Portal vein thrombosis surgery
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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
- Selective shunts
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- 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.
- 2. Thrombectomy
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- 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
- 3. Liver transplanation
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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.