Combined Surgical and Interventional Therapy of Acute Portal Vein Thrombosis without Cirrhosis: A New Effective Hybrid Approach for Recanalization of the Portal Venous System

Abstract

Acute portomesenteric venous thrombosis represents a rare event, but is associated with severe and potentially lethal complications. Portal vein thrombosis (PVT) usually develops in the main trunk reaching left or right hepatic branches and can extend to the superior mesenteric vein and/or splenic vein. Noncirrhotic, nonmalignant, or nontransplant PVT is rarely a solitary disease and mostly a consequence of hypercoagulability or hypofibrinolysis. Other underlying causes for acute PVT are abdominal trauma and septic conditions, such as pancreatitis. In addition, surgical interventions, such as splenectomy in particular, as well as other local factors can lead to acute PVT. Clinical symptoms of acute PVT are mostly unspecific and variable, which makes an accurate clinical diagnosis difficult. Most patients present with acute abdominal pain, nausea, diarrhea, or ileus symptoms, but some patients are even asymptomatic. For diagnosis of PVT, Doppler ultrasound and contrast-enhanced CT are the most common imaging techniques that detect intrahepatic and extrahepatic PVT explicitly. Additional information, for example, the extent of thrombosis (mesenteric veins) and underlying or concomitant findings, such as bowel ischemia or congestion, is provided by a contrastenhanced CT scan that also allows distinguishing acute from chronic PVT. Management of acute PVT can include anticoagulation, regional or systemic thrombolysis, thrombectomy, or a combination of these treatments, with the aim to