Inherited thrombophilia (20%) (e.g., factor V Leiden, prothrombin mutation)
Acquired thrombophilia
Myelodysplastic syndrome (11%)
Others: Pregnancy, hormone use (including oral contraceptive pills), antiphospholipid syndrome, etc.
Mortality rates without treatment; justify risk of endovascular treatment after failed anticoagulation
< 10%: Chronic PVT in patient without cirrhosis or malignancy
26%: Chronic PVT in patient with cirrhosis &/or malignancy
20-50%: Acute PVT with evidence of bowel ischemia/infarct
Clinical presentation
Acute thrombosis: Spectrum depends on severity
Right upper quadrant tenderness ± hepatomegaly
Jaundice, ascites
Findings of bowel ischemia/infarction with PVT
Abdominal pain
Nausea, vomiting, diarrhea
Fever, sepsis
Chronic thrombosis: Symptoms related to portal HTN
Ascites
Development of varices ± bleeding
Splenomegaly
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Alternative Procedures/Therapies
OUTCOMES
Complications
Expected Outcomes
Selected References
Sharma AM et al: Portal vein thrombosis: when to treat and how? Vasc Med. 21(1):61-9, 2016
Abdel-Aal AK et al: Endovascular treatment of acute portal vein thrombosis using ultrasound-accelerated catheter-directed thrombolysis. Vasc Endovascular Surg. 48(7-8):460-5, 2014
Wang MQ et al: Acute symptomatic mesenteric venous thrombosis: treatment by catheter-directed thrombolysis with transjugular intrahepatic route. Abdom Imaging. 36(4):390-8, 2011
Ponziani FR et al: Portal vein thrombosis: insight into physiopathology, diagnosis, and treatment. World J Gastroenterol. 16(2):143-55, 2010
Liu FY et al: Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis. World J Gastroenterol. 15(40):5028-34, 2009
Semiz-Oysu A et al: Interventional radiological management of prehepatic obstruction of [corrected] the splanchnic venous system. Cardiovasc Intervent Radiol. 2007 Jul-Aug;30(4):688-95. Erratum in: Cardiovasc Intervent Radiol. 31(1):232, 2008
Darcy M: Single-session treatment of portal vein thrombosis using combined pharmacomechanical thrombolysis. Semin Intervent Radiol. 24(3):327-32, 2007
Ferro C et al: Transjugular intrahepatic portosystemic shunt, mechanical aspiration thrombectomy, and direct thrombolysis in the treatment of acute portal and superior mesenteric vein thrombosis. Cardiovasc Intervent Radiol. 30(5):1070-4, 2007
Kim HS et al: Transhepatic catheter-directed thrombectomy and thrombolysis of acute superior mesenteric venous thrombosis. J Vasc Interv Radiol. 16(12):1685-91, 2005
Bilbao JI et al: Transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of venous symptomatic chronic portal thrombosis in non-cirrhotic patients. Cardiovasc Intervent Radiol. 27(5):474-80, 2004
Kumar S et al: Mesenteric venous thrombosis. N Engl J Med. 345(23):1683-8, 2001
Miller VE et al: Pulsed Doppler duplex sonography and CT of portal vein thrombosis. AJR Am J Roentgenol. 145(1):73-6, 1985
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
TERMINOLOGY
Definitions
Hepatic venous outflow obstruction
3 categories based on level of obstruction
Venoocclusive disease: Sinusoids and terminal venules
Toxin-induced nonthrombotic obstruction; often occurs after stem cell transplant, chemotherapy, or radiotherapy
Budd-Chiari syndrome (BCS)
Pain, ascites, liver enlargement caused by hepatic vein occlusion
Congestive hepatopathy
Passive hepatic congestion, usually related to right heart failure (e.g., tricuspid regurgitation, cor pulmonale)
Associated problems of hepatic venous outflow obstruction
Inherited thrombophilia (20%) (e.g., factor V Leiden, prothrombin mutation)
Acquired thrombophilia
Myelodysplastic syndrome (11%)
Others: Pregnancy, hormone use (including oral contraceptive pills), antiphospholipid syndrome, etc.
Mortality rates without treatment; justify risk of endovascular treatment after failed anticoagulation
< 10%: Chronic PVT in patient without cirrhosis or malignancy
26%: Chronic PVT in patient with cirrhosis &/or malignancy
20-50%: Acute PVT with evidence of bowel ischemia/infarct
Clinical presentation
Acute thrombosis: Spectrum depends on severity
Right upper quadrant tenderness ± hepatomegaly
Jaundice, ascites
Findings of bowel ischemia/infarction with PVT
Abdominal pain
Nausea, vomiting, diarrhea
Fever, sepsis
Chronic thrombosis: Symptoms related to portal HTN
Ascites
Development of varices ± bleeding
Splenomegaly
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Alternative Procedures/Therapies
OUTCOMES
Complications
Expected Outcomes
Selected References
Sharma AM et al: Portal vein thrombosis: when to treat and how? Vasc Med. 21(1):61-9, 2016
Abdel-Aal AK et al: Endovascular treatment of acute portal vein thrombosis using ultrasound-accelerated catheter-directed thrombolysis. Vasc Endovascular Surg. 48(7-8):460-5, 2014
Wang MQ et al: Acute symptomatic mesenteric venous thrombosis: treatment by catheter-directed thrombolysis with transjugular intrahepatic route. Abdom Imaging. 36(4):390-8, 2011
Ponziani FR et al: Portal vein thrombosis: insight into physiopathology, diagnosis, and treatment. World J Gastroenterol. 16(2):143-55, 2010
Liu FY et al: Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis. World J Gastroenterol. 15(40):5028-34, 2009
Semiz-Oysu A et al: Interventional radiological management of prehepatic obstruction of [corrected] the splanchnic venous system. Cardiovasc Intervent Radiol. 2007 Jul-Aug;30(4):688-95. Erratum in: Cardiovasc Intervent Radiol. 31(1):232, 2008
Darcy M: Single-session treatment of portal vein thrombosis using combined pharmacomechanical thrombolysis. Semin Intervent Radiol. 24(3):327-32, 2007
Ferro C et al: Transjugular intrahepatic portosystemic shunt, mechanical aspiration thrombectomy, and direct thrombolysis in the treatment of acute portal and superior mesenteric vein thrombosis. Cardiovasc Intervent Radiol. 30(5):1070-4, 2007
Kim HS et al: Transhepatic catheter-directed thrombectomy and thrombolysis of acute superior mesenteric venous thrombosis. J Vasc Interv Radiol. 16(12):1685-91, 2005
Bilbao JI et al: Transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of venous symptomatic chronic portal thrombosis in non-cirrhotic patients. Cardiovasc Intervent Radiol. 27(5):474-80, 2004
Kumar S et al: Mesenteric venous thrombosis. N Engl J Med. 345(23):1683-8, 2001
Miller VE et al: Pulsed Doppler duplex sonography and CT of portal vein thrombosis. AJR Am J Roentgenol. 145(1):73-6, 1985
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