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Extrahepatic Portal Vein Obstruction: Asian and Global Perspective

  • Rakhi Maiwall
  • Shiv Kumar Sarin
Chapter

Abstract

Portal vein thrombosis refers to either thrombotic or non-thrombotic occlusion of the portal vein as well as cavernoma formation. It is known to exist in association with cirrhosis or malignancy or without any associated condition i.e. non-malignant and non-cirrhotic portal vein thrombosis. Extra Hepatic Portal Venous Obstruction (EHPVO) refers to the development of portal cavernoma in the absence of associated liver disease and is the commonest cause of non-cirrhotic portal hypertension in Asia. The main pathophysiological basis of PVT is based on the “Virchow’s triad” which comprises of venous stasis, hypercoagulability and endothelial injury. Recently, an expert consensus has proposed a new classification system for PVT based on the site, clinical presentation (acute or chronic), degree of occlusion i.e. (partial or complete) and extent (extension into the splenic or superior mesenteric veins), symptomatic or asymptomatic as well as based on the type of underlying liver disease. Anticoagulation remains the mainstay of management in acute PVT and should be administered life-long in patients with an underlying proven thrombophilia. Transjugular intrahepatic portosystemic shunt even though challenging result in recanalization in a significant proportion of treated patients. Prevention of PVT with anticoagulants in compensated cirrhotics has been suggested to prevent disease progression and improve survival. Thrombectomy and thrombolysis can be done in selected symptomatic cases with acute PVT. Shunt surgery or meso-Rex bypass operation are the definitive treatment options in patients with EHPVO who have complications of portal hypertension.

Keywords

Portal vein thrombosis EHPVO Portal cavernoma Cirrhosis Anticoagulation TIPS Thrombophilia 

Notes

Acknowledgements

Disclosures: None to declare from authors.

Conflict of Interest: None to declare.

Writing assistance: None.

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of HepatologyInstitute of Liver and Biliary SciencesNew DelhiIndia

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