Educational Exhibit Abstract No. 346 - Optimizing access in the treatment of acute portal vein thrombosis: a pictorial review of different methods of obtaining access to the portal venous system for the purpose of lytic therapy with emphasis on the advantages and disadvantages of each technique

Abstract

Learning Objectives To describe the indications for thrombolytic therapy in the setting of acute, symptomatic portal vein thrombosis. To depict the different approaches to gaining access in the setting of acute portal vein thrombosis, as well as describe the pros and cons of each method. To provide useful hints in order to prevent common pitfalls. Background Portal vein thrombosis is a cause of significant morbidity amongst patients with endstage liver disease/hepatocellular carcinoma. Treatment in the acute, symptomatic setting may help to prevent life-threatening complications resulting from portal hypertension including variceal bleeding and mesenteric ischemia. Treatment may also help to prevent cavernous transformation of the portal vein, which can hinder transplant eligibility. Clinical Findings/Procedure Details The exhibit will include a pictorial review of cases describing different methods of obtaining access in the setting of acute portal vein thrombosis. Methods of access will include percutaneous routes as well as access via TIPS and DIPS placement. Cases will be followed by a description of the advantages and disadvantages of each method as well as a few helpful hints for troubleshooting based on the experience of multiple IRs at our academic institution. Conclusion and/or Teaching Points The use of thrombolytic therapy for the treatment of acute portal vein thrombosis can be associated with a high complication rate given the morbidity associated with endstage liver disease. This makes choosing the optimal access strategy for each individual patient extremely important in order to minimize complications and increase the likelihood of successful treatment. By familiarizing oneself with the pros and cons of each method, the IR can correctly choose the optimum route for access and hopefully avoid serious complications. Reference 1. Hollingshead M et al. Transcatheter Thrombolytic Therapy for Acute Mesenteric and Portal Vein Thrombosis. JVIR 2005: 16: 651-661.