Portal vein thrombus may be either bland andor mali. Pdf acute portal vein thrombosis unrelated to cirrhosis. Published data suggest that cmv hepatitis and, possibly, other types of acute viral hepatitis could be a local risk factor for acute pvt. In symptomatic patients not responding to systemic anticoagulation, interventional procedures have emerged as an. In liver cirrhosis, portal vein thrombosis pvt, which is defined as thrombosis that occurs within the main portal vein and intrahepatic portal branches, is one of the most common complications. The presence of pvt in cirrhosis varies with a reported incidence of 8. Moreover, patients with pvt have differential presentation depending upon the site of the thrombosis portal vein or portal vein territory, acute or chronic, and collateral veins development. Mvt may present with acute abdominal pain or may be an asymptomatic incidental. Portal vein thrombosis pvt is the obstruction of the trunk of the portal vein by a blood clot. Update on management of portal vein thrombosis and the. To assist health care professionals in the management of portal vein thrombosis pvt.
Acute portal vein thrombosis is usually symptomatic when associated with cirrhosis and. The clinical management of portal vein thrombosis pvt remains ambiguous due to its heterogeneous presentations and its associations with liver disease, malignancy, and hypercoagulable states. While the initial diagnosis clinically appeared to be inflammatory bowel disease, she was found to have a portal vein thrombosis pvt on mr cholangiopancreatography and acute. Venous thrombosis complicating acute pancreatitis h. To develop a new standard of care for patients with acute pvt and evidence of intestinal ischaemia. Acute pvt usually presents with pain abdomen while as chronic pvt presents. Icd9cm 452 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 452 should only be used for claims with a date of service on or before september 30, 2015. Insulin resistance and portal vein thrombosis clinical.
Randomized controlled trial of rivaroxaban versus warfarin in. Pvt as sudden formation of thrombus within the portal vein lumen, and chronic, when the. To assist health care professionals in the management of portal vein. Portal vein thrombosis american journal of medicine. Aggarwal, deepak jain, avinash rao acute pancreatitis is a sudden inflammation of the pancreas. The following describes the presentation of pvt in a young male, the. Successful recanalization of acute extensive portal vein. Occlusion of the portal vein by thrombus portal vein thrombosis. Portal vein thrombosis pvt is a blood clot of the portal vein, also known as the hepatic portal vein. Portal vein thrombosis radiology reference article. To develop a new standard of care for patients with acute. Naturally, the difficulty of recanalization increases with degree of thrombosis, whether acute or chronic in stage and noninvasive or invasive in management of pvt. Failure to detect and treat thromboses can result in mesenteric ischemia, chronic cavernous transformation, and complications of portal hypertension. Warfarin or lowmolecular weight heparin are the standardofcare treatment for acute pvt in cirrhosis, although there is enthusiasm in a paradigm shift switching to doacs for the treatment of acute pvt in cirrhosis, particularly since the.
Treatment of acute portal vein thrombosis by nontraditional. The portal vein is a vital vasculature providing up to 75%. The 12 remaining pa tients had only a single obstructed portal vein branch with or without splenic or superior mesenteric vein ob struction were all symptomatic. The main clinical presentation of acute pvt is abdominal pain, especially if the superior mesenteric vein is involved. After excluding the possibility of cirrhosis, the patient was switched from subcutaneous heparin prophylaxis to iv heparin and later bridged to warfarin.
Aneurysms of the portal vein are most often considered incidental findings of no specific clinical importance but rarely may be complicated by thrombosis and occlusion of the portal vein. Large cohort studies have reported a global prevalence of 1%, but in some. Request pdf clinical features, diagnosis and outcome of acute portal vein thrombosis the clinical features of acute portal vein thrombosis apvt are poorly defined in the literature. The patient, suffering from hemochromatosis for more than 20 years, complained of acute epigastric pain, dysphagia and fatigue for three weeks. Pancreatitis, superior mesenteric vein thrombosis, anticoagulant 1.
Newer oral anticoagulants noacs are being utilized increasingly for the treatment of venous thromboembolism vte. A prospective multicenter followup study aurelieplessier,1 sarwadarwishmurad,2 manuelhernandezguerra,3 yannconsigny,1 federicafabris,4 joneltrebicka,5 jorgheller,5 isabellemorard,6 luclasser,7 philippelanglet,7 mariehel. Kennoki n, saguchi t, sano t, moriya t, shirota n, otaka j, et al. In acute portal vein thrombosis, patients may be asymptomatic or present with life threaten ing intestinal ischemia and infarction. In patients with cirrhosis, symptoms resulting from acute pvt can be highly variable, likely related to the cumulative effect of venous thrombosis. Isolated superior mesenteric vein thrombosis in acute. Learn about the symptoms and treatment of this condition. A indicates acute pvt denoted by dark intraluminal filling within the portal vein. Although studies report comparable recanalization rates as anticoagulation, there have been reported higher risks for bleeding and mortality. Portal vein thrombosis an overview sciencedirect topics. Anticoagulation alone in acute, extensive portomesenteric vein thrombosis pvt does not always result in spontaneous clot lysis, and leaves the patient at risk of complications including intestinal infarction and portal hypertension.
Diagnosis, development, and treatment of portal vein. Acute portal vein thrombosis simulating acute pancreatitis. The occlusion of the portal vein by tumor invasion or tumor compression with secondary development of a. This study showed complete thrombosis of the main, right, and left portal veins. Anticoagulation therapy is the main line of treatment for acute portal vein thrombosis pvt in the absence of cirrhosis. The portal vein is formed by the confluence of the splenic and superior mesenteric veins, which drain the spleen and small intestine, respectively figure 1. Acute portal vein thrombosis, no longer a contraindication for transjugular intrahepatic portosystemic shunt tips insertion. The most frequent complications are thrombosis of the splenic or portal vein 3. Acute portal vein thrombosis pvt is characterized as recent portal vein or its branches.
Splanchnic vein thrombosis is often an incidental finding on radiological imaging performed to assess the severity of an attack of. It is a major cause of noncirrhotic presinusoidal portal hypertension. Clinical manifestations, diagnosis, and management and noncirrhotic portal hypertension. Pvt refers to the complete or partial obstruction of blood flow to the portal vein or its branches and can be related to invasion or constriction by a malignant tumor or to thrombosis. High incidence of pvt in the setting of liver cirrhosis is mainly due to hypercoagulable state and altered dynamic of blood flow in the portal vein. The portal vein is formed by the confluence of the splenic and superior mesenteric veins, which drain the spleen and small intestine, respectively. Evaluation and management of acute and chronic portal vein. Directacting oral anticoagulants doacs in cirrhosis and. Jun 28, 2019 the clinical management of portal vein thrombosis pvt remains ambiguous due to its heterogeneous presentations and its associations with liver disease, malignancy, and hypercoagulable states. The diagnostic results should be interpreted cautiously. The portal vein is a vital vasculature providing up to 75% of blood supply to the liver.
Successful treatment of acute portal vein thrombosis with. Although acute pvt is an uncommon diagnosis, it can lead to serious morbidity, including bowel infarction, as well as mortality. Patients are generally asymptomatic in the neonatal period. Portal vein pv thrombosis pvt is commonly seen in patients with cirrhosis and. Pvt in cirrhosis can have adverse outcomes as it is fre quently associated with variceal bleeding. Development of pvts in this patient population is thought sec.
Pdf treatment of acute portal vein thrombosis by non. Portal vein thrombosis pvt is one of the most common vascular disorders of the liver with significant morbidity and mortality. However, increased use of abdominal imaging has noted a large number of incidental pvt. Noac use is the standard of care for stroke prophylaxis in nonvalvular atrial fibrillation and treatment of acute vte involving extremities and pulmonary embolism. However, the use of this therapy in cirrhotic pvt is still with doubtful evidence. Abdominal duplex ultrasound confirmed extensive acute portal vein thrombosis invol. Warfarin or lowmolecular weight heparin are the standardofcare treatment for acute pvt in cirrhosis, although there is enthusiasm in a paradigm shift switching to doacs for the treatment of acute. Update on management of portal vein thrombosis and the role of. Literature evaluating noac use in the treatment of acute portal vein thrombosis is sparse. It usually happens in the setting of another disease such as pancreatitis, cirrhosis, diverticulitis or cholangiocarcinoma.
Portal vein is completely recanalised without residual thrombi. The first page of the pdf of this article appears above. Treatment of acute portal vein thrombosis by nontraditional anticoagulation. Seven patients had only left or right portal vein thrombosis. Portal vein thrombosis in liver cirrhosis intechopen. Portal vein pv thrombosis pvt is commonly seen in patients with cirrhosis and may be incidentally diagnosed in asymptomatic patients during routine imaging.
Toward a comprehensive new classification of portal vein. Acute thrombosis of a giant portal venous aneurysm santana. In contrast, most guidelines in the literature support the treatment of acute portal vein thrombosis. Anticoagulation for at least 3 months is generally recommended for recanalization to avoid intestinal infarction and worsening of portal hypertension. Like splenic vein thrombosis, portal vein thrombosis box 176 usually is not recognized in its acute phase, although when acute it may manifest as intestinal congestion leading to abdominal pain, diarrhea, rectal bleeding, and, in its most severe forms, lifethreatening intestinal ischemia and infarction. Portal hypertensive cholangiopathy, which masquerades as an. Acute portal vein thrombosis unrelated to cirrhosis. If the thrombus remains, portal venous hypertension and varices may result. Clinical features, diagnosis and outcome of acute portal vein. Clinical features vary in acute and chronic portal vein thrombosis. In liver cirrhosis, especially in advanced stages, pvt is one of the most common complications 3, 4, 5. Portal vein thrombosis a primer for the general physician.
Acute cholecystitis complicated with portal vein thrombosis. We report the case of a 23yearold woman who presented with bloody diarrhoea and multiple syncopal events. Anticoagulant options in the acute phase include unfractionated heparin. Portal vein thrombosis pvt is defined as thrombosis within the portal vein trunk and intrahepatic portal branches. In other words, the gap among patency of various portal venous. Insulin resistance and portal vein thrombosis clinical diabetes. Portal vein thrombosis digestive and liver disease. Successful recanalization of acute extensive portal vein thrombosis by aspiration thrombectomy and thrombolysis via an operatively. The management of portal vein thrombosis pvt has been complicated by a lack of randomized controlled trials in the area, the clinical dif. Update on management of portal vein thrombosis and the role. Acute portal vein thrombosis is a difficult clinical diagnosis because of the wide variety of clinical presentations. Prompt diagnosis and management of acute symptomatic portal vein thrombosis are essential. Although pvt is treatable, it can be lifethreatening.
Pvt can occur in the main portal vein, in the left or right. Pvt in cirrhosis can have adverse outcomes as it is frequently associated with. A 79yearold with acute portal vein thrombosis cleveland. Symptoms acute pvt may be clinically silent and diagnosed during a radiologic examination for other reasons such as acute pancreatitis. Patients with acute pvt have the sudden onset of portal venous. Like splenic vein thrombosis, portal vein thrombosis box 176 usually is not recognized in its acute phase, although when acute it may manifest as intestinal congestion leading to abdominal pain. Acute portal vein thrombosis pvt is an unusual clinical condition resulting from a combination of acquired, inherited, and local precipitating factors. Thrombosis of the superior mesenteric vein without simu1 l.
Neonatal portal vein thrombosis pvt is an increasingly recognized event. This case report of an abdomen ct performed on a patient with a history of portal vein thrombosis masqueraded as an acute on chronic portal vein thrombosis with cavernous collaterals. The portal vein is one of the splanchnic veins, formed at the confluence of the superior mesenteric and splenic veins and carries blood from the gastrointestinal tract to the liver. Portal hypertensive cholangiopathy, which masquerades as. It can extend downstream into the intrahepatic branches of the portal vein or upstream into the splenic andor mesenteric veins. The following describes the presentation of pvt in a young male, the search for risk factors and underlying etiology, and the debate of anticoagulation therapy.
Pvt is an uncommon site of thrombosis, estimated to occur in 4 per 100,000 individuals. Doppler confirmed the diagnosis of portal hypertensive cholangiopathy. Successful recanalization of acute extensive portal vein thrombosis by aspiration thrombectomy and thrombolysis via an operatively placed mesenteric catheter. Oct 24, 2017 portal vein thrombosis pvt is a blood clot that causes irregular blood flow to the liver. Ct scan of acute portal vein thrombosis pvt in a 56yearold female with nonalcoholic steatohepatitis nash cirrhosis presenting with acute pvt one month after bariatric surgery.
Occlusion of the portal vein by thrombus portal vein thrombosis pvt typically occurs in patients with cirrhosis andor prothrombotic disorders. Portal vein thrombosis pvt is a rare cause of abdominal pain, typically associated with cirrhosis or thrombophilia. See epidemiology and pathogenesis of portal vein thrombosis in adults and acute portal vein thrombosis in adults. Case report successful treatment of acute portal vein. The clinical manifestations of acute portal vein thrombosis pvt depend on the extent of the obstruction and the speed of its development. Patients with cirrhosis are at risk of developing acute portal vein thrombosis pvt.
Imaging in clinical decisionmaking for portal vein thrombosis. On usg abdomen, features of acute pancreatitis were present along with ascites, and an echogenic thrombus in the portal vein. In contrast, most guidelines in the literature support the treatment of acute portal vein thrombosis pvt with low molecular weight heparin lmwh and vitamin k antagonists vka. Newer oral anticoagulants in the treatment of acute portal. Portal vein thrombosis pvt is diagnosed when a venous thrombosis occurs within the main portal vein and intrahepatic portal branches 1, 2. May 01, 2015 a 79yearold with acute portal vein thrombosis. Splanchnic vein thrombosis is a rare complication of acute pancreatitis. Portal vein thrombosis unrelated to solid malignancy is common in patients with cirrhosis, but less frequently observed in patients without cirrhosis. Background acute portal vein thrombosis is a potentially fatal condition. In acute portal vein thrombosis, patients may be asymptomatic or present with lifethreaten ing intestinal ischemia and infarction. Clinical features, diagnosis and outcome of acute portal. Degree of portal vein thrombosis qi 2010 hepatology.
Obstruction of the portal vein or of its two branches was found in 83 patients 87%. This vein allows blood to flow from the intestines to the liver. Aetiopathogenesis, diagnosis and management portal vein thrombosis pvt refers to the occlusion of the trunk of the portal vein pv by formation of. Acute portal vein thrombosis in the setting of liver cirrhosis. Interventional treatment of acute portal vein thrombosis. Portal vein thrombosis is a condition that occurs when a blood clot occurs in the hepatic portal vein, which can lead to increased pressure in the portal vein system and reduced blood supply to the liver. The natural history and clinical outcome of pvt are highly. Ct scan of the abdomen with contrast confirmed the diagnosis of portal vein thrombosis pvt. The natural history and clinical outcome of pvt are highly variable, dependent upon size, extent and degree of the thrombotic occlusion, as well as the physiological impact of patient comorbidities. Portal vein thrombosis affects the hepatic portal vein, which can lead to portal hypertension and reduction of the blood supply to the liver. Overview mesenteric venous thrombosis mvt describes acute, subacute, or chronic thrombosis of the superior or inferior mesenteric vein or branches.
Since the first description of portal vein thrombosis pvt by balfour and stewart in 1869, in their report of a 20yearold patient who died from complications of splenomegaly, ascites, and varicose dilation with associated pvt, the clinical manifestations and management of pvt have been met with great interest. Introduction acute pancreatitis can cause many vascular complications, arterial or venous. Portal vein thrombosis may be seen in a variety of clinical contexts, and when acute can be a lifethreatening condition. A stepwise thrombolysis regimen in the management of acute. It originates posterior to the pancreas by the confluence of superior mesenteric and splenic veins, and, prior to entering into the liver, it divides into the left and right portal vein. Acute and chronic portal vein thrombosis in patients with cirrhosis kellie young, m. Acute intestinal ischaemia from a portal vein thrombosis. These collateral veins develop in few days after portal vein obstruction, and get completed within 3 to 5 weeks 14,15.
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