After Liver Transplantationmentioning

confidence: 99%

Portal Vein Thrombosis in Cirrhosis

Raja

Jacob

Asthana

2014

Journal of Clinical and Experimental Hepatology

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Portal vein thrombosis (PVT) is being increasingly recognized in patients with advanced cirrhosis and in those undergoing liver transplantation. Reduced flow in the portal vein is probably responsible for clotting in the spleno-porto-mesenteric venous system. There is also increasing evidence that hypercoagulability occurs in advanced liver disease and contributes to the risk of PVT. Ultrasound based studies have reported a prevalence of PVT in 10-25% of cirrhotic patients without hepatocellular carcinoma. Partial thrombosis of the portal vein is more common and may not have pathophysiological consequences. However, there is high risk of progression of partial PVT to complete PVT that may cause exacerbation of portal hypertension and progression of liver insufficiency. It is thus, essential to accurately diagnose and stage PVT in patients waiting for transplantation and consider anticoagulation therapy. Therapy with low molecular weight heparin and vitamin K antagonists has been shown to achieve complete and partial recanalization in 33-45% and 15-35% of cases respectively. There are however, no guidelines to help determine the dose and therapeutic efficacy of anticoagulation in patients with cirrhosis. Anticoagulation therapy related bleeding is the most feared complication but it appears that the risk of variceal bleeding is more likely to be dependent on portal pressure rather than solely related to coagulation status. TIPS has also been reported to restore patency of the portal vein. Patients with complete PVT currently do not form an absolute contraindication for liver transplantation. Thrombectomy or thromboendovenectomy is possible in more than 75% of patients followed by anatomical end-to-end portal anastomosis. When patency of the portal vein and/or superior mesenteric vein is not achieved, only non-anatomical techniques (reno-portal anastomosis or cavo-portal hemitransposition) can be performed. These techniques, which do not fully reverse portal hypertension, are associated with higher morbidity and mortality risks in the short term. ( J CLIN EXP HEPATOL 2013;4:320-331)

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Section: Outcomes After Liver Transplantationmentioning

confidence: 99%

Portal Vein Thrombosis in Cirrhosis

Raja

Jacob

Asthana

2014

Journal of Clinical and Experimental Hepatology

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“…However, the underlying cause of PVT in over 21% of patients was discovered to be pancreatic or hepatic malignancy [2]. Moreover, migratory thrombophlebitis has been associated with occult visceral malignancies for years [3].…”

Section: Discussionmentioning

confidence: 99%

Portal Vein Thrombosis: The Overlooked Association between Pancreatic Cancer and PVT

Badi¹,

Badro²,

Dhawan³

2017

Oncology and cancer case reports

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Portal vein thrombosis (PVT) is a complication of prothrombic disorders liver cirrhosis and malignancies. Pancreatic malignancy, specifically, is notorious for this complication because it upregulates tissue factor production, which activates the extrinsic coagulation cascade, thus inducing a hypercoagulable state. In this state, the body is susceptible to thrombus formation, resulting in venous thromboembolism (VTE) or PVT. Thus, considering a pancreatic malignancy as a top differential for PVT must be emphasized. Edema and peripancreatic inflammatory changes were also seen. A duodenal diverticulum was visualized in the region of the pancreatic head. The patient was discharged on warfarin and with outpatient follow-up.

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“… 1 . It may develop as a result of a number of local or systemic factors with liver cirrhosis being a significant predisposing factor, up to 16% of affected patients developing thrombus 1 …”

Section: Discussionmentioning

confidence: 99%

Portal vein thrombosis with contrast‐enhanced ultrasound in a patient with hepatocellular carcinoma: a case study

Salman

2012

Australas J Ultrason Med

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Portal vein thrombosis (PVT) is the presence of thrombus in the portal vein that causes partial or complete occlusion. It is prevalent in hepatocellular carcinoma (HCC), where it can be either bland or malignant depending on the presence of invasion. Recent studies have identified contrast‐enhanced ultrasound (CEUS) as the most reliable method of imaging to make this distinction. The arterial neovascularisation that is evident in a neoplastic thrombus can be visualised on CEUS with enhancement and pulsation, witnessed in real‐time. This case study describes the use of contrast‐enhanced ultrasound used as a non‐invasive method to define the bland and malignant components of portal vein thrombosis in a 76‐year‐old male with hepatocellular carcinoma and cirrhosis.

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Portal vein thrombosis: Insight into physiopathology, diagnosis, and treatment

Cited by 272 publications

References 136 publications

Portal Vein Thrombosis in Cirrhosis

Portal Vein Thrombosis in Cirrhosis

Portal Vein Thrombosis: The Overlooked Association between Pancreatic Cancer and PVT

Portal vein thrombosis with contrast‐enhanced ultrasound in a patient with hepatocellular carcinoma: a case study

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