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Portal Vein Thrombosis

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Complications of Cirrhosis

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Abstract

Portal vein thrombosis (PVT) is increasingly recognized in patients with cirrhosis due to the routine use of accurate noninvasive imaging studies, including Doppler ultrasound, computed tomography, and magnetic resonance imaging, for the detection and diagnosis of complications of end-stage liver disease. Possible risk factors for PVT in patients with cirrhosis include advanced liver disease, underlying thrombophilia, slowing of portal venous blood flow, and previous surgical or endoscopic treatment for portal hypertension. Possible consequences of PVT in patients with cirrhosis include progression of liver disease, ascites, refractory gastrointestinal bleeding, losing veins that can be used for providing portal venous inflow to the liver allograft, and decreased survival after liver transplantation. Differentiating PVT from malignant invasion by hepatocellular carcinoma is crucial but now facilitated by contrast-enhanced imaging. Treatment recommendations are based on limited data. Although placement of a transjugular intrahepatic portosystemic shunt and anticoagulation therapy appear to be feasible in many patients without an obviously increased risk of complications, the impact of these interventions on outcome is still unclear. Promising preliminary results using anticoagulation to prevent PVT and liver disease progression require confirmation.

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References

  1. Rodriguez-Castro KI, Porte RJ, Nadal E, Germani G, Burra P, Senzolo M. Management of nonneoplastic portal vein thrombosis in the setting of liver transplantation: a systematic review. Transplantation. 2012;94(11):1145–53.

    Article  PubMed  Google Scholar 

  2. Tuzuner A, Ersoz S, Hazinedaroglu S, Karayalcin K, Yerdel MA, Anadol E. Technical implications of living donor liver transplantation: a single-center experience. Transplant Proc. 2004;36(1):212–3.

    Article  CAS  PubMed  Google Scholar 

  3. Francoz C, Valla D, Durand F. Portal vein thrombosis, cirrhosis, and liver transplantation. J Hepatol. 2012;57(1):203–12.

    Article  PubMed  Google Scholar 

  4. Tsochatzis EA, Senzolo M, Germani G, Gatt A, Burroughs AK. Systematic review: portal vein thrombosis in cirrhosis. Aliment Pharmacol Ther. 2010;31(3):366–74.

    Article  CAS  PubMed  Google Scholar 

  5. Francoz C, Belghiti J, Vilgrain V, et al. Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation. Gut. 2005;54(5):691–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Amitrano L, Brancaccio V, Guardascione MA, et al. Portal vein thrombosis after variceal endoscopic sclerotherapy in cirrhotic patients: role of genetic thrombophilia. Endoscopy. 2002;34(7):535–8.

    Article  CAS  PubMed  Google Scholar 

  7. Nery F, Chevret S, Condat B, et al. Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis: Results of a longitudinal study. Hepatology. 2015;61:660–7.

    Google Scholar 

  8. Nonami T, Yokoyama I, Iwatsuki S, Starzl TE. The incidence of portal vein thrombosis at liver transplantation. Hepatology. 1992;16(5):1195–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Amitrano L, Guardascione MA, Brancaccio V, et al. Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. J Hepatol. 2004;40(5):736–41.

    Article  PubMed  Google Scholar 

  10. Tripodi A, Anstee QM, Sogaard KK, Primignani M, Valla DC. Hypercoagulability in cirrhosis: causes and consequences. J Thromb Haemost. 2011;9(9):1713–23.

    Article  CAS  PubMed  Google Scholar 

  11. Amitrano L, Brancaccio V, Guardascione MA, et al. Inherited coagulation disorders in cirrhotic patients with portal vein thrombosis. Hepatology. 2000;31(2):345–8.

    Article  CAS  PubMed  Google Scholar 

  12. 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(4):682–9.

    Article  PubMed  Google Scholar 

  13. Englesbe MJ, Schaubel DE, Cai S, Guidinger MK, Merion RM. Portal vein thrombosis and liver transplant survival benefit. Liver Transplant. 2010;16(8):999–1005.

    Article  Google Scholar 

  14. Ayala R, Grande S, Bustelos R, et al. Obesity is an independent risk factor for pre-transplant portal vein thrombosis in liver recipients. BMC Gastroenterol. 2012;12:114.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Amitrano L, Guardascione MA, Martino R, Manguso F, Menchise A, Balzano A. Hypoxic hepatitis occurring in cirrhosis after variceal bleeding: still a lethal disease. J Clin Gastroenterol. 2012;46(7):608–12.

    Article  PubMed  Google Scholar 

  16. Orloff MJ, Orloff MS, Orloff SL, Girard B. Portal vein thrombosis in cirrhosis with variceal hemorrhage. J Gastrointest Surg. 1997;1(2):123–30, discussion 130–1.

    Article  CAS  PubMed  Google Scholar 

  17. Martinez-Noguera A, Montserrat E, Torrubia S, Villalba J. Doppler in hepatic cirrhosis and chronic hepatitis. Semin Ultrasound CT MR. 2002;23(1):19–36.

    Article  PubMed  Google Scholar 

  18. Sandrasegaran K, Tahir B, Nutakki K, et al. Usefulness of conventional MRI sequences and diffusion-weighted imaging in differentiating malignant from benign portal vein thrombus in cirrhotic patients. Am J Roentgenol. 2013;201(6):1211–9.

    Article  Google Scholar 

  19. Piscaglia F, Gianstefani A, Ravaioli M, et al. Criteria for diagnosing benign portal vein thrombosis in the assessment of patients with cirrhosis and hepatocellular carcinoma for liver transplantation. Liver Transplant. 2010;16(5):658–67.

    Google Scholar 

  20. John BV, Konjeti R, Aggarwal A, et al. Impact of untreated portal vein thrombosis on pre and post liver transplant outcomes in cirrhosis. Ann Hepatol. 2013;12(6):952–8.

    CAS  PubMed  Google Scholar 

  21. Luca A, Caruso S, Milazzo M, et al. Natural course of extrahepatic nonmalignant partial portal vein thrombosis in patients with cirrhosis. Radiology. 2012;265(1):124–32.

    Article  PubMed  Google Scholar 

  22. Maruyama H, Okugawa H, Takahashi M, Yokosuka O. De novo portal vein thrombosis in virus-related cirrhosis: predictive factors and long-term outcomes. Am J Gastroenterol. 2013;108(4):568–74.

    Article  PubMed  Google Scholar 

  23. Senzolo M, T MS, Rossetto V, et al. Prospective evaluation of anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis. Liver Int. 2012;32(6):919–27.

    Article  CAS  PubMed  Google Scholar 

  24. Delgado MG, Seijo S, Yepes I, et al. Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol. 2012;10(7):776–83.

    Article  PubMed  Google Scholar 

  25. Plessier A, Darwish-Murad S, Hernandez-Guerra M, et al. Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology. 2010;51(1):210–8.

    Article  PubMed  Google Scholar 

  26. Villa E, Camma C, Marietta M, et al. Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis. Gastroenterology. 2012;143(5):1253–60.e1–4.

    Article  CAS  PubMed  Google Scholar 

  27. Hibi T, Nishida S, Levi DM, et al. When and why portal vein thrombosis matters in liver transplantation: a critical audit of 174 cases. Ann Surg. 2014;259(4):760–6.

    Article  PubMed  Google Scholar 

  28. Doenecke A, Tsui TY, Zuelke C, et al. Pre-existent portal vein thrombosis in liver transplantation: influence of pre-operative disease severity. Clin Transplant. 2010;24(1):48–55.

    Article  CAS  PubMed  Google Scholar 

  29. Amitrano L, Guardascione MA, Menchise A, et al. Safety and efficacy of anticoagulation therapy with low molecular weight heparin for portal vein thrombosis in patients with liver cirrhosis. J Clin Gastroenterol. 2010;44(6):448–51.

    CAS  PubMed  Google Scholar 

  30. Perarnau JM, Baju A, D’Alteroche L, Viguier J, Ayoub J. Feasibility and long-term evolution of TIPS in cirrhotic patients with portal thrombosis. Eur J Gastroenterol Hepatol. 2010;22(9):1093–8.

    Article  PubMed  Google Scholar 

  31. Luca A, Miraglia R, Caruso S, et al. Short- and long-term effects of the transjugular intrahepatic portosystemic shunt on portal vein thrombosis in patients with cirrhosis. Gut. 2011;60(6):846–52.

    Article  PubMed  Google Scholar 

  32. Han G, Qi X, He C, et al. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with symptomatic portal hypertension in liver cirrhosis. J Hepatol. 2011;54(1):78–88.

    Article  PubMed  Google Scholar 

  33. Lisman T, Kamphuisen PW, Northup PG, Porte RJ. Established and new-generation antithrombotic drugs in patients with cirrhosis—possibilities and caveats. J Hepatol. 2013;59(2):358–66.

    Article  CAS  PubMed  Google Scholar 

  34. De Santis A, Moscatelli R, Catalano C, et al. Systemic thrombolysis of portal vein thrombosis in cirrhotic patients: a pilot study. Dig Liver Dis. 2010;42(6):451–5.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. DHU UNITY, Service d’Hépatologie, Hôpital Beaujon, APHP, 100 Boulevard Leclerc, 92118, Clichy, France

    Dominique-Charles Valla MD

  2. Université Paris Diderot, CRI Paris-Montmartre, UMR S1149, Paris, France

    Dominique-Charles Valla MD

  3. CRI Paris-Montmartre, Inserm U1149, Paris, France

    Dominique-Charles Valla MD

  4. Labex Inflamex, PRES Sorbonne Paris Cité, Paris, France

    Dominique-Charles Valla MD

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  1. Dominique-Charles Valla MD
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Correspondence to Dominique-Charles Valla MD .

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Editors and Affiliations

  1. Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA

    Andrew P. Keaveny

  2. Institut de Malalties Digestives i Metaboliques, University of Barcelona, Barcelona, Spain

    Andrés Cárdenas

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Valla, DC. (2015). Portal Vein Thrombosis. In: Keaveny, A., Cárdenas, A. (eds) Complications of Cirrhosis. Springer, Cham. https://doi.org/10.1007/978-3-319-13614-1_20

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  • DOI: https://doi.org/10.1007/978-3-319-13614-1_20

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-13613-4

  • Online ISBN: 978-3-319-13614-1

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