title: Thrombosis of the portal venous system.
abstract: Portal vein thrombosis (PVT) is a rare cause of portal hypertension. Its diagnosis has been facilitated by improvements in imaging techniques, in particular Doppler sonography. The prevalence is about 1% in the general population, but much higher rates are observed in patients with hepatic cirrhosis (7%, range 0.6-17%), particularly those who also have hepatocellular carcinoma (HCC) (35%). The most common causes of PVT are myeloproliferative disorders, deficiencies of anticoagulant proteins, prothrombotic gene mutations, cirrhosis with portal hypertension, and HCC. Its development often requires the presence of two or more risk factors (local and/or systemic), e.g., a genetically determined thrombophilic state plus an infectious episode or abdominal surgery. It is clinically useful to distinguish between cirrhotic and noncirrhotic forms. Portal vein thrombosis is also traditionally classified as acute or chronic, but this distinction is often difficult. Color Doppler ultrasound is the first-line imaging study for diagnosis of PVT; magnetic resonance angiography and CT angiography are valid alternatives. The main complications are ischemic intestinal necrosis (in acute PVT) and esophageal varices (in chronic cases); the natural history of the latter differs depending on whether or not the thrombosis is associated with cirrhosis. The treatment of choice for PVT has never been adequately investigated. It is currently based on the use of anticoagulants associated, in some cases, with thrombolytics, but experience with the latter agents is too limited to draw any definite conclusions. In chronic thrombosis (even forms associated with cirrhosis), anticoagulant therapy is recommended and possibly, beta-blockers as well. Naturally, treatment of the underlying pathology is essential.
authors: Department of Clinical and Experimental Medicine, Clinica Medica 5, University of Padova, Italy.
authors: D
authors: D
authors: Sacerdoti
authors: G
authors: G
authors: Serianni
authors: S
authors: S
authors: Gaiani
authors: M
authors: M
authors: Bolognesi
authors: G
authors: G
authors: Bombonato
authors: A
authors: A
authors: Gatta
keywords: Hepatic cirrhosis.; Portal hypertension; Portal vein thrombosis
references: Radiology. 1990 Feb;174(2):309-19
references: 2404310
references: Hepatology. 1992 Nov;16(5):1195-8
references: 1427658
references: Gut. 2001 Nov;49(5):720-4
references: 11600478
references: J Hepatol. 2004 May;40(5):736-41
references: 15094219
references: Gastroenterology. 2001 Feb;120(2):490-7
references: 11159889
references: Ann Surg. 1974 Oct;180(4):487-93
references: 4472192
references: J Hepatol. 1993 Jun;18(2):258
references: 8409344
references: Hepatology. 2005 Mar;41(3):603-8
references: 15726653
references: Aliment Pharmacol Ther. 2006 Mar 15;23(6):767-75
references: 16556179
references: Gut. 2005 May;54(5):691-7
references: 15831918
references: Br J Surg. 1997 Jan;84(1):129-32
references: 9043477
references: J Vasc Interv Radiol. 2005 Dec;16(12):1653-9
references: 16371532
references: Clin Liver Dis. 2001 Aug;5(3):645-63
references: 11565135
references: Thromb Haemost. 1996 Feb;75(2):270-4
references: 8815575
references: Thromb Haemost. 1998 Dec;80(6):874-7
references: 9869152
references: Mayo Clin Proc. 1986 Feb;61(2):140-5
references: 3080643
references: Hepatology. 1996 May;23(5):1035-40
references: 8621130
references: Nature. 1994 May 5;369(6475):64-7
references: 8164741
references: AJR Am J Roentgenol. 1985 Jul;145(1):73-6
references: 3890495
references: Gastroenterology. 1995 Apr;108(4):1152-8
references: 7698583
references: Hepatogastroenterology. 2002 Sep-Oct;49(47):1405-11
references: 12239952
references: J Gastroenterol Hepatol. 2001 Jun;16(6):641-6
references: 11422617
references: Clin Transplant. 2004 Aug;18(4):390-4
references: 15233815
references: Transplantation. 2000 May 15;69(9):1772-4
references: 10830208
references: J Hepatol. 1992 Jul;15(3):299-303
references: 1447495
references: Gastroenterology. 1988 Apr;94(4):1063-9
references: 3345875
references: Aliment Pharmacol Ther. 2005 Jan 1;21(1):1-9
references: 15644039
references: World J Gastroenterol. 2006 Apr 7;12(13):2115-9
references: 16610067
references: Dis Colon Rectum. 2001 Apr;44(4):587-90
references: 11330588
references: Clin Radiol. 2002 May;57(5):377-83
references: 12014935
references: Hepatology. 2000 Sep;32(3):466-70
references: 10960436
references: Acta Radiol. 2000 Sep;41(5):470-3
references: 11016768
references: Am J Gastroenterol. 1996 Jan;91(1):163-5
references: 8561125
references: J Hepatol. 2005 Jul;43(1):167-76
references: 15925423
references: Am J Surg. 1996 Nov;172(5):449-52; discussion 452-3
references: 8942542
references: Eur J Gastroenterol Hepatol. 2005 Jul;17(7):745-51
references: 15947552
references: J Lab Clin Med. 2005 Oct;146(4):238-43
references: 16194685
references: Q J Med. 1979 Oct;48(192):627-39
references: 538223
references: Radiology. 2000 Jul;216(1):86-92
references: 10887231
references: Gastroenterol Clin Biol. 1996 Feb;20(1):103-5
references: 8734315
references: Br J Haematol. 2005 May;129(4):553-60
references: 15877740
references: Johns Hopkins Med J. 1969 Oct;125(4):171-83
references: 4903724
references: Radiology. 1995 Apr;195(1):153-7
references: 7892458
references: Hepatol Res. 2005 Jun;32(2):127-33
references: 15869904
references: J Vasc Interv Radiol. 2005 May;16(5):651-61
references: 15872320
references: Radiology. 1996 Oct;201(1):149-54
references: 8816536
references: Am J Physiol. 1985 Nov;249(5 Pt 1):G549-56
references: 3904482
references: Transplant Proc. 2005 Nov;37(9):3904-5
references: 16386579
references: Hepatology. 2000 Mar;31(3):587-91
references: 10706547
references: Gut. 1997 Jun;40(6):798-800
references: 9245936
references: Eur J Gastroenterol Hepatol. 2005 Mar;17(3):339-43
references: 15716659
references: Arch Intern Med. 1966 Jan;117(1):54-6
references: 5900489
references: World J Surg. 1998 Oct;22(10):1082-6
references: 9747171
references: Transplant Proc. 2005 Nov;37(9):3899-903
references: 16386578
references: Dig Dis Sci. 1992 Mar;37(3):340-6
references: 1735356