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Journal of Hepatology Aug 2021Portal vein thrombosis (PVT) is an increasingly recognised complication of cirrhosis whose incidence increases in parallel with the severity of cirrhosis. Several risk... (Review)
Review
Portal vein thrombosis (PVT) is an increasingly recognised complication of cirrhosis whose incidence increases in parallel with the severity of cirrhosis. Several risk factors have been associated with the occurrence and progression of PVT. Although the negative effect of complete PVT on the surgical outcome of liver transplant recipients is clear, its impact on cirrhosis progression remains uncertain. Treatment options include anticoagulants and interventional thrombolytic therapies, which are chosen almost on a case-by-case basis depending on the characteristics of the patient and the thrombus. In this manuscript, we review current knowledge regarding the epidemiology, risk factors, diagnosis and classification, natural history, clinical consequences and treatment of non-neoplastic PVT in cirrhosis.
Topics: Humans; Incidence; Liver Cirrhosis; Portal Vein; Risk Factors; Venous Thrombosis
PubMed: 33930474
DOI: 10.1016/j.jhep.2021.04.029 -
RoFo : Fortschritte Auf Dem Gebiete Der... Feb 2022Portal vein thrombosis (PVT) is a rare but severe entity that can cause clinically significant sequela such as worsening portal hypertension or mesenteric ischemia.... (Review)
Review
BACKGROUND
Portal vein thrombosis (PVT) is a rare but severe entity that can cause clinically significant sequela such as worsening portal hypertension or mesenteric ischemia. Those cases refractory to medical management may be referred for endovascular intervention. Several technical considerations have been described in the literature, but a cohesive comparison of these multiple techniques is lacking.
METHODS
The purpose of this article is to review the diagnosis and endovascular management of PVT, including areas in which further research is warranted.
RESULTS
Cases of PVT can be readily diagnosed using ultrasound, computed tomography, or magnetic resonance imaging. Treatment often begins with systemic anticoagulation and endovascular interventions may be used in selected cases. Determining the optimal approach to accessing the portal venous system depends on the underlying disease and chronicity of the thrombus and the degree of occlusion. Once access to the portal venous system is established, catheter-directed therapy may be performed to achieve recanalization.
CONCLUSION
Despite the heterogeneity in patient presentation, cases of PVT can be readily diagnosed across several imaging modalities. Strategizing interventional approaches involves evaluation of the underlying disease and the chronicity of the thrombus.
KEY POINTS
· This review will enable interventionalists to establish a framework for treating portal vein thrombosis by identifying patient risk factors and thrombus characteristics that determine patient management.. · The unique risks and benefits for transhepatic, transsplenic, and transmesenteric approaches for establishing portal venous access will be discussed.. · Advantages and complications of thrombolysis, thrombectomy, and transjugular intrahepatic portosystemic shunt creation for treating portal vein thrombosis will be reviewed in detail based on our extensive institutional experience..
CITATION FORMAT
· Ju C, Li X, Gadani S et al. Portal Vein Thrombosis: Diagnosis and Endovascular Management. Fortschr Röntgenstr 2022; 194: 169 - 180.
Topics: Endovascular Procedures; Humans; Portal Vein; Portasystemic Shunt, Transjugular Intrahepatic; Thrombosis; Treatment Outcome
PubMed: 34649289
DOI: 10.1055/a-1642-0990 -
Diagnostic and Interventional Radiology... Jan 2022Abernethy malformation is a rare condition in which portomesenteric blood bypasses the liver and drains into the systemic vein through a partial or complete shunt. It is... (Review)
Review
Abernethy malformation is a rare condition in which portomesenteric blood bypasses the liver and drains into the systemic vein through a partial or complete shunt. It is categorised into two types on the basis of the shunt pattern between the portal vein and systemic vein. Abernethy malformation is associated with multiple congenital anomalies and acquired complications. A detailed understanding of anatomy and embryology is a prerequisite to interpret the imaging findings. Computed tomography and magnetic resonance angiography can delineate the shunt anatomy and evaluate the concomitant malformations. It is essential to differentiate Abernethy malformation from intrahepatic portosystemic shunts and acquired extrahepatic portosystemic shunts. Mild metabolic abnormalities are treated with dietary modifications and medical therapy. Definitive treatment is done in symptomatic patients. Generally, type I Abernethy patients undergo liver transplantation, and type II undergo shunt occlusion by surgery or transcatheter coiling.
Topics: Humans; Liver Neoplasms; Liver Transplantation; Portal Vein; Portasystemic Shunt, Surgical; Vascular Malformations
PubMed: 34914605
DOI: 10.5152/dir.2021.20474 -
Journal of Hepato-biliary-pancreatic... Mar 2022Highlight A 51-year-old man was referred for further evaluation of a hepatic anomaly detected on abdominal ultrasonography. Contrast-enhanced computed tomography showed...
Highlight A 51-year-old man was referred for further evaluation of a hepatic anomaly detected on abdominal ultrasonography. Contrast-enhanced computed tomography showed an extremely rare portal venous anomaly, almost like a 'portal circle'. Ataka and colleagues present the first report of this type of anomaly and describe it from an embryological perspective.
Topics: Humans; Male; Middle Aged; Portal Vein; Tomography, X-Ray Computed; Ultrasonography
PubMed: 34637609
DOI: 10.1002/jhbp.1057 -
Journal of Visceral Surgery Oct 2019The circumportal pancreas (CPP) is a normal though rare anatomical variant of the pancreas resulting from fusion of ventral and dorsal pancreatic buds during...
The circumportal pancreas (CPP) is a normal though rare anatomical variant of the pancreas resulting from fusion of ventral and dorsal pancreatic buds during embryogenesis. Preoperative imaging in a 69-year-old man displayed the presence of a CPP completely encasing the portal vein. For pancreatic resection, missing a CPP is associated with a higher risk of postoperative complications.
Topics: Adenocarcinoma; Aged; Humans; Magnetic Resonance Imaging; Male; Pancreas; Pancreatectomy; Pancreatic Neoplasms; Portal Vein
PubMed: 30773440
DOI: 10.1016/j.jviscsurg.2019.02.001 -
Journal of Veterinary Internal Medicine Sep 2019Several options have been proposed for the treatment of congenital extrahepatic portosystemic shunts (cEHPSS) in dogs, but formal comparisons among different treatment... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several options have been proposed for the treatment of congenital extrahepatic portosystemic shunts (cEHPSS) in dogs, but formal comparisons among different treatment options are currently unavailable. A previous evidence-based review (2012) found low quality of evidence for papers assessing the treatment of cEHPSS in dogs.
OBJECTIVES
To assess the quality of evidence available in the treatment of cEHPSS, summarize the current state of knowledge with respect to outcome after cEHPSS management, and compare different treatment techniques.
ANIMALS
Not used.
METHODS
A bibliographic search was performed without date or language restrictions. Studies were assessed for quality of evidence (study design, study group sizes, subject enrollment quality, and overall risk of bias) and outcome measures reported (perioperative outcome, clinical outcome, and surgical or interventional outcome), all reported with 95% confidence intervals. A network meta-analysis was performed.
RESULTS
Forty-eight studies were included. Six retrospective studies (grade 4b) compared 2 techniques and 7 were abstracts (grade 5). The quality of evidence was low and risk of bias high. Regarding surgical outcome, statistically significant superiority of ameroid constrictor over thin film band was observed (P = .003). No other comparisons were statistically significant.
CONCLUSIONS AND CLINICAL IMPORTANCE
The evidence base of choice of treatment of cEHPSS in dogs remains weak despite recent publications on the subject. Ameroid is superior to thin film band in causing EHPSS closure. Blinded randomized studies comparing different treatment modalities, which routinely include postoperative imaging to assess cEHPSS closure and acquired portosystemic shunt development are essential.
Topics: Animals; Caseins; Dog Diseases; Dogs; Hydrogels; Ligation; Portal System; Portal Vein; Treatment Outcome
PubMed: 31471995
DOI: 10.1111/jvim.15607 -
Radiographics : a Review Publication of... Nov 2023Radiologists are familiar with the appearances of a normal portal vein; variations in its anatomy are commonplace and require careful consideration due to the... (Review)
Review
Radiologists are familiar with the appearances of a normal portal vein; variations in its anatomy are commonplace and require careful consideration due to the implications for surgery. These alterations in portal vein anatomy have characteristic appearances that are clearly depicted on CT, MR, and US images. Similarly, there are numerous congenital and acquired disorders of the portal vein that are deleterious to its function and can be diagnosed by using imaging alone. Some of these conditions have subtle imaging features, and some are conspicuous at imaging but poorly understood or underrecognized. The authors examine imaging appearances of the portal vein, first by outlining the classic and variant anatomy and then by describing each of the disorders that impact portal vein function. The imaging appearances of portal vein abnormalities discussed in this review include occlusion from and differentiation between bland thrombus and tumor in vein and the changes associated with resultant hepatic artery buffer response changes, cavernous transformation of the portal vein, and portal biliopathy; ascending thrombophlebitis of the portal vein (pylephlebitis); portal hypertension and its causes and sequelae; the newly described disease entity portosinusoidal vascular disorder; and intra- and extrahepatic shunts of the portal system, both congenital and acquired (including Abernethy malformations), and the associated risks. Current understanding of the pathophysiologic processes of each of these disorders is considered to aid the approach to reporting. RSNA, 2023 Quiz questions for this article are available in the supplemental material.
Topics: Humans; Portal Vein; Hypertension, Portal; Portal System; Hepatic Artery; Thrombosis; Vascular Diseases
PubMed: 37856316
DOI: 10.1148/rg.230058 -
Current Opinion in Organ Transplantation Apr 2022Portomesenteric thrombosis (PMT) is a serious condition encountered mainly in cirrhotic patients awaiting liver transplantation. More recently, this potentially fatal... (Review)
Review
PURPOSE OF REVIEW
Portomesenteric thrombosis (PMT) is a serious condition encountered mainly in cirrhotic patients awaiting liver transplantation. More recently, this potentially fatal complication has been described after bariatric surgery and inflammatory bowel disease. Several consensus guidelines have been published over the past few years and this mini review was conducted to discuss updated nontransplant treatment options based on currently available evidence.
RECENT FINDINGS
Anticoagulation is the mainstay of treatment for PMT involving <50% of the main portal vein. Transjugular intrahepatic portosystemic shunt are usually preserved for patients with more extensive disease or those with clinically significant portal hypertension that are treatment refractory.
SUMMARY
The extent of PMT, response to therapy, and complications related with PMT are the determinants of therapy.
Topics: Humans; Hypertension, Portal; Liver Cirrhosis; Liver Transplantation; Portal Vein; Portasystemic Shunt, Transjugular Intrahepatic; Thrombosis; Treatment Outcome
PubMed: 35143434
DOI: 10.1097/MOT.0000000000000964 -
Surgery Apr 2021
Topics: Embolization, Therapeutic; Hepatectomy; Hepatic Veins; Humans; Liver; Portal Vein
PubMed: 33759782
DOI: 10.1016/j.surg.2020.09.025 -
Radiologic Clinics of North America May 2024The visceral vasculature is inextricably intertwined with abdominopelvic disease staging, spread, and management in routine and emergent cases. Comprehensive evaluation... (Review)
Review
The visceral vasculature is inextricably intertwined with abdominopelvic disease staging, spread, and management in routine and emergent cases. Comprehensive evaluation requires specialized imaging techniques for abnormality detection and characterization. Vascular pathology is often encountered on nondedicated routine imaging examinations, which may obscure, mimic, or confound many vascular diagnoses. This review highlights normal arterial, portal venous, and systemic venous anatomy and clinically relevant variants; diagnostic pitfalls related to image-acquisition technique and disease mimics; and characteristics of common and rare vascular diseases to empower radiologists to confidently interpret the vascular findings and avoid misdiagnosis.
Topics: Humans; Portal Vein; Diagnostic Imaging; Diagnostic Errors
PubMed: 38553185
DOI: 10.1016/j.rcl.2023.12.003