Portal vein thrombosis surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]

Overview

Surgery is not the first-line treatment option for patients with portal vein thrombosis. Surgery is usually reserved for patients with either medical failed therapy, liver failure, and cirrhosis.

Indications

Surgery is not the first-line treatment option for patients with portal vein thrombosis. Surgery is usually reserved for patients with either:^[1]
Failed medical therapy
Liver failure
Cirrhosis

Surgery

Surgery procedures of portal vein thrombosis include:^[2]^[3]^[4]^[5]^[6]

1. Shunt surgery
- The preferred surgical shunt is usually distal splenorenal shunt. Splenectomy and other shunt procedures have been performed for patients with splenic vein thrombosis and whom surgery is undertaken.^[7]
- In pateinets with portal vein thrombosis indications for shunt surgery include:
  - Failed endotherapy
  - Symptomatic portal hypertensive biliopathy
  - Symptomatic hypersplenism
  - Ectopic variceal bleed
  - Severe growth retardation
  - Poor chances of follow up and on demand one time treatment
- Shunts may be selective or non-selective. The different types of shunt surgery include:
  - Selective shunts
    - Distal lienorenal shunt
    - Mesenteric–left portal vein bypass (Rex shunt)
    - Warren Zeppa distal splenorenal shunts
    - Mesocaval shunts
  - Non-selective shunts
    - Portocaval shunts
    - Proximal lienorenal shunts
    - End to side mesocaval and large diameter interposition portocaval shunts
    - Mesocaval shunts

2. Thrombectomy
- Mechanical thrombectomy by percutaneous transhepatic route remove thrombus in a recently developed portal vein thrombosis than occurred less than 30 days.
- Performing percutaneous transhepatic thromboaspiration is successful within 72 hours in some patients.

3. Liver transplanation
- Liver transplantation is indicated in case of liver failure.
- Liver failure may be happened due to any diseases, such as cirrhosis or portal vein thrombosis.
- “Model for end-stage liver disease” (MELD) score is used to govern priority for liver transplantation.
- The score range between 6 and 40 and is calculated using a logarithmic assessment of three objective and reproducibe variables including:
  - Total serum bilirubin
  - Creatinine concentrations
  - International normalized ratio

References

↑ Chawla YK, Bodh V (2015). “Portal vein thrombosis”. J Clin Exp Hepatol. 5 (1): 22–40. doi:10.1016/j.jceh.2014.12.008. PMC 4415192. PMID 25941431.
↑ Ponziani FR, Zocco MA, Campanale C, Rinninella E, Tortora A, Di Maurizio L, Bombardieri G, De Cristofaro R, De Gaetano AM, Landolfi R, Gasbarrini A (2010). “Portal vein thrombosis: insight into physiopathology, diagnosis, and treatment”. World J. Gastroenterol. 16 (2): 143–55. PMC 2806552. PMID 20066733.
↑ Parikh, Sameer; Shah, Riddhi; Kapoor, Prashant (2010). “Portal Vein Thrombosis”. The American Journal of Medicine. 123 (2): 111–119. doi:10.1016/j.amjmed.2009.05.023. ISSN 0002-9343.
↑ Parikh S, Shah R, Kapoor P (2010). “Portal vein thrombosis”. Am. J. Med. 123 (2): 111–9. doi:10.1016/j.amjmed.2009.05.023. PMID 20103016.
↑ Lendoire J, Raffin G, Cejas N, Duek F, Barros Schelotto P, Trigo P, Quarin C, Garay V, Imventarza O (2007). “Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome”. HPB (Oxford). 9 (5): 352–6. doi:10.1080/13651820701599033. PMC 2225512. PMID 18345318.
↑ Paskonis M, Jurgaitis J, Mehrabi A, Kashfi A, Fonouni H, Strupas K, Büchler MW, Kraus TW (2006). “Surgical strategies for liver transplantation in the case of portal vein thrombosis–current role of cavoportal hemitransposition and renoportal anastomosis”. Clin Transplant. 20 (5): 551–62. doi:10.1111/j.1399-0012.2006.00560.x. PMID 16968480.
↑ Lahat E, Lim C, Bhangui P, Fuentes L, Osseis M, Moussallem T, Salloum C, Azoulay D (2017). “Transjugular intrahepatic portosystemic shunt as a bridge to non-hepatic surgery in cirrhotic patients with severe portal hypertension: a systematic review”. HPB (Oxford). doi:10.1016/j.hpb.2017.09.006. PMID 29110990.

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[pmid25941431-1] Chawla YK, Bodh V (2015). “Portal vein thrombosis”. J Clin Exp Hepatol. 5 (1): 22–40. doi:10.1016/j.jceh.2014.12.008. PMC 4415192. PMID 25941431.

[pmid20066733-2] Ponziani FR, Zocco MA, Campanale C, Rinninella E, Tortora A, Di Maurizio L, Bombardieri G, De Cristofaro R, De Gaetano AM, Landolfi R, Gasbarrini A (2010). “Portal vein thrombosis: insight into physiopathology, diagnosis, and treatment”. World J. Gastroenterol. 16 (2): 143–55. PMC 2806552. PMID 20066733.

[ParikhShah2010-3] Parikh, Sameer; Shah, Riddhi; Kapoor, Prashant (2010). “Portal Vein Thrombosis”. The American Journal of Medicine. 123 (2): 111–119. doi:10.1016/j.amjmed.2009.05.023. ISSN 0002-9343.

[pmid20103016-4] Parikh S, Shah R, Kapoor P (2010). “Portal vein thrombosis”. Am. J. Med. 123 (2): 111–9. doi:10.1016/j.amjmed.2009.05.023. PMID 20103016.

[pmid18345318-5] Lendoire J, Raffin G, Cejas N, Duek F, Barros Schelotto P, Trigo P, Quarin C, Garay V, Imventarza O (2007). “Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome”. HPB (Oxford). 9 (5): 352–6. doi:10.1080/13651820701599033. PMC 2225512. PMID 18345318.

[pmid16968480-6] Paskonis M, Jurgaitis J, Mehrabi A, Kashfi A, Fonouni H, Strupas K, Büchler MW, Kraus TW (2006). “Surgical strategies for liver transplantation in the case of portal vein thrombosis–current role of cavoportal hemitransposition and renoportal anastomosis”. Clin Transplant. 20 (5): 551–62. doi:10.1111/j.1399-0012.2006.00560.x. PMID 16968480.

[pmid291109902-7] Lahat E, Lim C, Bhangui P, Fuentes L, Osseis M, Moussallem T, Salloum C, Azoulay D (2017). “Transjugular intrahepatic portosystemic shunt as a bridge to non-hepatic surgery in cirrhotic patients with severe portal hypertension: a systematic review”. HPB (Oxford). doi:10.1016/j.hpb.2017.09.006. PMID 29110990.

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