Clinical Management of Acute Portal/Mesenteric Vein Thrombosis.
BACKGROUND
Acute thrombosis of the portal vein (PV) and/or the mesenteric vein (MV) is a rare but potentially life-threatening disease. A multitude of risk factors for acute portal vein thrombosis (PVT)/mesenteric vein thrombosis (MVT) have been identified, including liver cirrhosis, malignancy, coagulation disorders, intra-abdominal infection/inflammation, and postoperative condition.


METHODS
This article analyses the treatment options for acute PVT/MVT.


RESULTS
Initially, the clinical management should identify patients with an intra-abdominal focus requiring immediate surgical intervention (e.g. bowel ischaemia). Subsequently, emphasis is placed on the recanalization of the PV/MV or at least the prevention of thrombus extension to avoid long-term complications of portal hypertension. Several therapeutic options are currently available, including anticoagulation therapy, local/systemic thrombolysis, interventional or surgical thrombectomy, and a combination of these procedures. Due to the lack of prospective randomized studies, a comparison between these therapeutic approaches regarding the efficacy of PV/MV recanalization is difficult, if not impossible.


CONCLUSIONS
In patients with acute PVT/MVT, an individualized treatment based on the clinical presentation, the underlying disease, the extent of the thrombosis, and the patients' comorbidities is mandatory. Therefore, these patients should be considered for an interdisciplinary therapy in specialized centres with the option to utilise all therapeutic approaches currently available.
Department of Surgery, University Hospital Regensburg, Regensburg, Germany.
Sven A
SA
Lang
Department of Surgery, University Hospital Regensburg, Regensburg, Germany.
Martin
M
Loss
Department of Radiology, University Hospital Regensburg, Regensburg, Germany.
Walter A
WA
Wohlgemuth
Department of Surgery, University Hospital Regensburg, Regensburg, Germany.
Hans J
HJ
Schlitt
Intervention; Portal/mesenteric vein thrombosis; Recanalization; Surgery