Diagnosis and Management of Acute and Chronic Portomesenteric Venous Thrombosis

Abstract

Thrombosis of the portal and mesenteric veins is relatively uncommon. Thrombosis can be acute or chronic. Management is dictated by symptoms on clinical presentation. Acute symptomatic mesenteric vein thrombosis may require aggressive endovascular intervention with mechanical thrombectomy, thromboaspiration, infusion of thrombolytic drugs, TIPS creation or surgery. Chronic, symptomatic portal and mesenteric vein thrombosis usually requires recanalization of occluded segments and stent placement. The three main catheterization techniques for access into the portal venous system are: transhepatic, transjugular and trans-splenic. Evidence-based therapeutic strategies for acute and chronic portal and mesenteric vein thrombosis have not been established. There are no prospective comparative studies to support superiority of any given technique in the management of these conditions. The purpose of this review is to present an overview of the etiology, physiopathology, clinical presentation, and management of acute and chronic portal and mesenteric vein thrombosis.

Portal Vein Thrombosis: Introduction to Imaging and Etiology

“…The most common of these predisposing factors are the transient proinflammatory states including abdominal surgery, intra-abdominal infection, inflammatory bowel disease, and pancreatitis. 12 Myeloproliferative neoplasms (MPNs) including polycythemia vera, essential thrombocythemia, and primary myelofibrosis are common risk factors for PVT with cirrhosis. 11 JAK2, a member of the Janus kinase family, is a non-receptor tyrosine kinase.…”

“…11 JAK2, a member of the Janus kinase family, is a non-receptor tyrosine kinase. 12 JAK2 is closely linked to MPNs and has been associated with splanchnic vein thrombosis. 11 12 Despite the long list of risk factors that can be associated with PVT, over a quarter of patients with PVT have no evident provoking or predisposing factor.…”

“…12 JAK2 is closely linked to MPNs and has been associated with splanchnic vein thrombosis. 11 12 Despite the long list of risk factors that can be associated with PVT, over a quarter of patients with PVT have no evident provoking or predisposing factor. Many of these patients likely carry some undiagnosed thrombophilia.…”