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1
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Chen F, Xiong QG, Lu F, Luo ZJ, Luo W, Zhou W. Genetic Diagnosis and Combinational Treatment With Pharmacomechanical Thrombectomy and Transjugular Intrahepatic Portosystemic Shunt for Non-cirrhotic and Non-malignant Portal Vein Thrombosis. Vasc Endovascular Surg 2025:15385744251334793. [PMID: 40227156 DOI: 10.1177/15385744251334793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2025]
Abstract
ObjectiveThis study aimed to evaluate the potential role of the whole-exome sequencing (WES) technique in screening pathogenic genes of non-cirrhotic and non-malignant portal vein thrombosis (PVT) and the clinical efficacy of AngioJet-assisted pharmacomechanical thrombectomy (PMT) with transjugular intrahepatic portosystemic stent shunt (TIPS) to treat this disease.Methods16 patients with acute non-cirrhotic and non-malignant PVT were retrospectively analyzed. 14 patients received genetically diagnosed using the WES technique, ten patients received PMT with or without TIPS and 6 cases received anticoagulation alone. Changes in clinical symptoms, and recanalization of the portal vein (PV) were also recorded.Results4 patients (28.6%) had JAK2 V617 F mutation, 4 patients (28.6%) had PROC mutations, 3 patients (21.4%) had SERPINC1mutations. Among patients treated with anticoagulation alone, 5 patients (83.3%, 5/6) developed cavernous transformation of PV and one patient with JAK2 V617 F mutation achieved complete recanalization of PV. One patient treated with PMT without TIPS developed PV cavernous transformation, eight patients (80%) treated with PMT and TIPS achieved complete or partial recanalization of PV. Three patients who developed intestinal necrosis all had SERPINC1 mutations and one of them died of intestinal necrosis. No recurrence was found during follow-up (1-36 months).ConclusionsThe WES technique offers a promising way to screen for thrombophilia in patients with non-cirrhotic and non-malignant PVT. Patients with SERPINC1 mutations are more inclined to develop intestinal necrosis than others. PMT combined with TIPS provides a safe and effective therapeutic alternative.
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Affiliation(s)
- Feng Chen
- Department of Vascular and Interventional Radiology, the second affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Qing Gen Xiong
- Department of Vascular and Interventional Radiology, the second affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Fei Lu
- Department of Vascular and Interventional Radiology, the second affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Zhi Jian Luo
- Department of Vascular and Interventional Radiology, the second affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Wei Luo
- Department of Vascular and Interventional Radiology, the second affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Wei Zhou
- Department of Vascular and Interventional Radiology, the second affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
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2
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Ueda T, Saito H, Shirai S, Sugihara F, Fujitsuna R, Matsumoto T, Hayashi H, Kumita SI. Endovascular Treatment for Acute Portal Vein Thrombosis. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2025; 10:e20230027. [PMID: 40384906 PMCID: PMC12078051 DOI: 10.22575/interventionalradiology.2023-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/27/2023] [Indexed: 05/20/2025]
Abstract
Acute portal vein thrombosis is characterized by nonspecific abdominal pain, causing severe morbidity and mortality. Prompt diagnosis is crucial to avoid short-term complications such as intestinal infarction, sepsis, and death. The therapeutic goal is to prevent thrombus extension into the mesenteric veins and intestinal ischemia complications. Systemic anticoagulation is the standard treatment. However, endovascular treatments such as thrombolysis, thrombectomy, balloon angioplasty, stent placement, and transjugular intrahepatic portosystemic shunt placement have been performed in patients who are refractory to anticoagulation therapy or at a high risk of intestinal ischemia. This review discusses the clinical and diagnostic considerations in acute portal vein thrombosis, focusing on current endovascular treatments that are effective and safe. However, prospective data are required to compare endovascular treatment techniques and assess their outcomes.
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Affiliation(s)
- Tatsuo Ueda
- Department of Radiology, Nippon Medical School Hospital, Japan
| | - Hidemasa Saito
- Department of Radiology, Nippon Medical School Hospital, Japan
| | - Sayaka Shirai
- Department of Radiology, Nippon Medical School Hospital, Japan
| | - Fumie Sugihara
- Department of Radiology, Nippon Medical School Hospital, Japan
| | | | - Taiga Matsumoto
- Department of Radiology, Nippon Medical School Hospital, Japan
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3
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Mathew MA, Boucher KA. Extensive Portal Vein Thrombosis Following Laparoscopic Cholecystectomy: Interplay of Liver Cirrhosis, Psoriasis, and Anticoagulation Oversight. Cureus 2025; 17:e79958. [PMID: 40177431 PMCID: PMC11964119 DOI: 10.7759/cureus.79958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2025] [Indexed: 04/05/2025] Open
Abstract
Portal vein thrombosis (PVT) is a rare but serious condition often associated with liver cirrhosis, malignancy, and hypercoagulable states. While PVT following laparoscopic surgery is uncommon, certain risk factors can predispose patients to this complication. A 65-year-old male with a history of untreated plaque psoriasis and alcoholic liver cirrhosis with portal hypertension developed PVT after a robot-assisted laparoscopic cholecystectomy. The patient presented with abdominal swelling and mild epigastric pain two months postoperatively. Imaging revealed an occlusive thrombus in the portal vein extending into the splenic and superior mesenteric veins, accompanied by bowel congestion, edema, and early signs of ischemia. The patient had been on warfarin prior to surgery for an unclear reason but had failed to resume warfarin use postoperatively due to a lack of follow-up with his primary care physician. After managing the patient's PVT with a heparin drip followed by apixaban, his symptoms improved. A thrombophilia panel revealed decreased activity of antithrombin III, factor II, and protein C. Thorough preoperative history-taking and postoperative primary care follow-up are essential, particularly in patients with multiple thromboembolic risk factors. The unexpected role of untreated psoriasis as a potential contributor to PVT highlights the need for further research into the systemic effects of chronic inflammatory conditions.
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Affiliation(s)
- Merry A Mathew
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Kent-Andrew Boucher
- Department of Surgery, Texas Tech University Health Sciences Center, Odessa, USA
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Lorenz J, Kwak DH, Martin L, Kesselman A, Hofmann LV, Yu Q, Youssef S, Ciolek P, Ahmed O. Endovascular Management of Noncirrhotic Acute Portomesenteric Venous Thrombosis. J Vasc Interv Radiol 2025; 36:17-30. [PMID: 39389231 DOI: 10.1016/j.jvir.2024.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 09/16/2024] [Accepted: 09/28/2024] [Indexed: 10/12/2024] Open
Abstract
Acute portomesenteric venous thrombosis (PVT) is a rare but potentially life-threatening condition in individuals without cirrhosis. Initial management typically involves anticoagulation therapy, but the optimal approach to interventional treatment remains a topic of ongoing research. This article explores both traditional and emerging endovascular techniques, providing an overview of the existing evidence supporting their use. Additionally, it delves into the significance of acute PVT in the context of contemporary pathologies, notably coronavirus disease 2019 infection, vaccine-induced immune thrombotic thrombocytopenia, and liver transplantation.
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Affiliation(s)
- Jonathan Lorenz
- Section of Interventional Radiology, Department of Radiology, the University of Chicago Medical Center, Chicago, Illinois
| | - Daniel H Kwak
- Section of Interventional Radiology, Department of Radiology, the University of Chicago Medical Center, Chicago, Illinois.
| | - Lynne Martin
- Division of Interventional Radiology, Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Andrew Kesselman
- Division of Interventional Radiology, Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Lawrence V Hofmann
- Division of Interventional Radiology, Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Qian Yu
- Section of Interventional Radiology, Department of Radiology, the University of Chicago Medical Center, Chicago, Illinois
| | - Salma Youssef
- University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Paul Ciolek
- Chicago Medical School of Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Osman Ahmed
- Section of Interventional Radiology, Department of Radiology, the University of Chicago Medical Center, Chicago, Illinois
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5
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Yuan JJ, Zhang HF, Zhang J, Li JZ. Mesenteric venous thrombosis in a young adult: A case report and review of the literature. World J Radiol 2024; 16:569-578. [PMID: 39494142 PMCID: PMC11525824 DOI: 10.4329/wjr.v16.i10.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 08/22/2024] [Accepted: 09/06/2024] [Indexed: 10/28/2024] Open
Abstract
BACKGROUND Acute mesenteric vein thrombosis (MVT) accounts for only 2%-10% of all cases of acute mesenteric ischaemia, with an incidence rate of ~0.1% in Europe and the United States. It represents < 10% of mesenteric infarction cases and is seen predominantly in older adults. In younger individuals, MVT is uncommon, with 36% of cases having unidentified mechanisms and causes. CASE SUMMARY A 27-year-old man presented to the emergency department on February 29, 2024, with a chief complaint of intermittent abdominal pain for 3 day. He was previously in good health. As the abdominal pain was not alleviated by conventional treatment, an abdominal computed tomography (CT) scan was performed, which showed increased density in the portal and mesenteric veins. Further imaging, including portal vein ultrasound, mesenteric CT angiography, and enhanced abdominal CT, revealed widespread thrombosis of the portal vein system (including the main portal vein, left and right branches, proximal mesenteric vein, and splenic vein). After 10 day of thrombectomy and anticoagulation therapy, the patient's abdominal pain had improved significantly. Follow-up assessments indicated that portal venous blood flow had largely returned to normal. He was discharged on March 9, 2024. During a follow-up exam 2 months later, repeat abdominal enhanced CT showed that the previously detected thrombi were no longer visible. CONCLUSION Clinicians should remain vigilant for acute MVT in young patients presenting with abdominal pain, to prevent misdiagnosis of this fatal condition.
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Affiliation(s)
- Jiao-Jiao Yuan
- Department of Emergency Medicine, Ninth Hospital of Xi'an, Xi’an 710000, Shaanxi Province, China
| | - Hai-Fu Zhang
- Department of Vascular Intervention, Ninth Hospital of Xi'an, Xi’an 710000, Shaanxi Province, China
| | - Jian Zhang
- Department of Emergency Medicine, Ninth Hospital of Xi'an, Xi’an 710000, Shaanxi Province, China
| | - Jun-Zhi Li
- Department of Emergency Medicine, Ninth Hospital of Xi'an, Xi’an 710000, Shaanxi Province, China
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Barrera-Lozano LM, Ramírez-Arbeláez JA, Muñoz CL, Becerra JA, Toro LG, Ardila CM. Portal Vein Thrombosis in Liver Transplantation: A Retrospective Cohort Study. J Clin Med 2023; 12:3951. [PMID: 37373645 PMCID: PMC10299236 DOI: 10.3390/jcm12123951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Portal vein thrombosis was considered a contraindication for liver transplantation. This study analyzes the perioperative complications and survival of liver transplant patients with portal vein thrombosis (PVT). A retrospective observational cohort study of liver transplant patients was conducted. The outcomes were early mortality (30 days) and patient survival. A total of 201 liver transplant patients were identified and 34 (17%) patients with PVT were found. The most frequent extension of thrombosis was Yerdel 1 (58.8%), and a portosystemic shunt was identified in 23 (68%) patients. Eleven patients (33%) presented any early vascular complication, PVT being the most frequent (12%). The multivariate regression analysis showed a statistically significant association between PVT and early complications (OR = 3.3, 95% confidence interval 1.4-7.7; p = 0.006). Moreover, early mortality was observed in eight patients (24%), of which two (5.9%) presented Yerdel 2. For Yerdel 1, patient survival according to the extent of thrombosis was 75% at 1 year and 3 years, while for Yerdel 2, it was 65% at 1 year, and 50% at 3 years (p = 0.04). Portal vein thrombosis significantly influenced early vascular complications. Furthermore, portal vein thrombosis Yerdel 2 or higher impacts the survival of liver grafts in the short and long term.
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Affiliation(s)
- Luis Manuel Barrera-Lozano
- Transplant Department, Hospital San Vicente Fundación, Rionegro 054047, Colombia; (L.M.B.-L.); (J.A.R.-A.); (C.L.M.); (L.G.T.)
- Vascular Medicine Department, Faculty of Medicine, Universidad de Antioquia UdeA, Medellín 050010, Colombia
| | - Jaime Alberto Ramírez-Arbeláez
- Transplant Department, Hospital San Vicente Fundación, Rionegro 054047, Colombia; (L.M.B.-L.); (J.A.R.-A.); (C.L.M.); (L.G.T.)
| | - Cristian Leonardo Muñoz
- Transplant Department, Hospital San Vicente Fundación, Rionegro 054047, Colombia; (L.M.B.-L.); (J.A.R.-A.); (C.L.M.); (L.G.T.)
| | | | - Luis Guillermo Toro
- Transplant Department, Hospital San Vicente Fundación, Rionegro 054047, Colombia; (L.M.B.-L.); (J.A.R.-A.); (C.L.M.); (L.G.T.)
| | - Carlos M. Ardila
- Basic Studies Department, School of Dentistry, Universidad de Antioquia UdeA, Medellín 050010, Colombia
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da Cruz Renó L, Tustumi F, Waisberg DR, Rocha-Santos V, Pinheiro RS, Macedo RA, Nacif LS, Ducatti L, De Martino RB, Trevisan AM, Carneiro-D’Albuquerque L, Andraus W. Venous thromboembolism in in-hospital cirrhotic patients: A systematic review. Front Med (Lausanne) 2022; 9:1027882. [PMID: 36419795 PMCID: PMC9676642 DOI: 10.3389/fmed.2022.1027882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/14/2022] [Indexed: 08/30/2023] Open
Abstract
INTRODUCTION Patients with liver cirrhosis are at a higher risk of hospitalization. The present review aimed to assess the risk of thromboembolism and its burden on hospitalized cirrhotic patients. MATERIALS AND METHODS A systematic review (PROSPERO: CRD42021256869) was conducted in PubMed, Embase, Cochrane, Lilacs, and a manual search of references. It evaluated studies that compare cirrhotic patients with venous thromboembolism (VTE) with cirrhotic patients without VTE or studies that compare cirrhotic patients with non-cirrhotic patients. No restrictions were set for the date of publication or language. The last search was conducted in June 2021. RESULTS After selection, 17 studies were included from an initial search of 5,323 articles. The chronic liver disease etiologies comprise viral, alcohol, autoimmune, NASH (non-alcoholic steatohepatitis), cryptogenic, hemochromatosis, cholestasis, and drug-related. The included studies were conflicted regarding the outcomes of VTE, pulmonary embolism, or bleeding. Patients with cirrhosis associated with VTE had prolonged length of hospital stay, and patients with cirrhosis were at higher risk of portal thrombosis. CONCLUSION In-hospital cirrhotic patients are a heterogeneous group of patients that may present both thrombosis and bleeding risk. Clinicians should take extra caution to apply both prophylactic and therapeutic anticoagulation strategies. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021256869].
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Affiliation(s)
| | - Francisco Tustumi
- Transplantation Unit, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
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Naidu SG, Alzubaidi SJ, Patel IJ, Iwuchukwu C, Zurcher KS, Malik DG, Knuttinen MG, Kriegshauser JS, Wallace AL, Katariya NN, Mathur AK, Oklu R. Interventional Radiology Management of Adult Liver Transplant Complications. Radiographics 2022; 42:1705-1723. [DOI: 10.1148/rg.220011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sailendra G. Naidu
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Sadeer J. Alzubaidi
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Indravadan J. Patel
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Chris Iwuchukwu
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Kenneth S. Zurcher
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Dania G. Malik
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Martha-Gracia Knuttinen
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - J. Scott Kriegshauser
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Alex L. Wallace
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Nitin N. Katariya
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Amit K. Mathur
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Rahmi Oklu
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
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Barah A, Al-Hashimi I, Kassamali R, Aldebyani Q, Almokdad O, Elmagdoub A, Khader M, Rehman SU, Omar A. Catheter-Directed Thrombolysis in the treatment of acute Portomesenteric Vein Thrombosis after Laparoscopic Sleeve Gastrectomy. Thromb J 2022; 20:57. [PMID: 36175959 PMCID: PMC9524041 DOI: 10.1186/s12959-022-00415-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 03/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Portomesenteric Vein Thrombosis (PMVT) following Laparoscopic Sleeve Gastrectomy (LSG) is an uncommon but potentially debilitating complication. Catheter-Directed Thrombolysis (CDT) has an evolving role in recanalizing the venous flow and preventing thrombus propagation. Therefore, it can be used as an alternative or in combination with systemic anticoagulants in selected patients. We report two trans-hepatic and trans-splenic CDT. The patient’s clinical details, radiological findings, safety, and efficacy are reported. Cases presentation Two patients presented to the Emergency Department (ED) within 14 days of surgery. The presenting complaints were generally nonspecific. The diagnosis of PMVT was established in both patients based on abdominal Contrast-Enhanced Computed Tomography (CECT). The two patients received a combined therapy of subcutaneous (SC) heparinization and CDT using a trans-hepatic approach in case 1 and a trans-splenic approach in case 2. Subsequent post-procedure venograms and CECT were performed and showed significant thrombus resolution. Both patients received oral anticoagulant therapy upon discharge with a successful overall recovery. Conclusion PMVT is an infrequent and severe post LSG complication. Various approaches for re-establishing the portal venous flow have been described according to the severity of venous thrombosis. This article describes CDT therapy as a safe and effective option for treating PMVT in symptomatic patients.
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Affiliation(s)
- Ali Barah
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar.
| | - Israa Al-Hashimi
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
| | - Rahil Kassamali
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
| | - Qayed Aldebyani
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
| | - Omran Almokdad
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
| | - Ayman Elmagdoub
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Khader
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
| | - Saad U Rehman
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Omar
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
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10
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Zurcher KS, Smith MV, Naidu SG, Saini G, Patel IJ, Knuttinen MG, Kriegshauser JS, Oklu R, Alzubaidi SJ. Transsplenic Portal System Catheterization: Review of Current Indications and Techniques. Radiographics 2022; 42:1562-1576. [PMID: 35984753 DOI: 10.1148/rg.220042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Multiple diseases of the portal system require effective portal vein access for endovascular management. While percutaneous transhepatic and transjugular approaches remain the standard methods of portal vein access, transsplenic access (TSA) has gained recognition as an effective and safe technique to access the portal system in patients with contraindications to traditional approaches. Recently, the utility of percutaneous TSA has grown, with described treatments including recanalization of chronic portal vein occlusion, placement of stents for portal vein stenosis, portal vein embolization of the liver, embolization of gastric varices, placement of complicated transjugular intrahepatic portosystemic shunts, and interventions after liver transplant. The authors provide a review of percutaneous TSA, including indications, a summary of related portal vein diseases, and the different techniques used for access and closure. In addition, an imaging-based review of technical considerations of TSA interventions is presented, with a review of potential procedural complications. With technical success rates that mirror or rival the standard methods and reported low rates of major complications, TSA can be a safe and effective option in clinical scenarios where traditional approaches are not feasible. ©RSNA, 2022.
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Affiliation(s)
- Kenneth S Zurcher
- From the Division of Vascular and Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Mathew V Smith
- From the Division of Vascular and Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Sailendra G Naidu
- From the Division of Vascular and Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Gia Saini
- From the Division of Vascular and Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Indravadan J Patel
- From the Division of Vascular and Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - M Grace Knuttinen
- From the Division of Vascular and Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - J Scott Kriegshauser
- From the Division of Vascular and Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Rahmi Oklu
- From the Division of Vascular and Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Sadeer J Alzubaidi
- From the Division of Vascular and Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054
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11
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DeLeeuw P, Agbim U. Pre-transplant portal vein thrombosis in non-alcoholic fatty liver disease patients-pathogenesis, risk factors, and implications on management. Transl Gastroenterol Hepatol 2022; 7:27. [PMID: 35892050 PMCID: PMC9257532 DOI: 10.21037/tgh-19-361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 07/20/2020] [Indexed: 02/18/2024] Open
Abstract
Along with the worldwide increase in obesity and metabolic syndrome, non-alcoholic fatty liver disease (NAFLD) and its more severe subset, non-alcoholic steatohepatitis (NASH), are on path to become the leading cause of liver transplantation in the United States. NAFLD, as well as obesity, create an inflammatory milieu via the release of adipocytokines. In turn, the inflammatory environment can trigger an increase in prothrombotic factors. Independent of inflammation, the severity of NASH is associated with a graded increase in hypercoagulability such as an increase in factor VIII, increase in plasminogen activator inhibitor-1, and decrease in protein C. Ultimately, this environment creates an increase in thrombotic risk, leading to higher rates of pre-transplant portal vein thrombosis (PVT) in patients with NASH cirrhosis vesus other causes of cirrhosis. Many studies have shown worse outcomes in liver transplant recipients with PVT as it complicates anastomotic reconstruction which can negatively affect portal blood supply needed for adequate liver functioning. Management and treatment of PVT is not standardized, but from a pharmacologic standpoint, multiple classes of anticoagulants have shown to be successful in recanalization of the portal vein and preventing recurrence of clot with minimal bleeding complications. The increasing prevalence of NASH cirrhosis and subsequent increase in PVT require further research for improved outcomes.
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Affiliation(s)
- Peter DeLeeuw
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Uchenna Agbim
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
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Biolato M, Paratore M, Di Gialleonardo L, Marrone G, Grieco A. Direct oral anticoagulant administration in cirrhotic patients with portal vein thrombosis: What is the evidence? World J Hepatol 2022; 14:682-695. [PMID: 35646264 PMCID: PMC9099104 DOI: 10.4254/wjh.v14.i4.682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/22/2021] [Accepted: 04/03/2022] [Indexed: 02/06/2023] Open
Abstract
In recent years, the traditional concept that cirrhosis-related coagulopathy is an acquired bleeding disorder has evolved. Currently, it is known that in cirrhotic patients, the hemostatic system is rebalanced, which involves coagulation factors, fibrinolysis and platelets. These alterations disrupt homeostasis, skewing it toward a procoagulant state, which can lead to thromboembolic manifestations, especially when hemodynamic and endothelial factors co-occur, such as in the portal vein system in cirrhosis. Portal vein thrombosis is a common complication of advanced liver cirrhosis that negatively affects the course of liver disease, prognosis of cirrhotic patients and success of liver transplantation. It is still debated whether portal vein thrombosis is the cause or the consequence of worsening liver function. Anticoagulant therapy is the mainstay treatment for acute symptomatic portal vein thrombosis. In chronic portal vein thrombosis, the role of anticoagulant therapy is still unclear. Traditional anticoagulants, vitamin K antagonists and low-molecular-weight heparin are standard-of-care treatments for portal vein thrombosis. In the last ten years, direct oral anticoagulants have been approved for the prophylaxis and treatment of many thromboembolic-related diseases, but evidence on their use in cirrhotic patients is very limited. The aim of this review was to summarize the evidence about the safety and effectiveness of direct oral anticoagulants for treating portal vein thrombosis in cirrhotic patients.
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Affiliation(s)
- Marco Biolato
- Internal and Liver Transplant Medicine Unit, CEMAD, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Institute of Internal Medicine, Catholic University of Sacred Heart, Rome 00168, Italy.
| | - Mattia Paratore
- Institute of Internal Medicine, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Luca Di Gialleonardo
- Institute of Internal Medicine, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Giuseppe Marrone
- Internal and Liver Transplant Medicine Unit, CEMAD, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Institute of Internal Medicine, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Antonio Grieco
- Internal and Liver Transplant Medicine Unit, CEMAD, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Institute of Internal Medicine, Catholic University of Sacred Heart, Rome 00168, Italy
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13
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Gadani S, Partovi S, Levitin A, Zerona N, Sengupta S, D’Amico G, Diago Uso T, Menon KVN, Quintini C. Narrative review of portal vein thrombosis in cirrhosis: pathophysiology, diagnosis, and management from an interventional radiology perspective. Cardiovasc Diagn Ther 2022; 12:135-146. [PMID: 35282661 PMCID: PMC8898691 DOI: 10.21037/cdt-21-98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 10/25/2021] [Indexed: 09/01/2023]
Abstract
OBJECTIVE This paper examines the incidence, clinical presentation, and pathophysiology of portal vein thrombosis (PVT) in cirrhosis. Additionally, we have reviewed the literature regarding the current status of medical and interventional radiology management of PVT and have proposed a novel algorithm for the management given different clinical scenarios. Lastly two representative cases displaying endovascular treatment options are provided. BACKGROUND Portal vein thrombus in the setting of cirrhosis is an increasingly recognized clinical issue with debate on its pathophysiology, natural course, and optimal treatment. Approximately one-third of patients are asymptomatic, and detection of the thrombus is an incidental finding on imaging performed for other reasons. In 30% to 50% of patients, PVT resolves spontaneously. However, there is increased post-transplant mortality in patients with completely occlusive PVT, therefore effective early revascularization strategies are needed for patients with complete PVT who are expected to undergo liver transplant. Additionally, no consensus has been reached regarding PVT treatment in terms of timing and type of interventions as well as type and duration of anticoagulation. METHODS Computerized literature search as well as discussion with experts in the field. CONCLUSIONS Management of PVT is complex, as many variables affect which treatments can be used. Anticoagulation appears to be the optimal first-line treatment in patients with acute PVT but without bleeding varices or mesenteric ischemia. Minimally invasive treatments include various methods of mechanical thrombectomy, chemical thrombolysis, and transjugular intrahepatic portosystemic shunt (TIPS) placement with or without variceal embolization. Definitive recommendations are difficult due to lack of high quality data and continued research is needed to evaluate the efficacy of different anticoagulants as well as the timing and use of various minimally invasive therapies in specific circumstances.
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Affiliation(s)
- Sameer Gadani
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sasan Partovi
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Abraham Levitin
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nicholas Zerona
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Shreya Sengupta
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Giuseppe D’Amico
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Teresa Diago Uso
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - K. V. Narayanan Menon
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Cristiano Quintini
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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14
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Gao Y, Liu H, Tang F, Zhang X, Li F, Ye Q, Yuan H, Lv H, Han T. Efficacy and safety of anticoagulants in liver cirrhosis patients with portal vein thrombosis: A meta-analysis. Clin Res Hepatol Gastroenterol 2021; 45:101649. [PMID: 33601064 DOI: 10.1016/j.clinre.2021.101649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the efficacy and safety of anticoagulants in liver cirrhosis patients with portal vein thrombosis (PVT). METHODS PubMed, BioMed Central, Cochrane Library and Web of Science were retrieved to identify relevant literature. Forest plots were applied to display the results of the meta-analysis. The odds ratios (ORs) were used as the effect index for the enumeration data, and the effect size was expressed as 95% confidence intervals (CIs). Publication bias was evaluated by funnel plots and Egger's test. RESULTS Eight articles included 225 patients with liver cirrhosis and PVT receiving anticoagulants and 232 not receiving anticoagulants. The data demonstrated that the recanalization rate of PVT was significantly higher in patients with anticoagulant treatment than in patients without anticoagulant treatment (OR=5.60; 95% CI: 3.40-9.22; P<0.001). The exacerbation risk of PVT was significantly lower in patients with anticoagulant treatment than in patients without anticoagulant treatment (OR=0.15; 95% CI: 0.04-0.54; P<0.001). A significantly lower portal hypertension bleeding effect was observed in patients with anticoagulant treatment than in patients without anticoagulant treatment (OR=0.21; 95% CI: 0.10-0.45; P<0.001). Low molecular weight heparins (LMWH) were more effective in preventing the PVT exacerbation in liver cirrhosis patients with PVT than warfarin (OR=0.16; 95% CI: 0.08-0.35). CONCLUSIONS Anticoagulants were effective and safe in treating patients with liver cirrhosis and PVT as they could increase the PVT recanalization rate and decrease the risks of PVT exacerbation and portal hypertension bleeding.
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Affiliation(s)
- Yanying Gao
- Department of Gastroenterology, Tianjin Third Central Hospital, Tianjin 300170, China
| | - Hua Liu
- Department of Gastroenterology, Tianjin Third Central Hospital, Tianjin 300170, China
| | - Fei Tang
- Department of Gastroenterology, Tianjin Third Central Hospital, Tianjin 300170, China
| | - Xu Zhang
- Department of Gastroenterology, Tianjin Third Central Hospital, Tianjin 300170, China
| | - Fenghui Li
- Department of Gastroenterology, Tianjin Third Central Hospital, Tianjin 300170, China
| | - Qing Ye
- Department of Gastroenterology, Tianjin Third Central Hospital, Tianjin 300170, China
| | - Haixia Yuan
- Department of Gastroenterology, Tianjin Third Central Hospital, Tianjin 300170, China
| | - Hongmin Lv
- Department of Gastroenterology, Tianjin Third Central Hospital, Tianjin 300170, China
| | - Tao Han
- Department of Gastroenterology, Tianjin Third Central Hospital, Tianjin 300170, China.
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Abstract
Portal vein thrombosis (PVT) is one of the common complications of liver cirrhosis, which can further increase portal vein pressure and aggravate liver function decompensation. However, due to the insidious onset and atypical symptoms, the importance of PVT has been neglected in clinical work for quite a long time. With the development of clinical diagnostic technology, the detection rate of PVT has increased year by year. At present, the well-established treatment methods for PVT include anticoagulant therapy, interventional therapy, and surgical treatment. However, the optimal choice for PVT treatment remains unclear. In this paper, we briefly review the recent progress in the diagnosis and treatment of PVT in order to provide a theoretical reference for the refined clinical management of patients with PVT.
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Affiliation(s)
- Wen-Yue Wu
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Hefei 237000, Anhui Province, China
| | - De-Run Kong
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Hefei 237000, Anhui Province, China
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Cannella R, Taibbi A, Porrello G, Dioguardi Burgio M, Cabibbo G, Bartolotta TV. Hepatocellular carcinoma with macrovascular invasion: multimodality imaging features for the diagnosis. Diagn Interv Radiol 2020; 26:531-540. [PMID: 32990243 DOI: 10.5152/dir.2020.19569] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Hepatocellular carcinoma (HCC) is frequently associated with macrovascular invasion of the portal vein or hepatic veins in advanced stages. The accurate diagnosis of macrovascular invasion and the differentiation from bland non-tumoral thrombus has significant clinical and management implications, since it narrows the therapeutic options and it represents a mandatory contraindication for liver resection or transplantation. The imaging diagnosis remains particularly challenging since the imaging features of HCC with macrovascular invasion may be subtle, especially in lesions showing infiltrative appearance. However, each radiologic imaging modality may provide findings suggesting the presence of tumor thrombus rather than bland thrombus. The purpose of this paper is to review the current guidelines and imaging appearance of HCC with macrovascular invasion. Knowledge of the most common imaging features of HCC with macrovascular invasion may improve the diagnostic confidence of tumor thrombus in clinical practice and help to guide patients' management.
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Affiliation(s)
- Roberto Cannella
- Department of Radiology - BiND, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Adele Taibbi
- Department of Radiology - BiND, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Giorgia Porrello
- Department of Radiology - BiND, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Marco Dioguardi Burgio
- Department of Radiology, AP-HP, Hôpital Beaujon, Clichy, Hauts-de-Seine, France;INSERM U1149 "centre de recherche sur l'inflammation", Université de Paris, Paris, France
| | - Giuseppe Cabibbo
- Department of Health Promotion, Division of Gastroenterology and Hepatology, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
| | - Tommaso Vincenzo Bartolotta
- Department of Radiology - BiND, University Hospital "Paolo Giaccone", Palermo, Italy;Department of Radiology, Fondazione Istituto Giuseppe Giglio, Cefalù (Palermo), Italy
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