Extrahepatic portal vein thrombosis: aetiology and determinants of survival.
BACKGROUND
Malignancy, hypercoagulability, and conditions leading to decreased portal flow have been reported to contribute to the aetiology of extrahepatic portal vein thrombosis (EPVT). Mortality of patients with EPVT may be associated with these concurrent medical conditions or with manifestations of portal hypertension, such as variceal haemorrhage.


METHODS
To determine which variables have prognostic significance with respect to survival, we performed a retrospective study of 172 adult EPVT patients who were followed over the period 1984-1997 in eight university hospitals.


RESULTS
Mean follow up was 3.9 years (range 0.1-13.1). Overall survival was 70% (95% confidence interval (CI) 62-76%) at one year, 61% (95% CI, 52-67%) at five years, and 54% (95% CI, 45-62%) at 10 years. The one, five, and 10 year survival rates in the absence of cancer, cirrhosis, and mesenteric vein thrombosis were 95% (95% CI 87-98%), 89% (95% CI 78-94%), and 81% (95% CI 67-89%), respectively (n=83). Variables at diagnosis associated with reduced survival according to multivariate analysis were advanced age, malignancy, cirrhosis, mesenteric vein thrombosis, absence of abdominal inflammation, and serum levels of aminotransferase and albumin. The presence of variceal haemorrhage and myeloproliferative disorders did not influence survival. Only four patients died due to variceal haemorrhage and one due to complications of a portosystemic shunt procedure.


CONCLUSIONS
We conclude that mortality among patients with EPVT is related primarily to concurrent disorders leading to EPVT and not to complications of portal hypertension.
Janssen
H L
HL
Department of Gastroenterology and Hepatology, University Hospital Rotterdam, The Netherlands. devlaming@mdl.arz.nl
Wijnhoud
A
A
Haagsma
E B
EB
van Uum
S H
SH
van Nieuwkerk
C M
CM
Adang
R P
RP
Chamuleau
R A
RA
van Hattum
J
J
Vleggaar
F P
FP
Hansen
B E
BE
Rosendaal
F R
FR
van Hoek
B
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000032:analysis; D016001:Confidence Intervals; D004067:Digestive System Neoplasms / Q000097:blood / Q000150:complications; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000097:blood / Q000150:complications; D008875:Middle Aged; D015999:Multivariate Analysis; D011169:Portal Vein; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D000637:Transaminases / Q000097:blood; D020246:Venous Thrombosis / Q000097:blood / Q000209:etiology* / Q000401:mortality
D000418:Albumins; D000637:Transaminases