Chronic portal vein thrombosis: transcapsular hepatic collateral vessels and communicating ectopic varices.
OBJECTIVE
To assess patients with chronic portal vein thrombosis (PVT) with respect to transcapsular collateral veins, the communication between these veins and ectopic varices, and the cause of PVT.


METHODS
This study was approved by the institutional review committees, and written informed consent was obtained. From November 2003 to March 2008, 145 consecutive patients with chronic PVT due to a variety of causes were assessed for transcapsular collaterals and ectopic varices with ultrasonography (US). Analysis of contingency tables was performed with the Fisher exact test.


RESULTS
Transcapsular collaterals were detected in 15 (10.3%) of 145 patients with chronic PVT. They were restricted to patients with a history of hepatobilary surgery, severe pancreatitis, or abdominal surgery (n = 21) and were not detected in patients with liver cirrhosis, systemic coagulopathy, extrahepatic malignancy, idiopathic PVT, chronic pancreatitis, or infectious or inflammatory diseases (n = 124) (P < .001). Ectopic varices were infrequent in 70 patients with liver cirrhosis (n = 2, 3%) but were common in 14 patients with PVT after hepatobiliary surgery (n = 9, 64%) (P < .001, odds ratio = 21.4). Direct communication between transcapsular collaterals and ectopic varices was visible in all nine patients in this cohort. In eight of these patients, ectopic varices were found to be the bleeding source in gastrointestinal hemorrhage.


CONCLUSIONS
Transcapsular collaterals frequently occur in patients with chronic PVT due to hepatobilary surgery or necrotizing pancreatitis. They are associated with ectopic varices; therefore, awareness of transcapsular collaterals in this patient subgroup will help to localize ectopic varices as potential bleeding source.
Seeger
Marcus
M
Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany. mseeger@1med.uni-kiel.de
Günther
Rainer
R
Hinrichsen
Holger
H
Both
Marcus
M
Helwig
Ulf
U
Arlt
Alexander
A
Stelck
Birte
B
Bräsen
Jan H
JH
Sipos
Bence
B
Schafmayer
Clemens
C
Braun
Felix
F
Bröring
Dieter C
DC
Schreiber
Stefan
S
Hampe
Jochen
J
D002908:Chronic Disease; D003097:Collateral Circulation; D003287:Contrast Media; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008279:Magnetic Resonance Imaging; D010743:Phospholipids; D011169:Portal Vein / Q000000981:diagnostic imaging* / Q000601:surgery; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011379:Prognosis; D013459:Sulfur Hexafluoride; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014648:Varicose Veins / Q000000981:diagnostic imaging* / Q000601:surgery; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000601:surgery
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride