Subscribe to RSS
DOI: 10.1055/s-0038-1660798
Acute Portal Vein Thrombosis: Current Trends in Medical and Endovascular Management
Publication History
Publication Date:
06 August 2018 (online)
![](https://www.thieme-connect.de/media/sir/201803/lookinside/thumbnails/10-1055-s-0038-1660798_001076-1.jpg)
Abstract
Acute portal vein thrombosis (PVT) is a relatively rare diagnosis with a nonspecific clinical presentation. Imaging plays an important role in establishing the diagnosis as well as the etiology and complications of acute PVT. Prompt diagnosis is essential to prevent catastrophic short-term complications including bowel infarction, sepsis, and possible death; missed diagnosis can also result in the long-term sequelae of portal hypertension. Differentiation of acute from chronic PVT is crucial as management strategies differ. Currently, guidelines for treating acute PVT recommend immediate initiation of systemic anticoagulation. Catheter-directed therapy may be used in combination with systemic anticoagulation in the setting of bowel ischemia or as an adjunct in patients with a contraindication to systemic anticoagulation. In this review article, we discuss the diagnosis and clinical features of acute PVT, focusing on current medical and endovascular management strategies including mechanical thrombectomy and fibrinolytic therapy.
-
References
- 1 Sheen CL, Lamparelli H, Milne A, Green I, Ramage JK. Clinical features, diagnosis and outcome of acute portal vein thrombosis. QJM 2000; 93 (08) 531-534
- 2 Catalano OA, Choy G, Zhu A, Hahn PF, Sahani DV. Differentiation of malignant thrombus from bland thrombus of the portal vein in patients with hepatocellular carcinoma: application of diffusion-weighted MR imaging. Radiology 2010; 254 (01) 154-162
- 3 Condat B, Valla D. Nonmalignant portal vein thrombosis in adults. Nat Clin Pract Gastroenterol Hepatol 2006; 3 (09) 505-515
- 4 Primignani M, Martinelli I, Bucciarelli P. , et al. Risk factors for thrombophilia in extrahepatic portal vein obstruction. Hepatology 2005; 41 (03) 603-608
- 5 Condat B, Pessione F, Helene Denninger M, Hillaire S, Valla D. Recent portal or mesenteric venous thrombosis: increased recognition and frequent recanalization on anticoagulant therapy. Hepatology 2000; 32 (03) 466-470
- 6 Denninger MH, Chaït Y, Casadevall N. , et al. Cause of portal or hepatic venous thrombosis in adults: the role of multiple concurrent factors. Hepatology 2000; 31 (03) 587-591
- 7 Janssen HL, Meinardi JR, Vleggaar FP. , et al. Factor V Leiden mutation, prothrombin gene mutation, and deficiencies in coagulation inhibitors associated with Budd-Chiari syndrome and portal vein thrombosis: results of a case-control study. Blood 2000; 96 (07) 2364-2368
- 8 Plessier A, Darwish-Murad S, Hernandez-Guerra M. , et al; European Network for Vascular Disorders of the Liver (EN-Vie). Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology 2010; 51 (01) 210-218
- 9 Dentali F, Galli M, Gianni M, Ageno W. Inherited thrombophilic abnormalities and risk of portal vein thrombosis. a meta-analysis. Thromb Haemost 2008; 99 (04) 675-682
- 10 De Stefano V, Fiorini A, Rossi E. , et al. Incidence of the JAK2 V617F mutation among patients with splanchnic or cerebral venous thrombosis and without overt chronic myeloproliferative disorders. J Thromb Haemost 2007; 5 (04) 708-714
- 11 Kiladjian JJ, Cervantes F, Leebeek FW. , et al. The impact of JAK2 and MPL mutations on diagnosis and prognosis of splanchnic vein thrombosis: a report on 241 cases. Blood 2008; 111 (10) 4922-4929
- 12 Primignani M, Barosi G, Bergamaschi G. , et al. Role of the JAK2 mutation in the diagnosis of chronic myeloproliferative disorders in splanchnic vein thrombosis. Hepatology 2006; 44 (06) 1528-1534
- 13 Hall TC, Garcea G, Metcalfe M, Bilku D, Dennison AR. Management of acute non-cirrhotic and non-malignant portal vein thrombosis: a systematic review. World J Surg 2011; 35 (11) 2510-2520
- 14 Amitrano L, Guardascione MA, Scaglione M. , et al. Prognostic factors in noncirrhotic patients with splanchnic vein thromboses. Am J Gastroenterol 2007; 102 (11) 2464-2470
- 15 Turnes J, García-Pagán JC, González M. , et al. Portal hypertension-related complications after acute portal vein thrombosis: impact of early anticoagulation. Clin Gastroenterol Hepatol 2008; 6 (12) 1412-1417
- 16 European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu. Vascular diseases of the liver. J Hepatol 2016; 64 (01) 179-202
- 17 DeLeve LD, Valla DC, Garcia-Tsao G. ; American Association for the Study Liver Diseases. Vascular disorders of the liver. Hepatology 2009; 49 (05) 1729-1764
- 18 Jun KW, Kim MH, Park KM. , et al. Mechanical thrombectomy-assisted thrombolysis for acute symptomatic portal and superior mesenteric venous thrombosis. Ann Surg Treat Res 2014; 86 (06) 334-341
- 19 Klinger C, Riecken B, Schmidt A. , et al. Transjugular local thrombolysis with/without TIPS in patients with acute non-cirrhotic, non-malignant portal vein thrombosis. Dig Liver Dis 2017; 49 (12) 1345-1352
- 20 Zocco MA, Di Stasio E, De Cristofaro R. , et al. Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development. J Hepatol 2009; 51 (04) 682-689
- 21 Hollingshead M, Burke CT, Mauro MA, Weeks SM, Dixon RG, Jaques PF. Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis. J Vasc Interv Radiol 2005; 16 (05) 651-661