Skip to main content
SpringerLink
Log in

Portal vein velocity predicts portal vein system thrombosis after splenectomy with esophagogastric devascularization

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Portal vein system thrombosis (PVST) is a potentially fatal complication after splenectomy with esophagogastric devascularization (SED) in cirrhotic patients with portal hypertension. However, the impact of portal vein velocity (PVV) on PVST after SED remains unclear. Therefore, this study aims to explore this issue.

Methods

Consecutive cirrhotic patients with portal hypertension who underwent SED at Tongji Hospital between January 2010 and June 2022 were enrolled. The patients were divided into two groups based on the presence or absence of PVST, which was assessed using ultrasound or computed tomography after the operation. PVV was measured by duplex Doppler ultrasound within one week before surgery. The independent risk factors for PVST were analyzed using univariate and multivariate logistic regression analysis. A nomogram based on these variables was developed and internally validated using 1000 bootstrap resamples.

Results

A total of 562 cirrhotic patients with portal hypertension who underwent SED were included, and PVST occurred in 185 patients (32.9%). Multivariate logistic regression analysis showed that PVV was the strongest independent risk factor for PVST. The incidence of PVST was significantly higher in patients with PVV ≤ 16.5 cm/s than in those with PVV > 16.5 cm/s (76.2% vs. 8.5%, p < 0.0001). The PVV-based nomogram was internally validated and showed good performance (optimism-corrected c-statistic = 0.907). Decision curve and clinical impact curve analyses indicated that the nomogram provided a high clinical benefit.

Conclusion

A nomogram based on PVV provided an excellent preoperative prediction of PVST after splenectomy with esophagogastric devascularization.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ginès P, Krag A, Abraldes JG, Solà E, Fabrellas N, Kamath PS (2021) Liver cirrhosis. Lancet 398:1359–1376. https://doi.org/10.1016/S0140-6736(21)01374-X

    Article  PubMed  Google Scholar 

  2. Lv Y, Fan D, Han G (2023) Transjugular intrahepatic portosystemic shunt for portal hypertension: 30 years experience from China. Liver Int 43:18–33. https://doi.org/10.1111/liv.15313

    Article  PubMed  Google Scholar 

  3. de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C, Faculty BVII (2022) Baveno VII—renewing consensus in portal hypertension. J Hepatol 76:959–974. https://doi.org/10.1016/j.jhep.2021.12.022

    Article  PubMed  Google Scholar 

  4. de Franchis R, Faculty BVI (2015) Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol 63:743–752. https://doi.org/10.1016/j.jhep.2015.05.022

    Article  PubMed  Google Scholar 

  5. European Association for the Study of the Liver (2016) EASL Clinical Practice Guidelines: liver transplantation. J Hepatol 64:433–485. https://doi.org/10.1016/j.jhep.2015.10.006

    Article  Google Scholar 

  6. Li Y, Fu X, Li Y, Liu P, Liu S, Pan Y (2022) Early prevention and risk factors analysis of portal vein system thrombosis after laparoscopic splenectomy and pericardial devascularization. Surg Endosc 36:8918–8926. https://doi.org/10.1007/s00464-022-09340-5

    Article  PubMed  PubMed Central  Google Scholar 

  7. Zhe C, Jian-wei L, Jian C, Yu-dong F, Ping B, Shu-guang W, Shu-guo Z (2013) Laparoscopic versus open splenectomy and esophagogastric devascularization for bleeding varices or severe hypersplenism: a comparative study. J Gastrointest Surg 17:654–659. https://doi.org/10.1007/s11605-013-2150-4

    Article  PubMed  Google Scholar 

  8. Chen Z-L, Yao L-Q, Pu J-L, Wu H, Xu X-F, Chen T-H, Zhou Y-H, Wang H, Chen Z-Y, Sun L-Y, Diao Y-K, Zhong J-H, Lau WY, Pawlik TM, Huang D-S, Shen F, Liang Y-J, Yang T (2022) Impact of concurrent splenectomy and esophagogastric devascularization on surgical outcomes of partial hepatectomy for hepatocellular carcinoma in patients with clinically significant portal hypertension: a multicenter propensity score matching analysis. Eur J Surg Oncol 48:1078–1086. https://doi.org/10.1016/j.ejso.2021.11.118

    Article  PubMed  Google Scholar 

  9. Zhang E-L, Zhang Z-Y, Huang Z-Y (2023) Splenectomy may facilitate systemic therapy for advanced hepatocellular carcinoma with hypersplenism. Hepatobiliary Surg Nutr 12:137–139. https://doi.org/10.21037/hbsn-22-545

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ikeda M, Sekimoto M, Takiguchi S, Kubota M, Ikenaga M, Yamamoto H, Fujiwara Y, Ohue M, Yasuda T, Imamura H, Tatsuta M, Yano M, Furukawa H, Monden M (2005) High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: a prospective study with contrast-enhanced CT scan. Ann Surg 241:208–216. https://doi.org/10.1097/01.sla.0000151794.28392.a6

    Article  PubMed  PubMed Central  Google Scholar 

  11. Intagliata NM, Caldwell SH, Tripodi A (2019) Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis. Gastroenterology 156:1582-1599.e1. https://doi.org/10.1053/j.gastro.2019.01.265

    Article  PubMed  Google Scholar 

  12. Wu L-F, Bai D-S, Shi L, Jin S-J, Zhou B-H, Jiang G-Q (2022) Predictors of portal vein thrombosis after laparoscopic splenectomy and azygoportal disconnection in hepatitis B cirrhosis: a prospective study. Surg Endosc 36:4090–4098. https://doi.org/10.1007/s00464-021-08730-5

    Article  PubMed  Google Scholar 

  13. Lai W, Lu S-C, Li G-Y, Li C-Y, Wu J-S, Guo Q-L, Wang M-L, Li N (2012) Anticoagulation therapy prevents portal-splenic vein thrombosis after splenectomy with gastroesophageal devascularization. World J Gastroenterol 18:3443–3450. https://doi.org/10.3748/wjg.v18.i26.3443

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Kinjo N, Kawanaka H, Akahoshi T, Tomikawa M, Yamashita N, Konishi K, Tanoue K, Shirabe K, Hashizume M, Maehara Y (2010) Risk factors for portal venous thrombosis after splenectomy in patients with cirrhosis and portal hypertension. Br J Surg 97:910–916. https://doi.org/10.1002/bjs.7002

    Article  CAS  PubMed  Google Scholar 

  15. Jiang G-Q, Bai D-S, Chen P, Xia B-L, Qian J-J, Jin S-J (2016) Predictors of portal vein system thrombosis after laparoscopic splenectomy and azygoportal disconnection: a retrospective cohort study of 75 consecutive patients with 3-months follow-up. Int J Surg 30:143–149. https://doi.org/10.1016/j.ijsu.2016.04.047

    Article  PubMed  Google Scholar 

  16. Qian Y, Li K (2017) The early prevention and treatment of PVST after laparoscopic splenectomy: a prospective cohort study of 130 patients. Int J Surg 44:147–151. https://doi.org/10.1016/j.ijsu.2017.05.072

    Article  PubMed  Google Scholar 

  17. Blann AD, Lip GY (2001) Virchow’s triad revisited: the importance of soluble coagulation factors, the endothelium, and platelets. Thromb Res 101:321–327. https://doi.org/10.1016/s0049-3848(00)00419-9

    Article  CAS  PubMed  Google Scholar 

  18. Turon F, Driever EG, Baiges A, Cerda E, García-Criado Á, Gilabert R, Bru C, Berzigotti A, Nuñez I, Orts L, Reverter JC, Magaz M, Camprecios G, Olivas P, Betancourt-Sanchez F, Perez-Campuzano V, Blasi A, Seijo S, Reverter E, Bosch J, Borràs R, Hernandez-Gea V, Lisman T, Garcia-Pagan JC (2021) Predicting portal thrombosis in cirrhosis: a prospective study of clinical, ultrasonographic and hemostatic factors. J Hepatol 75:1367–1376. https://doi.org/10.1016/j.jhep.2021.07.020

    Article  PubMed  Google Scholar 

  19. Stine JG, Wang J, Shah PM, Argo CK, Intagliata N, Uflacker A, Caldwell SH, Northup PG (2018) Decreased portal vein velocity is predictive of the development of portal vein thrombosis: a matched case–control study. Liver Int 38:94–101. https://doi.org/10.1111/liv.13500

    Article  PubMed  Google Scholar 

  20. Zocco MA, Di Stasio E, De Cristofaro R, Novi M, Ainora ME, Ponziani F, Riccardi L, Lancellotti S, Santoliquido A, Flore R, Pompili M, Rapaccini GL, Tondi P, Gasbarrini GB, Landolfi R, Gasbarrini A (2009) Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development. J Hepatol 51:682–689. https://doi.org/10.1016/j.jhep.2009.03.013

    Article  PubMed  Google Scholar 

  21. Tran T, Demyttenaere SV, Polyhronopoulos G, Séguin C, Artho GP, Kaneva P, Fried GM, Feldman LS (2010) Recommended timing for surveillance ultrasonography to diagnose portal splenic vein thrombosis after laparoscopic splenectomy. Surg Endosc 24:1670–1678. https://doi.org/10.1007/s00464-009-0828-1

    Article  PubMed  Google Scholar 

  22. Kramer AA, Zimmerman JE (2007) Assessing the calibration of mortality benchmarks in critical care: the Hosmer-Lemeshow test revisited. Crit Care Med 35:2052–2056. https://doi.org/10.1097/01.CCM.0000275267.64078.B0

    Article  PubMed  Google Scholar 

  23. DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845

    Article  CAS  PubMed  Google Scholar 

  24. Vickers AJ, Cronin AM, Elkin EB, Gonen M (2008) Extensions to decision curve analysis, a novel method for evaluating diagnostic tests, prediction models and molecular markers. BMC Med Inform Decis Mak 8:53. https://doi.org/10.1186/1472-6947-8-53

    Article  PubMed  PubMed Central  Google Scholar 

  25. Senzolo M, Garcia-Tsao G, García-Pagán JC (2021) Current knowledge and management of portal vein thrombosis in cirrhosis. J Hepatol 75:442–453. https://doi.org/10.1016/j.jhep.2021.04.029

    Article  PubMed  Google Scholar 

  26. Zoli M, Iervese T, Merkel C, Bianchi G, Magalotti D, Marchesini G, Gatta A, Pisi E (1993) Prognostic significance of portal hemodynamics in patients with compensated cirrhosis. J Hepatol 17:56–61. https://doi.org/10.1016/s0168-8278(05)80521-5

    Article  CAS  PubMed  Google Scholar 

  27. Ramachandran P, Dobie R, Wilson-Kanamori JR, Dora EF, Henderson BEP, Luu NT, Portman JR, Matchett KP, Brice M, Marwick JA, Taylor RS, Efremova M, Vento-Tormo R, Carragher NO, Kendall TJ, Fallowfield JA, Harrison EM, Mole DJ, Wigmore SJ, Newsome PN, Weston CJ, Iredale JP, Tacke F, Pollard JW, Ponting CP, Marioni JC, Teichmann SA, Henderson NC (2019) Resolving the fibrotic niche of human liver cirrhosis at single-cell level. Nature 575:512–518. https://doi.org/10.1038/s41586-019-1631-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Trautwein C, Friedman SL, Schuppan D, Pinzani M (2015) Hepatic fibrosis: concept to treatment. J Hepatol 62:S15-24. https://doi.org/10.1016/j.jhep.2015.02.039

    Article  CAS  PubMed  Google Scholar 

  29. Lemoinne S, Cadoret A, Rautou P-E, El Mourabit H, Ratziu V, Corpechot C, Rey C, Bosselut N, Barbu V, Wendum D, Feldmann G, Boulanger C, Henegar C, Housset C, Thabut D (2015) Portal myofibroblasts promote vascular remodeling underlying cirrhosis formation through the release of microparticles. Hepatology 61:1041–1055. https://doi.org/10.1002/hep.27318

    Article  CAS  PubMed  Google Scholar 

  30. Tripodi A, Primignani M, Chantarangkul V, Dell’Era A, Clerici M, de Franchis R, Colombo M, Mannucci PM (2009) An imbalance of pro- vs anti-coagulation factors in plasma from patients with cirrhosis. Gastroenterology 137:2105–2111. https://doi.org/10.1053/j.gastro.2009.08.045

    Article  CAS  PubMed  Google Scholar 

  31. Tripodi A, Mannucci PM (2011) The coagulopathy of chronic liver disease. N Engl J Med 365:147–156. https://doi.org/10.1056/NEJMra1011170

    Article  CAS  PubMed  Google Scholar 

  32. Intagliata NM, Argo CK, Stine JG, Lisman T, Caldwell SH, Violi F, Faculty of the 7th International Coagulation in Liver Disease (2018) Concepts and controversies in haemostasis and thrombosis associated with liver disease: proceedings of the 7th international coagulation in liver disease conference. Thromb Haemost 118:1491–1506. https://doi.org/10.1055/s-0038-1666861

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Li J, Wu Q-Q, Zhu R-H, Lv X, Wang W-Q, Wang J-L, Liang B-Y, Huang Z-Y, Zhang E-L (2022) Machine learning predicts portal vein thrombosis after splenectomy in patients with portal hypertension: comparative analysis of three practical models. World J Gastroenterol 28:4681–4697. https://doi.org/10.3748/wjg.v28.i32.4681

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Swinson B, Waters PS, Webber L, Nathanson L, Cavallucci DJ, O’Rourke N, Bryant RD (2022) Portal vein thrombosis following elective laparoscopic splenectomy: incidence and analysis of risk factors. Surg Endosc 36:3332–3339. https://doi.org/10.1007/s00464-021-08649-x

    Article  PubMed  Google Scholar 

  35. Krauth M-T, Lechner K, Neugebauer EAM, Pabinger I (2008) The postoperative splenic/portal vein thrombosis after splenectomy and its prevention—an unresolved issue. Haematologica 93:1227–1232. https://doi.org/10.3324/haematol.12682

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank all the medical staff involved in this study.

Funding

This work was supported by Hubei Provincial Special Grants for Scientific and Technical Innovation (2021BCA115).

Author information

Authors and Affiliations

  1. Hepatic Surgical Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, China

    Jin-lin Wang, Jian Li, Wen-qiang Wang, Xing Lv, Rong-hua Zhu, Tong Yuan, Zhi-wei Zhang, Er-lei Zhang & Zhi-yong Huang

Authors
  1. Jin-lin Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jian Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wen-qiang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xing Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rong-hua Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tong Yuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhi-wei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Er-lei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Zhi-yong Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concepts: J-LW, Z-WZ; Study design: J-LW, Z-WZ, E-LZ, Z-YH; Data acquisition: J-LW; Data analysis and interpretation: J-LW, JL, W-QW; Statistical analysis: J-LW, JL, XL, R-HZ, TY; Manuscript editing: J-LW; Manuscript review: E-LZ, Z-WZ, Z-YH. All authors read and approved the final version of the manuscript.

Corresponding authors

Correspondence to Zhi-wei Zhang, Er-lei Zhang or Zhi-yong Huang.

Ethics declarations

Disclosures

Jin-lin Wang, Jian Li, Wen-qiang Wang, Xing Lv, Rong-hua Zhu, Tong Yuan, Er-lei Zhang, Zhi-wei Zhang, and Zhi-yong Huang have no conflicts of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 15 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, Jl., Li, J., Wang, Wq. et al. Portal vein velocity predicts portal vein system thrombosis after splenectomy with esophagogastric devascularization. Surg Endosc 38, 648–658 (2024). https://doi.org/10.1007/s00464-023-10566-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-023-10566-0

Keywords

Search

Navigation