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

Other less common PVT local causes are adenopathy, systemic inflammatory response syndrome, and surgical traumas to the portal venous system, such as portosystemic shunting, splenectomy, liver transplantation, ablative therapy for HCC, and fine needle aspiration of abdominal masses[ 1 ]. PVT can be classified into four categories, depending on the extension: J Am Coll Surg. The role of anticoagulation in pylephlebitis.

Extensive mesenteric vein and portal vein thrombosis successfully treated by thrombolysis and anticoagulation. Diagnosis and management of mesenteric infarction.

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

Treatment plrta portal venous thrombosis with selective superior mesenteric artery infusion of recombinant tissue plasminogen activator. Recent portal or mesenteric venous thrombosis: Single center experience of 39 patients with preoperative portal vein thrombosis among adult living donor liver transplantations.

In the past, male sex, previous surgery or interventional treatment for portal hypertension, previous variceal bleeding, low platelet count, and advanced cavrrnoma failure have been associated with an increased risk of PVT development[ 2318588 ].


Factor V Leiden mutation, prothrombin gene mutation, and deficiencies in coagulation inhibitors associated with Budd-Chiari syndrome and portal vein thrombosis: Finally, shunt surgery distal splenorenal shunt or Rex shunt, in children might be applied as the last choice, and only in absence of splenic or superior mesenteric vein thrombosis[ ].

Percutaneous transhepatic treatment of cacernoma mesenteric venous thrombosis. Several causes can be involved in the pathogenesis of PVT and, frequently, more than one coexist. Inherited prothrombotic defects in Budd-Chiari syndrome and portal vein thrombosis: Otherwise, prognosis depends on the underlying liver disease[ 1122279 ].

If CT scan is not rapidly available, obtain Doppler-sonography.

Thus, for all these reasons and the good results reported in literature, today PVT has no longer to be considered a contraindication but only a disadvantage and, in some cases, might present a possible indication to liver transplantation[,]. Color Doppler ultrasonography in the diagnosis of cavernous transformation of the portal vein.

A prospective evaluation of primary myeloproliferative disorders. Furthermore, contrast-enhanced MR angiography is useful to assess flow direction in the portal venous system and its patency, to identify a cavernomatous transformation, to determine the presence of varices, and to verify the correct function of surgical shunts[ 8182 ].

Coagulation abnormalities in malignancy: Liver transplantation in adult patients with portal vein thrombosis: It appears to be more accurate than US or computed tomography CT scans in discovering portal invasion by tumors[ dde78 ].

Intestinal congestion and ischemia are typical manifestations of acute PVT; abdominal pain or distention, diarrhea, rectal bleeding, nausea, vomiting, anorexia, fever, lactacidosis, splenomegaly and sepsis might be variably present[ 6364 ]. lx

Am J Clin Pathol. Portal vein thrombosis following splenectomy. As first, local causes such as cirrhosis, primary or metastatic malignancies, pylephlebitis, liver cysts, vascular abnormalities webs or aneurysmsand pancreatitis have to be excluded. They are more frequent after an episode of gastrointestinal bleeding or associated with renal failure or lq in older patients[ 86467 ].


Malformación cavernomatosa de la vena porta

Etiology and consequences of thrombosis in abdominal vessels. Thrombolytic treatment of portal thrombosis. Catheter-directed thrombolysis with transjugular access in portal vein thrombosis secondary to pancreatitis.

The spectrum of portal vein thrombosis in liver transplantation. Eversion thromboendovenectomy in organized portal vein ve during liver transplantation. In fact, when thrombosis is extended to both portal and mesenteric veins, the risk of bowel ischemia is considerable and mortality high, despite a lower risk of variceal bleeding[ 61 ].

Thrombolytic therapy in patients with portal vein thrombosis: Occasionally, it is not possible to recognize any overt cause of PVT; generally, the clinical course is favorable for these dd, with a low incidence of complications.

Surgical thrombectomy is usually not recommended, as high morbidity and mortality have been reported; percutaneous transhepatic mechanical thrombectomy might also be effective in recent thrombosis, but vascular traumas are frequent and may stimulate rethrombosis[ ]. The first case of PVT was reported in by Balfour re Stewart, describing a patient presenting splenomegaly, ascites, and variceal dilation[ 3 ].