Management of Portal and Mesenteric Venous Thrombosis

Abstract

Portal vein thrombosis is a rare condition seen in the general population, though is more prevalent in certain populations with thrombophilia as well as in patients with cirrhosis. Because morbidity and mortality can be significant with portal vein thrombosis, diagnosis and appropriate management are crucial. In noncirrhotic patients, untreated portal vein thrombosis can result in mesenteric ischemia and complications of portal hypertension. In cirrhosis, portal vein thrombosis is often incidentally found on routine screening imaging, and the treatment outside of transplant candidates is more controversial. In this review, we will outline risk factors for portal vein thrombosis, discuss indications for treatment, and evaluate both pharmacological and endovascular treatment options, highlighting unique clinical considerations dependent on the presence or absence of cirrhosis.

Narrative review of portal vein thrombosis in cirrhosis: pathophysiology, diagnosis, and management from an interventional radiology perspective

“…Chronic PVT usually presents with signs of portal hypertension including upper gastrointestinal bleeding secondary to esophageal and gastric varices and/or portal gastropathy, splenomegaly with pancytopenia, and ascites. Rarely, patients may present with cholestasis from portal bilopathy due to cavernous transformation of the portal vein (11,12).…”

“…Virchow's triad of hypercoagulability, stasis of blood flow, and endothelial injury leading to thrombosis is present in the portal and mesenteric venous system in the setting of cirrhosis, specifically in decompensated cirrhosis (12).…”