Current Treatment Options in Gastroenterology

, Volume 10, Issue 6, pp 435–443

Portal vein thrombosis

Article

Opinion statement

Portal vein thrombosis (PVT) can be a difficult clinical problem to assess and manage. A high index of suspicion is needed for a PVT diagnosis given the subtle presentation and potentially serious long-term complications. It should be considered a clue to the presence of one or several underlying disorders, including prothrombotic disorders, whether or not a local precipitating factor is identified. The accruing evidence shows that acute PVT can and probably should be treated with anticoagulation or thrombolytic agents in an effort to prevent extension of thrombus, mesenteric vessel occlusion, and portal hypertension. However, chronic PVT should be treated conservatively with measures to control major consequences related to portal hypertension. Anticoagulation therapy duration should be tailored to the identified predisposing factors.

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References and Recommended Reading

  1. 1.
    Cohen J, Edelman RR, Chopra S: Portal vein thrombosis: a review. Am J Med 1992, 92:173–182.PubMedCrossRefGoogle Scholar
  2. 2.
    Lerut JP, Mazza D, van Leeuw V, et al.: Adult liver transplantation and abnormalities of splanchnic veins: experience in 53 patients. Transpl Int 1997, 10:125–132.PubMedCrossRefGoogle Scholar
  3. 3.
    Nonami T, Yokoyama I, Iwatsuki S, Starzl TE: The incidence of portal vein thrombosis at liver transplantation. Hepatology 1992, 16:1195–1198.PubMedGoogle Scholar
  4. 4.
    Stieber AC, Zetti G, Todo S, et al.: The spectrum of portal vein thrombosis in liver transplantation. Ann Surg 1991, 213:199–206.PubMedCrossRefGoogle Scholar
  5. 5.
    Okuda K, Ohnishi K, Kimura K, et al.: Incidence of portal vein thrombosis in liver cirrhosis. An angiographic study in 708 patients. Gastroenterology 1985, 89:279–286.PubMedGoogle Scholar
  6. 6.
    Orozco H, Takahashi T, Mercado MA, et al.: Postoperative portal vein obstruction in patients with idiopathic portal hypertension. J Clin Gastroenterol 1990, 12:607.PubMedCrossRefGoogle Scholar
  7. 7.
    Valla DC, Condat B: Portal vein thrombosis in adults: pathophysiology, pathogenesis and management. J Hepatol 2000, 32:865–871.PubMedCrossRefGoogle Scholar
  8. 8.
    Valla DC, Condat B, Lebrec D: Spectrum of portal vein thrombosis in the West. J Gastroenterol Hepatol 2002, 17(Suppl 3):S224–S227.PubMedCrossRefGoogle Scholar
  9. 9.
    Henderson JM, Gilmore GT, Mackay GJ, et al.: Hemodynamics during liver transplantation: the interactions between cardiac output and portal venous and hepatic arterial flows. Hepatology 1992, 16:715–718.PubMedCrossRefGoogle Scholar
  10. 10.
    Perlemuter G, Bejanin H, Fritsch J, et al.: Biliary obstruction caused by portal cavernoma: a study of 8 cases. J Hepatol 1996, 25:58–63.PubMedCrossRefGoogle Scholar
  11. 11.
    Ohnishi K, Okuda K, Ohtsuki T, et al.: Formation of hilar collaterals or cavernous transformation after portal vein obstruction by hepatocellular carcinoma. Observations in ten patients. Gastroenterology 1984, 87:1150–1153.PubMedGoogle Scholar
  12. 12.
    Vogelzang RL, Anschuetz SL, Gore RM: Budd-Chiari syndrome: CT observations. Radiology 1987, 163:329–333.PubMedGoogle Scholar
  13. 13.
    Denninger MH, Chait Y, Casadevall N, et al.: Cause of portal or hepatic venous thrombosis in adults: the role of multiple concurrent factors. Hepatology 2000, 31:587–591.PubMedCrossRefGoogle Scholar
  14. 14.
    Falanga A, Rickles FR: Pathophysiology of the thrombophilic state in the cancer patient. Semin Thromb Hemost 1999, 25:173–182.PubMedGoogle Scholar
  15. 15.
    Valla D, Casadevall N, Huisse MG, et al.: Etiology of portal vein thrombosis in adults. A prospective evaluation of primary myeloproliferative disorders. Gastroenterology 1988, 94:1063–1069.PubMedGoogle Scholar
  16. 16.
    Amitrano L, Brancaccio V, Guardascione MA, et al.: Inherited coagulation disorders in cirrhotic patients with portal vein thrombosis. Hepatology 2000, 31:345–348.PubMedCrossRefGoogle Scholar
  17. 17.
    Arkel YS: Thrombosis and cancer. Semin Oncol 2000, 27:362–374.PubMedGoogle Scholar
  18. 18.
    Ni YH, Wang NC, Peng MY, et al.: Bacteroides fragilis bacteremia associated with portal vein and superior mesentery vein thrombosis secondary to antithrombin III and protein C deficiency: a case report. J Microbiol Immunol Infect 2002, 35:255–258.PubMedGoogle Scholar
  19. 19.
    Schwartz DS, Gettner PA, Konstantino MM, et al.: Umbilical venous catheterization and the risk of portal vein thrombosis. J Pediatr 1997, 131:760–762.PubMedCrossRefGoogle Scholar
  20. 20.
    Rosendaal FR: Venous thrombosis: a multicausal disease. Lancet 1999, 353:1167–1173.PubMedCrossRefGoogle Scholar
  21. 21.
    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, 96:2364–2368.PubMedGoogle Scholar
  22. 22.
    Bertina RM: Factor V Leiden and other coagulation factor mutations affecting thrombotic risk. Clin Chem 1997, 43:1678–1683.PubMedGoogle Scholar
  23. 23.
    Margaglione M, Brancaccio V, Giuliani N, et al.: Increased risk for venous thrombosis in carriers of the prothrombin G→A20210 gene variant. Ann Intern Med 1998, 129:89–93.PubMedGoogle Scholar
  24. 24.
    Brown K, Luddington R, Williamson D, et al.: Risk of venous thromboembolism associated with a G to A transition at position 20210 in the 3′-untranslated region of the prothrombin gene. Br J Haematol 1997, 98:907–909.PubMedCrossRefGoogle Scholar
  25. 25.
    Margaglione M, D’Andrea G, d’Addedda M, et al.: The methylenetetrahydrofolate reductase TT677 genotype is associated with venous thrombosis independently of the coexistence of the FV Leiden and the prothrombin A20210 mutation. J Thromb Haemost 1998, 79:907–911.Google Scholar
  26. 26.
    Bernades P, Baetz A, Levy P, et al.: Splenic and portal venous obstruction in chronic pancreatitis. A prospective longitudinal study of a medical-surgical series of 266 patients. Dig Dis Sci 1992, 37:340–346.PubMedCrossRefGoogle Scholar
  27. 27.
    Alvarez F, Bernard O, Brunelle F, et al.: Portal obstruction in children. I. Clinical investigation and hemorrhage risk. J Pediatr 1983, 103:696–702.PubMedCrossRefGoogle Scholar
  28. 28.
    Capron JP, Lemay JL, Muir JF, et al.: Portal vein thrombosis and fatal pulmonary thromboembolism associated with oral contraceptive treatment. J Clin Gastroenterol 1981, 3:295–298.PubMedCrossRefGoogle Scholar
  29. 29.
    Donaldson LB, Plant RK: Pregnancy complicated by extrahepatic portal hypertension: review of literature and report of two cases. Am J Obstet Gynecol 1971, 110:255–264.PubMedGoogle Scholar
  30. 30.
    Kojima Y, Suzuki S, Sakaguchi T, et al.: Portal vein thrombosis caused by microwave coagulation therapy for hepatocellular carcinoma: report of a case. Surg Today 2000, 30:844–848.PubMedCrossRefGoogle Scholar
  31. 31.
    Eguchi A, Hashizume M, Kitano S, et al.: High rate of portal thrombosis after splenectomy in patients with esophageal varices and idiopathic portal hypertension. Arch Surg 1991, 126:752–755.PubMedGoogle Scholar
  32. 32.
    Fujita F, Lyass S, Otsuka K, et al.: Portal vein thrombosis following splenectomy: identification of risk factors. Am Surg 2003, 69:951–956.PubMedGoogle Scholar
  33. 33.
    Freedman AM, Sanyal AJ, Tisnado J, et al.: Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review. Radiographics 1993, 13:1185–1210.PubMedGoogle Scholar
  34. 34.
    Politoske D, Ralls P, Korula J: Portal vein thrombosis following endoscopic variceal sclerotherapy. Prospective controlled comparison in patients with cirrhosis. Dig Dis Sci 1996, 41:185–190.PubMedCrossRefGoogle Scholar
  35. 35.
    Bilodeau M, Aubry MC, Houle R, et al.: Evaluation of hepatocyte injury following partial ligation of the left portal vein. J Hepatol 1999, 30:29–37.PubMedCrossRefGoogle Scholar
  36. 36.
    Harada H, Imamura H, Miyagawa S, Kawasaki S: Fate of the human liver after hemihepatic portal vein embolization: cell kinetic and morphometric study. Hepatology 1997, 26:1162–1170.PubMedGoogle Scholar
  37. 37.
    Wanless IR, Wong F, Blendis LM, et al.: Hepatic and portal vein thrombosis in cirrhosis: possible role in development of parenchymal extinction and portal hypertension. Hepatology 1995, 21:1238–1247.PubMedGoogle Scholar
  38. 38.
    Condat B, Pessione F, Hillaire S, et al.: Current outcome of portal vein thrombosis in adults: risk and benefit of anticoagulant therapy. Gastroenterology 2001, 120:490–497.PubMedCrossRefGoogle Scholar
  39. 39.
    Janssen HL: Changing perspectives in portal vein thrombosis. Scand J Gastroenterol Suppl 2000, 232:69–73.PubMedGoogle Scholar
  40. 40.
    Uflacker R: Applications of percutaneous mechanical thrombectomy in transjugular intrahepatic portosystemic shunt and portal vein thrombosis. Tech Vasc Interv Radiol 2003, 6:59–69.PubMedCrossRefGoogle Scholar
  41. 41.
    Parvey HR, Raval B, Sandler CM: Portal vein thrombosis: imaging findings. AJR Am J Roentgenol 1994, 162:77–81.PubMedGoogle Scholar
  42. 42.
    Tanaka K, Numata K, Okazaki H, et al.: Diagnosis of portal vein thrombosis in patients with hepatocellular carcinoma: efficacy of color Doppler sonography compared with angiography. AJR Am J Roentgenol 1993, 160:1279–1283.PubMedGoogle Scholar
  43. 43.
    Taylor CR: Computed tomography in the evaluation of the portal venous system. J Clin Gastroenterol 1992, 14:167–172.PubMedCrossRefGoogle Scholar
  44. 44.
    Taylor CR, McCauley TR: Magnetic resonance imaging in the evaluation of the portal venous system. J Clin Gastroenterol 1992, 14:268–273.PubMedGoogle Scholar
  45. 45.
    Ueno N, Tomiyama T, Tano S, et al.: Color Doppler ultrasonography in the diagnosis of portal vein invasion in patients with pancreatic cancer. J Ultrasound Med 1997, 16:825–830.PubMedGoogle Scholar
  46. 46.
    Yerdel MA, Gunson B, Mirza D, et al.: Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation 2000, 69:1873–1881.PubMedCrossRefGoogle Scholar
  47. 47.
    Haddad MC, Clark DC, Sharif HS, et al.: MR, CT, and ultrasonography of splanchnic venous thrombosis. Gastrointest Radiol 1992, 17:34–40.PubMedCrossRefGoogle Scholar
  48. 48.
    Greaves M: Antiphospholipid antibodies and thrombosis. Lancet 1999, 354:1031.PubMedCrossRefGoogle Scholar
  49. 49.
    Abraldes JG, Bosch J: Novel approaches to treat portal hypertension. J Gastroenterol Hepatol 2002, 17(Suppl 3): S232–S241.PubMedCrossRefGoogle Scholar
  50. 50.
    Kahn D, Krige JE, Terblanche J, et al.: A 15-year experience of injection sclerotherapy in adult patients with extrahepatic portal venous obstruction. Ann Surg 1994, 219:34–39.PubMedCrossRefGoogle Scholar
  51. 51.
    Warren WD, Henderson JM, Millikan WJ, et al.: Management of variceal bleeding in patients with noncirrhotic portal vein thrombosis. Ann Surg 1988, 207:623–634.PubMedCrossRefGoogle Scholar
  52. 52.
    Blum U, Haag K, Rossle M, et al.: Noncavernomatous portal vein thrombosis in hepatic cirrhosis: treatment with transjugular intrahepatic portosystemic shunt and local thrombolysis. Radiology 1995, 195:153–157.PubMedGoogle Scholar
  53. 53.
    Opitz T, Buchwald AB, Lorf T, et al.: The transjugular intrahepatic portosystemic stent-shunt (TIPS) as rescue therapy for complete Budd-Chiari syndrome and portal vein thrombosis [in German]. Z Gastroenterol 2003, 41:413–418.PubMedCrossRefGoogle Scholar
  54. 54.
    Orozco H, Takahashi T, Mercado MA, et al.: The Sugiura procedure for patients with hemorrhagic portal hypertension secondary to extrahepatic portal vein thrombosis. Surg Gynecol Obstet 1991, 173:45–48.PubMedGoogle Scholar
  55. 55.
    Harnar T, Johansen K, Haskey R, Barker E: Left-sided portal hypertension from pancreatic pseudotumor. Am J Gastroenterol 1982, 77:639–641.PubMedGoogle Scholar
  56. 56.
    Baril N, Wren S, Radin R, et al.: The role of anticoagulation in pylephlebitis. Am J Surg 1996, 172:449–452. Discussion 452–453.PubMedCrossRefGoogle Scholar
  57. 57.
    Condat B, Pessione F, Helene Denninger M, et al.: Recent portal or mesenteric venous thrombosis: increased recognition and frequent recanalization on anticoagulant therapy. Hepatology 2000, 32:466–470.PubMedCrossRefGoogle Scholar
  58. 58.
    Malkowski P, Pawlak J, Michalowicz B, et al.: Thrombolytic treatment of portal thrombosis. Hepatogastroenterology 2003, 50:2098–2100.PubMedGoogle Scholar
  59. 59.
    Rosen MP, Sheiman R: Transhepatic mechanical thrombectomy followed by infusion of TPA into the superior mesenteric artery to treat acute mesenteric vein thrombosis. J Vasc Interv Radiol 2000, 11:195–198.PubMedCrossRefGoogle Scholar
  60. 60.
    Walser EM, NcNees SW, De La Pena O, et al.: Portal venous thrombosis: percutaneous therapy and outcome. J Vasc Interv Radiol 1998, 9:119–127.PubMedCrossRefGoogle Scholar
  61. 61.
    Manzanet G, Sanjuan F, Orbis P, et al.: Liver transplantation in patients with portal vein thrombosis. Liver Transpl 2001, 7:125–131.PubMedCrossRefGoogle Scholar
  62. 62.
    Molmenti EP, Roodhouse TW, Molmenti H, et al.: Thrombendvenectomy for organized portal vein thrombosis at the time of liver transplantation. Ann Surg 2002, 235:292–296.PubMedCrossRefGoogle Scholar
  63. 63.
    Orlando G, De Luca L, Toti L, et al.: Liver transplantation in the presence of portal vein thrombosis: report from a single center. Transplant Proc 2004, 36:199–202.PubMedCrossRefGoogle Scholar
  64. 64.
    Tzakis AG, Kirkegaard P, Pinna AD, et al.: Liver transplantation with cavoportal hemitransposition in the presence of diffuse portal vein thrombosis. Transplantation 1998, 65:619–624.PubMedCrossRefGoogle Scholar
  65. 65.
    Moreno Gonzalez E, Garcia Garcia I, Gomez Sanz R, et al.: Liver transplantation in patients with thrombosis of the portal, splenic or superior mesenteric vein. Br J Surg 1993, 80:81–85.PubMedCrossRefGoogle Scholar
  66. 66.
    Figueras J, Torras J, Rafecas A, et al.: Extra-anatomic venous graft for portal vein thrombosis in liver transplantation. Transpl Int 1997, 10:407–408.PubMedCrossRefGoogle Scholar
  67. 67.
    Rodriguez-Luna H, Vargas H: Portal and splenic vein thrombosis. In Hepatology: A Textbook of Liver Disease. Edited by Boyer T, Wright T, Manns M. Philadelphia: Elsevier; 2006:905–914.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Division of Transplantation MedicineMayo Clinic ScottsdalePhoenixUSA

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