Endovascular treatment of acute and chronic portal vein thrombosis in patients with cirrhotic and non-cirrhotic liver

Autor: Per Sangfelt, Rickard Nyman, Kerstin Rosenqvist, Fredrik Rorsman, Lars-Gunnar Eriksson
Rok vydání: 2015
Předmět:
Adult
Liver Cirrhosis
Male
medicine.medical_specialty
medicine.medical_treatment
Portal venous pressure
Esophageal and Gastric Varices
030218 nuclear medicine & medical imaging
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
medicine
Humans
Blood Transfusion
Thrombolytic Therapy
Radiology
Nuclear Medicine and imaging
Thrombus
Survival rate
Aged
Retrospective Studies
Venous Thrombosis
Radiological and Ultrasound Technology
Portal Vein
business.industry
Endovascular Procedures
General Medicine
Thrombolysis
Middle Aged
medicine.disease
Thrombosis
Surgery
Portal vein thrombosis
Survival Rate
Venous thrombosis
Treatment Outcome
Female
Stents
030211 gastroenterology & hepatology
Radiology
Portasystemic Shunt
Transjugular Intrahepatic
business
Transjugular intrahepatic portosystemic shunt
Zdroj: Acta Radiologica. 57:572-579
ISSN: 1600-0455
0284-1851
DOI: 10.1177/0284185115595060
Popis: Background Treatment of patients with portal vein thrombosis (PVT) differs due to different etiology and wide range of symptoms but certain patients seems to benefit from endovascular intervention. Purpose To assess the safety and efficiency of endovascular treatment of acute and chronic PVT in patients with cirrhotic and non-cirrhotic liver. Material and Methods Twenty-one patients with PVT treated with an endovascular procedure in 2002–2013 were studied retrospectively. Data on etiology, onset and extension of thrombus, presenting symptoms, methods of intervention, portal pressure gradients, complications, recurrence of symptoms, re-interventions, clinical status at latest follow-up, and survival were collected. Results Four non-cirrhotic patients with acute extensive PVT and bowel ischemia were treated with local thrombolysis, in three combined with placement of a transjugular intrahepatic portosystemic shunt (TIPS) placement. Three recovered and have survived more than 6 years. In six non-cirrhotic patients with chronic PVT and acute or threatening variceal bleeding recanalization and TIPS were successful in three and failed in three. Eleven cirrhotic patients with PVT and variceal bleeding or refractory ascites were successfully treated with recanalization and TIPS. Re-intervention was performed in five of these patients and five patients died, three within 12 months of intervention. Four cirrhotic patients had episodes of shunt-related encephalopathy and three had variceal re-bleeding. Conclusion TIPS was found to be effective in reducing portal hypertension in patients with PVT. In patients with extensive PVT and bowel ischemia treatment with TIPS combined with thrombolysis should be considered.
Databáze: OpenAIRE
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