Chronic mesenteric venous thrombosis: evaluation and determinants of survival during long-term follow-up.
OBJECTIVE
The natural history of chronic portomesenteric (PM) and portosplenomesenteric (PSM) venous thrombosis is defined poorly. Therapeutic options are limited, and are directed at the prevention of variceal bleeding and the control of abdominal pain related to gastrointestinal hyperemia.


METHODS
Patients with extensive PM and PSM thrombosis were reviewed retrospectively to evaluate the efficacy of medical therapy and to determine which clinical variables had prognostic significance regarding long-term survival.


RESULTS
Sixty patients, with a median age at diagnosis of 44 years (range, 18-68 y), were assessed. The median follow-up period was 3.5 years (range, 0.2-32.0 y). The overall survival rate was 73.3%, with 1- and 5-year survival rates of 81.6%, and 78.3%, respectively. One- and 5-year survival rates, excluding patients who died from malignancy-related causes, were 85.7% and 82.1%, respectively. Factors associated with improved survival included treatment with beta-blockers (P = .02; odds ratio [OR], .09; 95% confidence interval [CI], 0.01-0.70) and anticoagulation (P = .005; OR, 0.01; 95% CI, <0.01 to 0.26). Eighteen patients in total were anticoagulated, including 8 patients who had variceal bleeding, all of whom underwent endoscopic band ligation of esophageal varices before anticoagulation. By using Cox regression analysis, variables associated with reduced survival were the presence of ascites (P = .001; OR, 42.6; 95% CI, 5.03-360), and hyperbilirubinemia (P = .01; OR, 13.8; 95% CI, 1.9-100) at presentation. Six patients died of variceal hemorrhage.


CONCLUSIONS
Patients with chronic PM and PSM venous thrombosis without underlying malignancy have an acceptable long-term survival. Treatment with beta-blockers and anticoagulation appears to improve outcome.
Orr
David W
DW
Institute of Liver Studies, King's College Hospital, Denmark Hill, London, England.
Harrison
Phillip M
PM
Devlin
John
J
Karani
John B
JB
Kane
Pauline A
PA
Heaton
Nigel D
ND
O'Grady
John G
JG
Heneghan
Michael A
MA
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001201:Ascites / Q000150:complications; D002908:Chronic Disease; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy; D006801:Humans; D006932:Hyperbilirubinemia / Q000150:complications; D008026:Ligation; D008131:London / Q000453:epidemiology; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D008642:Mesenteric Veins; D008875:Middle Aged; D015999:Multivariate Analysis; D012709:Serum Albumin / Q000032:analysis; D015996:Survival Rate; D020246:Venous Thrombosis / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D014859:Warfarin / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000925:Anticoagulants; D012709:Serum Albumin; D014859:Warfarin