Acute Portal Vein Thrombosis

Abstract

Acute portal vein thrombosis (PVT) is characterized by thrombus formation within the portal vein or its branches. This thrombus formation leads to a nonspecific clinical presentation, which emphasizes the need for imaging to establish the diagnosis. Prompt diagnosis is vital, because if left untreated, acute PVT can lead to bowel infarction or the clinical sequelae of portal hypertension. Currently, guidelines recommend anticoagulation as first line therapy for patients with acute PVT with endovascular management reserved for those who fail anticoagulation or present with signs of bowel ischemia. However, many patients treated with anticoagulation will develop portal vein cavernoma and long term sequalea of portal hypertension, which suggests the need for earlier endovascular intervention in select patients. This article will discuss the risk factors for development of acute PVT, the clinical presentation and diagnosis of the disease, and the pharmacologic, endovascular, and surgical therapy options.

Keywords

PVT - recanalization - thrombus

• References

• 1 Condat B, Pessione F, Helene Denninger M, Hillaire S, Valla D. Recent portal or mesenteric venous thrombosis: increased recognition and frequent recanalization on anticoagulant therapy. Hepatology 2000; 32 (03) 466-470
• 2 Denninger MH, Chaït Y, Casadevall N. , et al. Cause of portal or hepatic venous thrombosis in adults: the role of multiple concurrent factors. Hepatology 2000; 31 (03) 587-591
• 3 Plessier A, Darwish-Murad S, Hernandez-Guerra M. , et al; European Network for Vascular Disorders of the Liver (EN-Vie). Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology 2010; 51 (01) 210-218
• 4 Primignani M, Martinelli I, Bucciarelli P. , et al. Risk factors for thrombophilia in extrahepatic portal vein obstruction. Hepatology 2005; 41 (03) 603-608
• 5 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 (07) 2364-2368
• 6 Colaizzo D, Amitrano L, Tiscia GL. , et al. The JAK2 V617F mutation frequently occurs in patients with portal and mesenteric venous thrombosis. J ThrombHaemost 2007; 5 (01) 55-61
• 7 De Stefano V, Fiorini A, Rossi E. , et al. Incidence of the JAK2 V617F mutation among patients with splanchnic or cerebral venous thrombosis and without overt chronic myeloproliferative disorders. J Thromb Haemost 2007; 5 (04) 708-714
• 8 Kiladjian JJ, Cervantes F, Leebeek FW. , et al. The impact of JAK2 and MPL mutations on diagnosis and prognosis of splanchnic vein thrombosis: a report on 241 cases. Blood 2008; 111 (10) 4922-4929
• 9 Primignani M, Barosi G, Bergamaschi G. , et al. Role of the JAK2 mutation in the diagnosis of chronic myeloproliferative disorders in splanchnic vein thrombosis. Hepatology 2006; 44 (06) 1528-1534
• 10 Dentali F, Galli M, Gianni M, Ageno W. Inherited thrombophilic abnormalities and risk of portal vein thrombosis. a meta-analysis. Thromb Haemost 2008; 99 (04) 675-682
• 11 Raffa S, Reverter JC, Seijo S. , et al. Hypercoagulability in patients with chronic noncirrhotic portal vein thrombosis. Clin Gastroenterol Hepatol 2012; 10 (01) 72-78
• 12 Abdu RA, Zakhour BJ, Dallis DJ. Mesenteric venous thrombosis--1911 to 1984. Surgery 1987; 101 (04) 383-388
• 13 Harward TR, Green D, Bergan JJ, Rizzo RJ, Yao JS. Mesenteric venous thrombosis. J Vasc Surg 1989; 9 (02) 328-333
• 14 Grendell JH, Ockner RK. Mesenteric venous thrombosis. Gastroenterology 1982; 82 (02) 358-372
• 15 Acosta S, Alhadad A, Svensson P, Ekberg O. Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg 2008; 95 (10) 1245-1251
• 16 Amitrano L, Guardascione MA, Scaglione M. , et al. Prognostic factors in noncirrhotic patients with splanchnic vein thromboses. Am J Gastroenterol 2007; 102 (11) 2464-2470
• 17 Turnes J, García-Pagán JC, González M. , et al. Portal hypertension-related complications after acute portal vein thrombosis: impact of early anticoagulation. Clin Gastroenterol Hepatol 2008; 6 (12) 1412-1417
• 18 Clavien PA. Diagnosis and management of mesenteric infarction. Br J Surg 1990; 77 (06) 601-603
• 19 European Association for the Study of the Liver. Electronic address: [e-mail]. EASL Clinical Practice Guidelines: vascular diseases of the liver. J Hepatol 2016; 64 (01) 179-202
• 20 Valla DC, Condat B. Portal vein thrombosis in adults: pathophysiology, pathogenesis and management. J Hepatol 2000; 32 (05) 865-871
• 21 Rajani R, Björnsson E, Bergquist A. , et al. The epidemiology and clinical features of portal vein thrombosis: a multicentre study. Aliment Pharmacol Ther 2010; 32 (09) 1154-1162
• 22 Rahmouni A, Mathieu D, Golli M. , et al. Value of CT and sonography in the conservative management of acute splenoportal and superior mesenteric venous thrombosis. Gastrointest Radiol 1992; 17 (02) 135-140
• 23 Tessler FN, Gehring BJ, Gomes AS. , et al. Diagnosis of portal vein thrombosis: value of color Doppler imaging. Am J Roentgenol 1991; 157 (02) 293-296
• 24 Plessier A, Rautou PE, Valla DC. Management of hepatic vascular diseases. J Hepatol 2012; 56 (Suppl. 01) S25-S38
• 25 Senzolo M, Riggio O, Primignani M. ; Italian Association for the Study of the Liver (AISF) ad hoc. Vascular disorders of the liver: recommendations from the Italian Association for the Study of the Liver (AISF) ad hoc committee. Dig Liver Dis 2011; 43 (07) 503-514
• 26 Elkrief L, Corcos O, Bruno O. , et al. Type 2 diabetes mellitus as a risk factor for intestinal resection in patients with superior mesenteric vein thrombosis. Liver Int 2014; 34 (09) 1314-1321
• 27 DeLeve LD, Valla DC, Garcia-Tsao G. ; American Association for the Study Liver Diseases. Vascular disorders of the liver. Hepatology 2009; 49 (05) 1729-1764
• 28 Condat B, Valla D. Nonmalignant portal vein thrombosis in adults. Nat Clin Pract Gastroenterol Hepatol 2006; 3 (09) 505-515
• 29 Condat B, Vilgrain V, Asselah T. , et al. Portal cavernoma-associated cholangiopathy: a clinical and MR cholangiography coupled with MR portography imaging study. Hepatology 2003; 37 (06) 1302-1308
• 30 Llop E, de Juan C, Seijo S. , et al. Portal cholangiopathy: radiological classification and natural history. Gut 2011; 60 (06) 853-860
• 31 Kumar S, Sarr MG, Kamath PS. Mesenteric venous thrombosis. N Engl J Med 2001; 345 (23) 1683-1688
• 32 Kumar S, Kamath PS. Acute superior mesenteric venous thrombosis: one disease or two?. Am J Gastroenterol 2003; 98 (06) 1299-1304
• 33 Chamarthy MR, Anderson ME, Pillai AK, Kalva SP. Thrombolysis and transjugular intrahepatic portosystemic shunt creation for acute and subacute portal vein thrombosis. Tech Vasc Interv Radiol 2016; 19 (01) 42-51
• 34 Hollingshead M, Burke CT, Mauro MA, Weeks SM, Dixon RG, Jaques PF. Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis. J Vasc Interv Radiol 2005; 16 (05) 651-661
• 35 Liu FY, Wang MQ, Duan F, Wang ZJ, Song P. Interventional therapy for symptomatic-benign portal vein occlusion. Hepatogastroenterology 2010; 57 (104) 1367-1374
• 36 Lopera JE, Correa G, Brazzini A. , et al. Percutaneous transhepatic treatment of symptomatic mesenteric venous thrombosis. J Vasc Surg 2002; 36 (05) 1058-1061
• 37 Semiz-Oysu A, Keussen I, Cwikiel W. Interventional radiological management of prehepatic obstruction of [corrected] the splanchnic venous system. Cardiovasc Intervent Radiol 2007; 30 (04) 688-695
• 38 Wang MQ, Liu FY, Duan F, Wang ZJ, Song P, Fan QS. Acute symptomatic mesenteric venous thrombosis: treatment by catheter-directed thrombolysis with transjugular intrahepatic route. Abdom Imaging 2011; 36 (04) 390-398
• 39 Klinger C, Riecken B, Schmidt A. , et al. Transjugular local thrombolysis with/without TIPS in patients with acute non-cirrhotic, non-malignant portal vein thrombosis. Dig Liver Dis 2017; 49 (12) 1345-1352
• 40 Zocco MA, Di Stasio E, De Cristofaro R. , et al. Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development. J Hepatol 2009; 51 (04) 682-689
• 41 Malkowski P, Pawlak J, Michalowicz B. , et al. Thrombolytic treatment of portal thrombosis. Hepatogastroenterology 2003; 50 (54) 2098-2100
• 42 Brunaud L, Antunes L, Collinet-Adler S. , et al. Acute mesenteric venous thrombosis: case for nonoperative management. J Vasc Surg 2001; 34 (04) 673-679