title: Portal venous thrombosis after distal pancreatectomy: clinical outcomes.
abstract: OBJECTIVE
  Outcomes of patients developing portal vein (PV) thrombosis (PVT) after distal pancreatectomy (DP) are unknown. The goal of this study was to identify risk factors for PVT and describe the long-term outcomes in these patients.
  
  
  METHODS
  Patients undergoing DP without repair or reconstruction of the PV between 2001 and 2011 were included. Patients that showed evidence of PVT on pre-operative imaging were excluded from the study. Location and extent of thrombosis was determined by post-operative computed tomography or ultrasound imaging in all patients. Evidence of systemic thrombosis (if present) in addition to PVT was also documented.
  
  
  RESULTS
  In the study period, 991 patients underwent DP and 21 (2.1%) patients were diagnosed with PVT. Pancreatic neoplasm was the most frequent indication for operation (n = 11). Thrombus occurred in the main PV in 15 and the right branch of the PV in 8 patients. Complete PV occlusion occurred in nine patients with a median time to diagnosis of 16 days (range 5-85 days). Seventeen patients were anticoagulated for a median duration of 6 months (range 3.3-36 months) after the diagnosis of PVT. Over a median follow-up of 22 months, resolution of PVT occurred in seven patients. Predictors of non-resolution of PVT included anesthesia time >180 min (p = 0.025), DM type II (p = 0.03), BMI >30 Kg/m(2) (p = 0.03), occlusive PVT (p < 0.001), or thrombus in a sectoral branch (p = 0.02). Anticoagulation therapy did not influence the frequency of thrombus resolution and was complicated by gastrointestinal hemorrhage in four patients. There was no mortality as a direct result of PVT or anticoagulation.
  
  
  CONCLUSIONS
  PVT after distal pancreatectomy is a rare complication. Serious complications as a direct result of PVT in this setting are uncommon and are not dependent on thrombus resolution. Although anticoagulation does not appear to influence the rate of PVT resolution in this small retrospective series, we support the use of anticoagulation until larger, controlled studies define clear advantages or disadvantages.
authors.affiliation: Division of Gastroenterologic and General Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Ashwin S
authors.initials: AS
authors.lastname: Kamath
authors.forename: Michael G
authors.initials: MG
authors.lastname: Sarr
authors.forename: David M
authors.initials: DM
authors.lastname: Nagorney
authors.forename: Robert D
authors.initials: RD
authors.lastname: McBane
authors.forename: Michael B
authors.initials: MB
authors.lastname: Farnell
authors.forename: Kaye M Reid
authors.initials: KM
authors.lastname: Lombardo
authors.forename: Florencia G
authors.initials: FG
authors.lastname: Que
authors.forename: John H
authors.initials: JH
authors.lastname: Donohue
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kendrick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D011169:Portal Vein; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D055815:Young Adult
chemical_list: D000925:Anticoagulants