World Journal of Surgery

, 35:2510 | Cite as

Management of Acute Non-cirrhotic and Non-malignant Portal Vein Thrombosis: A Systematic Review

  • T. C. Hall
  • G. Garcea
  • M. Metcalfe
  • D. Bilku
  • A. R. Dennison



No definitive evidence exists regarding the treatment of acute portal vein thrombosis (PVT). Treatment modalities described include conservative management, anticoagulation, thrombolysis, and thrombectomy. This review examines the impact of such treatment, its outcomes, and the complications resulting from the resultant portal hypertension.


A Medline literature search was undertaken using the keywords portal vein thrombosis, anticoagulation, thrombolysis, and thrombectomy. The primary end point was portal vein recanalization. Secondary outcome measures were morbidity and the development of portal hypertension and its sequelae, including variceal bleeding. Data from articles relating to PVT in the context of cirrhosis, malignancy, or liver transplant were excluded.


Early systemic anticoagulation results in complete portal vein recanalization in 38.3% of cases and partial recanalization in 14.0% of cases. Spontaneous recanalization without treatment can only be expected in up to 16.7% of patients. Frequently this is only when associated with self-limiting underlying pathology and/or minimal thrombus extension. Thrombolysis can be associated with major complications in up to 60% of patients.


The natural history of acute PVT is poorly described. Spontaneous resolution of acute portal vein thrombosis is uncommon. Early anticoagulation results in a satisfactory rate of recanalization with minimal procedure-associated morbidity. Thrombolysis should be used with caution and only considered if the disease is progressive and signs of mesenteric ischemia are present. Further well-designed trials with precise outcome reporting are needed to improve our understanding of the disease.


Portal Vein Portal Hypertension Thrombolytic Therapy Portal Vein Thrombosis Superior Mesenteric Vein 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Chawla Y, Duseja A, Dhiman RK (2009) Review article: the modern management of portal vein thrombosis. Aliment Pharmacol Ther 30:881–894PubMedCrossRefGoogle Scholar
  2. 2.
    Primignani M (2010) Portal vein thrombosis, revisited. Dig Liver Dis 42:163–170PubMedCrossRefGoogle Scholar
  3. 3.
    Sarin SK, Sollano JD, Chawla YK et al (2006) Consensus on extra-hepatic portal vein obstruction. Liver Int 26:512–519PubMedCrossRefGoogle Scholar
  4. 4.
    Rahmouni A, Mathieu D, Golli M et al (1992) Value of CT and sonography in the conservative management of acute splenoportal and superior mesenteric venous thrombosis. Gastrointest Radiol 17:135–140PubMedCrossRefGoogle Scholar
  5. 5.
    Turnes J, García-Pagán JC, González M et al (2008) Portal hypertension-related complications after acute portal vein thrombosis: impact of early anticoagulation. Clin Gastroenterol Hepatol 6:1412–1417PubMedCrossRefGoogle Scholar
  6. 6.
    Joh JH, Kim DI (2005) Mesenteric and portal vein thrombosis: treated with early initiation of anticoagulation. Eur J Vasc Endovasc Surg 29:204–208PubMedCrossRefGoogle Scholar
  7. 7.
    Sogaard KK, Astrup LB, Vilstrup H et al (2007) Portal vein thrombosis; risk factors, clinical presentation and treatment. BMC Gastroenterol 7:34PubMedCrossRefGoogle Scholar
  8. 8.
    Amitrano L, Guardascione MA, Scaglione M et al (2007) Prognostic factors in noncirrhotic patients with splanchnic vein thromboses. Am J Gastroenterol 102:2464–2470PubMedCrossRefGoogle Scholar
  9. 9.
    Condat B, Pessione F, Helene Denninger M et al (2000) Recent portal or mesenteric venous thrombosis: increased recognition and frequent recanalization on anticoagulant therapy. Hepatology 32:466–470PubMedCrossRefGoogle Scholar
  10. 10.
    Romano F, Caprotti R, Conti M et al (2006) Thrombosis of the splenoportal axis after splenectomy. Langenbecks Arch Surg 391:483–488PubMedCrossRefGoogle Scholar
  11. 11.
    Sheen CL, Lamparelli H, Milne A et al (2000) Clinical features, diagnosis and outcome of acute portal vein thrombosis. Q J Med 93:531–534Google Scholar
  12. 12.
    Wang MQ, Guo LP, Lin HY et al (2010) Transradial approach for transcatheter selective superior mesenteric artery urokinase infusion therapy in patients with acute extensive portal and superior mesenteric vein thrombosis. Cardiovasc Intervent Radiol 33:80–89PubMedCrossRefGoogle Scholar
  13. 13.
    Malkowski P, Pawlak J, Michalowicz B et al (2003) Thrombolytic treatment of portal thrombosis. Hepatogastroenterology 50:2098–2100PubMedGoogle Scholar
  14. 14.
    Wang MQ, Lin HY, Guo LP et al (2009) Acute extensive portal and mesenteric venous thrombosis after splenectomy: treated by interventional thrombolysis with transjugular approach. World J Gastroenterol 15:3038–3045PubMedCrossRefGoogle Scholar
  15. 15.
    Hollingshead M, Burke CT, Mauro MA et al (2005) Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis. J Vasc Interv Radiol 16:651–661PubMedGoogle Scholar
  16. 16.
    Squizzato A, Ageno W, Cattaneo A et al (2007) A case report and literature review of portal vein thrombosis associated with cytomegalovirus infection in immunocompetent patients. Clin Infect Dis 44:e13–e16PubMedCrossRefGoogle Scholar
  17. 17.
    Louvet A, Texier F, Dharancy S et al (2006) Anticoagulation therapy may reverse biliary abnormalities due to acute portal thrombosis. Dig Dis Sci 51:11–17PubMedCrossRefGoogle Scholar
  18. 18.
    Miniati DN, Padidar AM, Kee ST et al (2005) Portal vein thrombosis after laparoscopic splenectomy: an ongoing clinical challenge. JSLS 9:335–338PubMedGoogle Scholar
  19. 19.
    Crowe A, Taffinder N, Layer GT et al (1992) Portal vein thrombosis in a complicated case of Crohn’s disease. Postgrad Med J 68:291–293PubMedCrossRefGoogle Scholar
  20. 20.
    Hegenbarth K, Fickert P, Aschauer M et al (2002) Successful management of acute portal vein thrombosis by low molecular weight heparin and oral anticoagulation. Am J Gastroenterol 97:1567–1568PubMedCrossRefGoogle Scholar
  21. 21.
    Gopal SV, Smith I, Malka V (2009) Acute portal venous thrombosis after blunt abdominal trauma. Am J Emerg Med 27:372.e1–372.e3CrossRefGoogle Scholar
  22. 22.
    Davies M, Satyadas T, Akle CA (2002) Spontaneous resolution of a superior mesenteric vein thrombosis after laparoscopic Nissen fundoplication. Ann R Coll Surg Engl 84:177–180PubMedGoogle Scholar
  23. 23.
    Henao EA, Bohannon WT, Silva MB Jr (2003) Treatment of portal venous thrombosis with selective superior mesenteric artery infusion of recombinant tissue plasminogen activator. J Vasc Surg 38:1411–1415PubMedCrossRefGoogle Scholar
  24. 24.
    Kercher KW, Sing RF, Watson KW et al (2002) Transhepatic thrombolysis in acute portal vein thrombosis after laparoscopic splenectomy. Surg Laparosc Endosc Percutan Tech 12:131–136PubMedCrossRefGoogle Scholar
  25. 25.
    Nakai M, Sato M, Sahara S et al (2006) Transhepatic catheter-directed thrombolysis for portal vein thrombosis after partial splenic embolisation in combination with balloon-occluded retrograde transvenous obliteration of splenorenal shunt. World J Gastroenterol 12:5071–5074PubMedGoogle Scholar
  26. 26.
    Tsujikawa T, Ihara T, Sasaki M et al (1996) Effectiveness of combined anticoagulant therapy for extending portal vein thrombosis in Crohn’s disease. Report of a case. Dis Colon Rectum 39:823–825PubMedCrossRefGoogle Scholar
  27. 27.
    Tateishi A, Mitsui H, Oki T et al (2001) Extensive mesenteric vein and portal vein thrombosis successfully treated by thrombolysis and anticoagulation. J Gastroenterol Hepatol 16:1429–1433PubMedCrossRefGoogle Scholar
  28. 28.
    Al Haq SM, Visweshwar NI, Contractor QQ (1996) Thrombolysis of acute portal vein thrombus. Indian J Gastroenterol 15:22–23PubMedGoogle Scholar
  29. 29.
    Poplausky MR, Kaufman JA, Geller SC et al (1996) Mesenteric venous thrombosis treated with urokinase via the superior mesenteric artery. Gastroenterology 110:1633–1635PubMedCrossRefGoogle Scholar
  30. 30.
    Rosen MP, Sheiman R (2000) Transhepatic mechanical thrombectomy followed by infusion of TPA into the superior mesenteric artery to treat acute mesenteric vein thrombosis. J Vasc Interv Radiol 11(2 Pt 1):195–198PubMedCrossRefGoogle Scholar
  31. 31.
    Preventza OA, Habib FA, Young SC et al (2005) Portal vein thrombosis: an unusual complication of laparoscopic cholecystectomy. JSLS 9:87–90PubMedGoogle Scholar
  32. 32.
    Plessier A, Darwish-Murad S, Hernandez-Guerra M et al (2010) Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology. 51:210–218PubMedGoogle Scholar
  33. 33.
    Baril N, Wren S, Radin R et al (1996) The role of anticoagulation in pylephlebitis. Am J Surg 172:449–453PubMedCrossRefGoogle Scholar
  34. 34.
    Garcia-Pagán JC, Hernández-Guerra M, Bosch J (2008) Extrahepatic portal vein thrombosis. Semin Liver Dis 28:282–292PubMedCrossRefGoogle Scholar
  35. 35.
    Condat B, Pessione F, Hillaire S et al (2001) Current outcome of portal vein thrombosis in adults: risk and benefit of anticoagulant therapy. Gastroenterology 120:490–497PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • T. C. Hall
    • 1
  • G. Garcea
    • 1
  • M. Metcalfe
    • 1
  • D. Bilku
    • 1
  • A. R. Dennison
    • 1
  1. 1.Department of Hepatobiliary and Pancreatic SurgeryUniversity Hospitals of LeicesterLeicesterUK

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