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Abdominal Radiology

, Volume 44, Issue 10, pp 3453–3462 | Cite as

Current concepts in portal vein thrombosis: etiology, clinical presentation and management

  • Sadeer AlzubaidiEmail author
  • Indravadan Patel
  • Aman Saini
  • Grace Knuttinen
  • Sailendra Naidu
  • Scott Kriegshuaser
  • Hassan Albadawi
  • Rahmi Oklu
Review
  • 130 Downloads
Part of the following topical collections:
  1. CME articles

Abstract

Objective

The aim of this article is to focus on etiology, risk factors, clinical presentation and classification systems of acute and chronic PVT as well as focusing on current diagnostic and therapeutic options for the management of acute and chronic PVT.

Results

PVT represents a serious clinical concern in cirrhotic patients and in those with specific local or systemic risk factors. The rate and extent of thrombus formation can significantly impact patient presentation and the resulting clinical outcomes. The presentation of acute PVT can range from abdominal pain to intestinal ischemia/infarction and even death, while chronic PVT can remain clinically silent. A number of imaging modalities including US, CT and MRI can be used to confirm the diagnosis. In addition to addressing underlying risk factors, AC therapy forms a cornerstone of treatment and has demonstrated efficacy in both acute and chronic settings. Proper caution should be used when initiating AC therapy in cirrhotic patients given their underlying coagulopathic status with attention now being paid to NOACs and LMWH. For patients with bowel ischemia, extensive thrombosis, contraindications or poor response to AC, or for those with co-morbidities that preclude AC, minimally invasive endovascular techniques offer alternative treatment options.

Conclusion

Familiarity with the etiology, clinical presentation and classification of PVT optimize early detection and incorporate effective therapeutic options, the management of these complex patients should be undertaken by a multidisciplinary team. Minimally invasive catheter-based therapies and endovascular portosystemic shunt creation demonstrated efficacy in the treatment of AC-resistant patients and for patients with extensive or complicated disease.

Keywords

Portal vein thrombosis Portal hypertension Transsplenic 

Notes

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Interventional RadiologyMayo Clinic ArizonaPhoenixUSA

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