Correction of Extrahepatic Portal Vein Thrombosis by the Mesenteric to Left Portal Vein Bypass

Superina, Riccardo; Bambini, Daniel A.; Lokar, Joan; Rigsby, Cynthia K.; Whitington, Peter F.

doi:10.1097/01.sla.0000205827.73706.97

Cited by 121 publications

(130 citation statements)

References 20 publications

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“…Therefore, its efficiency is very limited and the mortality rate due to gastric bleeding is high [13] . The application of surgical treatment is limited by tissue damage and additional complications [14][15][16][17] . With the development of interventional radiology, minimally invasive technology has become one of the predominant means of treating acute-subacute PV-SMV thrombosis without obvious intestinal necrosis, perforation, and peritonitis [18][19][20][21][22][23][24][25][26] .…”

Section: Discussionmentioning

confidence: 99%

Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

Liu¹,

Wang²,

Fan³

et al. 2009

WJG

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AIM:To summarize our methods and experience with interventional treatment for symptomatic acute-subacute portal vein and superior mesenteric vein thrombosis (PV-SMV) thrombosis. METHODS:Forty-six patients (30 males, 16 females, aged 17-68 years) with symptomatic acute-subacute portal and superior mesenteric vein thrombosis were accurately diagnosed with Doppler ultrasound scans, computed tomography and magnetic resonance imaging. They were treated with interventional therapy, including direct thrombolysis (26 cases through a transjugular intrahepatic portosystemic shunt; 6 through percutaneous transhepatic portal vein cannulation) and indirect thrombolysis (10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization). RESULTS:The blood reperfusion of PV-SMV was achieved completely or partially in 34 patients 3-13 d after thrombolysis. In 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased significantly. Symptoms in these 45 patients were improved dramatically without severe operational complications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment. In 3 patients with interventional treatment, thrombi re-formed 1, 3 and 4 mo after treatment. In these 3 patients, indirect PV-SMV thrombolysis was performed again and was successful. CONCLUSION:Interventional treatment, including direct or indirect PV-SMV thrombolysis, is a safe and effective method for patients with symptomatic acutesubacute PV-SMV thrombosis.

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Section: Discussionmentioning

confidence: 99%

Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

Liu¹,

Wang²,

Fan³

et al. 2009

WJG

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“…Follow-up results ranging between 1 and 7 years are available. In the largest study reported till date, 34 patients underwent this procedure with a success rate of 91%, good shunt patency rate, and rebleeding rate of 8% with amelioration of hypersplenism in most patients [59]. Although promising, long-term follow-up studies are needed to confirm its efficacy.…”

Section: Surgery For Secondary Prophylaxismentioning

confidence: 99%

“…Nonsurgical shunts such as TIPS have no role in EHPVO yet. The surgical options in EHPVO have been recently bolstered by the development of a new type of shunt, the mesenterico-left portal vein bypass (Rex shunt) in children [59]. This is a new paradigm in surgical treatment.…”

Section: Surgery For Secondary Prophylaxismentioning

confidence: 99%

Current Role of Surgery in Portal Hypertension

Pal

2011

Indian J Surg

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Treatment for portal hypertension (PHT) has evolved from surgery being the only option during the 1970s to the wide range of options currently available. Surgery has not vanished from the therapeutic armamentarium, but its role has changed and is constantly evolving. The present review primarily focuses on the role of surgery in tackling patients with PHT and varices with regard to the Indian scenario and also looks at its relevance, given the availability of a host of other therapeutic options.Keywords Portal hypertension . Portosystemic shunt . Surgery . Variceal haemorrhage Pathophysiology of PHTFor understanding how surgery can help modify the natural course in patients with PHT, it is necessary to understand its pathophysiology and the natural history of varices in such patients. PHT is usually the consequence of increased resistance to portal blood flow coupled with increased blood flow through the splanchnic circulation because of a hyperdynamic circulatory state that exists both in cirrhotics and to some extent in noncirrhotic etiologies (large congested splenomegaly) as well. Traditionally, at the ultrastructural level, PHT has been classified into presinusoidal, sinusoidal, and postsinusoidal. It is for the sinusoidal and postsinusoidal blocks that there is an accurate but invasive way of monitoring the portal pressure by using the method to estimate the hepatic venous pressure gradient (HVPG) in the vascular/hemodynamic lab [1][2][3]. In cirrhotic patients, as about a third to half of them will actually have PHT; HVPG >5 mmHg indicates PHT. PHT becomes clinically significant when the HVPG is ≥10 mmHg [1][2][3]. This is the pressure threshold when PHT leads to the formation of esophagogastric varices, retroperitoneal and periportal collaterals, hypersplenism, low serum albuminascitic albumin gradient ascites, spontaneous bacterial peritonitis, etc. Varices rupture and bleed only when the HVPG >12 mmHg [1][2][3]. Natural History of PHTIt has been estimated that varices are present in about 30-40% of compensated cirrhotics and nearly two-thirds of the decompensated patients. In cirrhotic patients without varices on the first endoscopy, the annual incidence of new varices is between 5% and 10% [1,4]. Once developed, the progression of varices from small to large depends on the deterioration of liver function and continued hepatic insult (virus-, alcohol-, metabolic-, drug-induced, etc.). The overall annual incidence of bleeding is about 4% and this increases to 15% per year in those with large varices, red signs, and poor Child's status [1,[4][5][6]. About a third of the cirrhotic patients with varices will bleed and the mortality following each episode of bleeding is about 20% (maybe higher) in experienced tertiary health centers. Early mortality (within 6 weeks) following an acute episode of variceal bleeding depends on the etiology of PHT, the severity of underlying liver disease (Child's C, model for end-stage liver disease [MELD] >18), actively bleeding varices, bleeding gastric varices (GV...

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“…The mesoportal bypass (MPB) is a recent advancement in shunt restoring mesenteric blood flow to the liver through the Rex venous recessus (interposition of a jugular venous allograft between the superior mesenteric vein and the intrahepatic left portal vein). This "Rex shunt" restores the physiological hepatopetal flow and thereby corrects the liver dysfunction, coagulation parameters and also improves the growth potential (Superina, 2006;Mack, 2003;Lautz, 2009). It appears that doing the Rex shunt early after diagnosis rather than waiting till complications will be beneficial.…”

Section: Surgical Management Of Ehpvomentioning

confidence: 99%

“…Although these shunts are effective in controlling variceal bleeding, encephalopathy is a concern in patients with poor liver functions. Follow up studies have shown shunt patency in 85-98% of children with long term survival in >95% cases (Lautz, 2009;Bismuth, 1980;Gauthier, 1989;Mitra, 1993;Prasad, 1994;Orloff, 1994;Superina, 2006;Shariff, 2010). Risk of variceal recurrence and rebleed is there in case of shunt blockage.…”

Section: Surgical Management Of Ehpvomentioning

confidence: 99%

Extra Hepatic Portal Venous Obstruction in Children

Arora¹,

Das²

2012

Portal Hypertension - Causes and Complications

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Correction of Extrahepatic Portal Vein Thrombosis by the Mesenteric to Left Portal Vein Bypass

Abstract: MLPVB provides excellent relief of symptoms in children with idiopathic EHPVT and results in liver growth and normalization of coagulation parameters. This surgery is corrective and should be done at as early an age as possible.

Cited by 121 publications

References 20 publications

Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

Current Role of Surgery in Portal Hypertension

Extra Hepatic Portal Venous Obstruction in Children

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