Acute Portal Vein Research Articles

P1676: COVID VACCINE INDUCED IMMUNO THROMBOCYTOPENIA AND THROMBOSIS - OBSERVATIONAL STUDY

Background: Vaccination has been an important strategic tool in helping to bring the COVID pandemic to an end. A multitude of vaccines are available, a few of which have undergone phase 3 trials and been approved for use across the world. In India, Covishield, a viral vector-based RNA vaccine (ChAdOX1) was the most used vaccine. Viral vector vaccines were reported to cause serious thrombotic complications (Vaccine induced thrombocytopenia and thrombosis), especially cerebral sinus venous thrombosis in young females, by generating antibodies against PF4 antigen. Here we report three cases of non-fatal but serious thrombotic complications in patients that received Covishield vaccine. Aims: In this observational study we aimed to study the thrombotic adverse effects following COVID vaccination. Methods: Patients admitted to our 250 bedded multi-specialty hospital with any thrombotic complications were assessed for temporal relationship with Covid vaccination. Results: - Sno Case 1 Case 2 Case 3 Age 47yrs 37yrs 75yrs Sex Male Male Male Underlying condition Membranous nephropathy –Partial remission (urine protein creatinine ratio: 2.4g/g, albumin: 3.4 g/dL) - Diabetes Hypertension Vaccine type Covishield Covishield Covishield Time between Vaccination and effect 2days 6weeks 2days Presentation Syncopal episode Acute upper and peri-umbilical abdominal pain. Right sided abdominal pain. haemodynamically unstable with right ventricular strain pattern. CT abdomen - acute portal vein and superior mesenteric vein thrombosis CT abdomen-acute thrombosis of right main renal artery with infarction of right kidney. CTPA- saddle thrombus Platelet count 100 x 103/cmm 135 x 103/cmm 130 x 103/cmm HIT screen[PF4] - ++ - Treatment Thrombolysis à Rivoroxaban Warfarin Thrombectomy Outcome Alive Alive Alive Summary/Conclusion: Here were described three different cases of thrombosis that presented within 6 week of receiving first dose of Covishield vaccine. A common feature with all of the patients was relatively mild thrombocytopenia, and possibly an underlying predisposition for thrombosis. In one patient we could conclusively prove the presence of HIT antibodies as much was known about VITT by then. The aim of this article is to bring awareness to the wider community about the possible association of vaccination in the context of acute thrombosis. It is imperative that heparin be avoided in these patients. Fondaparinux is a suitable alternative. Further anti-coagulation could be with either warfarin or novel oral anti-coagulants. IVIG was also used in the treatment of some patients with cerebral venous sinus thrombosis.

Acute liver failure precipitated by acute Budd-Chiari syndrome and complete portal vein thrombosis.

Acute Budd‐Chiari syndrome and complete portal vein thrombosis are important features of myeloproliferative neoplasm that may occur simultaneously, resulting in acute liver failure. Liver transplantation could be effective even in such a catastrophic condition without post‐transplant complications.

Clinical study of transjugular intrahepatic portosystemic shunt combined with AngioJet thrombectomy for acute portal vein thrombosis in non-cirrhosis.

To evaluate the outcomes of the transjugular intrahepatic portosystemic shunt (TIPS) combined with AngioJet thrombectomy in patients with noncirrhotic acute portal vein (PV) thrombosis.Retrospective analysis from January 2014 to March 2017, 23 patients underwent TIPS combined with AngioJet thrombectomy for acute PV thrombosis in noncirrhosis. The rates of technical success, the patency of the PV, liver function changes, and complications were evaluated.Twenty-three patients underwent combined treatment, with a technical success rate of 100%. Twenty-four hours after treatment, PV thrombosis grade was improved significantly (P = .001). Before and after treatment, Albumin (gm/dl), aspartate transaminase (IU/l), alanine transaminase (IU/l), and platelets (109/L) were all significantly improved (P < .05). Minor complications include hematoma, hematuria, and hepatic encephalopathy. After 1 week of treatment, computed tomography scan revealed 8.7% (2/23) cases of hepatic envelope hematoma (thickness less than 2 cm). Hemoglobinuria occurred in 18/23 (78.3%) patients after treatment and returned to normal within 1 to 2 days. Two patients 2/23 (8.7%) had transient grade I encephalopathy after TIPS. The 1-year overall survival rate was 100% (23/23). No major complications during treatment in all patientsAngioJet thrombectomy via TIPS has a favorable short-term effect in clearing thrombus and alleviating symptoms in diffuse acute PVT. The long-term efficacy of this treatment needs to be further studied.

Urgent intraoperative endovascular stent placement to resolve acute hepatic or portal venous obstruction during liver surgery: a case series

BackgroundAcute obstruction of the hepatic vein (HV) or the portal vein (PV), particularly when it occurs during liver surgery, is potentially fatal unless repaired swiftly. As surgical interventions for this problem are technically demanding and potentially unsuccessful, other treatment options are needed.Case presentationWe report two cases of acute, surgically uncorrectable HV or PV obstruction during liver resection or living donor liver transplantation (LDLT), which was successfully treated with urgent intraoperative placement of endovascular stents using interventional radiology (IVR). In Case 1, a patient with colonic liver metastases underwent a non-anatomic partial hepatectomy of the segments 4 and 8 with middle hepatic vein (MHV) resection. Additionally, the patient underwent an extended right posterior sectionectomy with right hepatic vein (RHV) resection for tumors involving RHV. Reconstruction of the MHV was needed to avoid HV congestion of the anterior section of the liver. The MHV was firstly reconstructed by an end-to-end anastomosis between the MHV and RHV resected stumps. However, the reconstruction failed to retain the HV outflow and the anterior section became congested. Serial trials of surgical revisions including re-anastomosis, vein graft interposition and vein graft patch-plasty on the anastomotic wall failed to recover the HV outflow. In Case 2, a pediatric patient with biliary atresia underwent an LDLT and developed an intractable PV obstruction during surgery. Re-anastomosis with vein graft interposition failed to restore the PV flow and elongated warm ischemic time became critical. In both cases, the misalignment in HV or PV reconstruction was likely to have caused flow obstruction, and various types of surgical interventions failed to recover the venous flow. In both cases, an urgent IVR-directed placement of self-expandable metallic stents (SEMS) restored the HV or PV perfusion quickly and effectively, and saved the patients from developing critical conditions. Furthermore, in Cases 1 and 2, the SEMS placed were patent for a sufficient period of time (32 and 44 months, respectively).ConclusionsThe IVR-directed, urgent, intraoperative endovascular stenting is a safe and efficient treatment tool that serves to resolve the potentially fatal acute HV or PV obstruction that occurs in the middle of liver surgery.

Acute or recent portal vein thrombosis in cirrhosis predicts a hidden or upcoming diagnosis of hepatocellular carcinoma

Acute or recent portal vein thrombosis in cirrhosis predicts a hidden or upcoming diagnosis of hepatocellular carcinoma

Successful recanalization of acute extensive portal vein thrombosis by aspiration thrombectomy and thrombolysis via an operatively placed mesenteric catheter: a case report.

Portal vein thrombosis (PVT) after hepatobiliary surgery is rare but can cause lethal and severe complications. If early diagnosis and recanalization can be achieved, the PVT is expected to be eliminated. A 70-year-old male was diagnosed as having hepatocellular carcinoma occupying the right lobe of the liver. As oligometastatic lung tumors were simultaneously detected on contrast-enhanced CT (CECT), hepatectomy was not indicated. However, the primary tumor was very large, and as large tumor size can be associated with an unfavorable prognosis, and owing to the strong desire of the patient, he underwent right lobe hepatectomy. Jaundice appeared on post-operative Day (POD) 2 and CECT displayed slight intraheptatic bile duct dilation. However, a PVT did not exist at this time. Percutaneous transhepatic biliary drainage was performed and Doppler echo displayed intrahepatic and extrahepatic PVT on post-operative Day 5. Emergent thrombectomy was performed using a Vasplyser PlusTM thrombus aspiration catheter (Johnson & Johnson K.K. Medical Company, Tokyo, Japan) via the ileocolic vein under laparotomy. The mesenteric catheter was placed at the distal point of the residual PVT. Thrombolysis and anticoagulant therapy were performed using heparin and urokinase. In the CECT performed 16 days after the additional operation, the PVT had disappeared and the portal vein was completely recanalized. The mesenteric catheter was removed on the same day and oral anticoagulant therapy was continued. At the time of writing, 14 months have passed with no recurrence of PVT. Early diagnosis of PVT enables treatment with emergent thrombectomy, thrombolysis, and anticoagulant therapy. These treatments result in the improvement of portal vein flow and the complete disappearance of PVT.

Long-Term Outcome of Portal Vein Stent Placement in Pediatric Liver Transplant Recipients: A Comparison with Balloon Angioplasty

PurposeTo evaluate the long-term efficacy of stent placement versus balloon angioplasty for portal vein (PV) stenosis in pediatric liver transplant (LT) recipients. Materials and MethodsFifty patients (<18 years old; median, 14 months) who underwent percutaneous transhepatic balloon angioplasty (n = 12), transhepatic stent placement (n = 18), or intraoperative transmesenteric stent placement (n = 20) between 1994 and 2015 were retrospectively analyzed. The median intervals from LT to percutaneous transhepatic angioplasty, stent, and intraoperative stent were 145 days (range, 27–2072), 98 days (range, 5–2289), and 0 days (range, 0–14), respectively. The primary study endpoint was the primary patency of each group. Secondary study endpoints included procedural complications, functional stent stenosis, and stent fractures. ResultsThe median clinical follow-up periods were 81 months (range, 13–179), 118 months (range, 65–181), and 112 months (range, 47–168) in each group, respectively. In the angioplasty group, the 1-, 5-, and 10-year primary patency rates were all 75% ± 13%. The corresponding rates were all 100% in the percutaneous transhepatic stent group and 90% ± 7%, 90% ± 7%, and 85% ± 8%, respectively, in the intraoperative transmesenteric stent group (P = .103). Major procedural complications occurred in 4 patients, including 1 case with PV tear after percutaneous transhepatic post-stent angioplasty, and 3 cases with acute PV thrombosis after intraoperative transmesenteric stent. Functional stent stenosis and stent fractures occurred in 1 and 2 patients, respectively. ConclusionsNo statistically significant difference was observed between the 3 groups in terms of the long-term primary patency rates. Therefore, angioplasty should be considered first to treat PV stenosis in pediatric LT recipients.

Hemodynamic Changes in Portal Vein and Frequencies of Acute and Chronic Portal Vein Thrombosis in Pediatric Patients Presenting with Hematemesis

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; The objective of the study is to calculate the frequency of portal vein thrombosis in pediatric patients presenting with hematemesis and to estimate the frequency of acute and chronic portal vein thrombosis in these cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and Methods:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;Pediatric patients of 1 – 15 years of age of either sex, presenting to emergency or gastroenterology department with complaint of hematemesis were included. Informed consent was taken from parents/guardians. This is a Descriptive cross sectional study conducted in department of pediatric radiology, Children Hospital and Institute of child Health Lahore from 11-12-2012 to 10-6-2013. Doppler ultrasound of these patients was performed at Core Vision pro SSA 350-A Doppler machine (Toshiba, Japan) using standard imaging protocols. The data was analyzed using SPSS version 17.0 (SPSS Inc., IL, Chicago, USA)&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;In this study, 41% (n = 41) between 1 – 5 years, 38% (n = 38) between 6 – 10 years and only 21% (n = 21) between 11 – 15 years of age, 64%( n = 64) were male and remaining 36% (n = 36) were females, frequency of portal vein thrombosis in pediatric patients presenting with hematemesis reveals in 37% (n = 37) while 63% (n = 63) had no findings of PVT, frequency of acute and chronic forms in patients positive for portal vein thrombosis was 40.54% (n = 15) had acute and 59.46% (n = 22) had chronic portal vein thrombosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;We concluded that the frequency of portal vein thrombosis in pediatric patients presenting with hematemesis and frequency of acute and chronic forms in patients positive for portal vein thrombosis is in accordance with other studies while color Doppler ultrasound is a useful diagnostic modality being noninvasive and cost effective.&lt;/p&gt;

Efficacy and safety of treatment of acute nonmalignant portal vein thrombosis with subcutaneous fondaparinux in patients with cirrhosis and marked thrombocytopenia

Efficacy and safety of treatment of acute nonmalignant portal vein thrombosis with subcutaneous fondaparinux in patients with cirrhosis and marked thrombocytopenia

Transradial approach for transcatheter selective superior mesenteric artery urokinase infusion therapy in patients with acute extensive portal and superior mesenteric vein thrombosis

To evaluate the feasibility and efficacy of urokinase infusion therapy via a transradial approach for transcatheter superior mesenteric artery (SMA) in patients with acute extensive portal and superior mesenteric venous thrombosis. During a period of 8 years, 47 patients with acute extensive thrombosis of portal vein (PV) and superior mesenteric veins (SMV) received urokinase infusion therapy by transcatheter selective SMA via radial artery. Their mean age was 44 ± 13 years (range: 19 - 65). Through radial sheath, a 5F catheter was placed into SMA and subsequently the infusion of urokinase was given for 5 - 11 days (mean: 7.1 ± 2.5). Adequate anticoagulation was initiated during treatment, throughout hospitalization and post-discharge. Follow-up contrast-enhanced computed tomography (CT) was performed in each patient every 3 days and before the removal of infusion catheter. Termination of urokinase infusion therapy was decided on the basis of clinical and radiographic findings. Technical success was achieved in all patients. Two patients had worsening abdominal pain, developed the signs of peritonitis at 24 hours after interventional treatment and underwent eventual laparotomy with the resection of necrotic bowel. Substantial clinical improvement was observed in 45 (95.7%) of them after the procedure. Minor complications at the radial puncture site were observed in 7 patients (14.9%) and infusion therapy continued. Follow-up CT scans at pre-discharge demonstrated a nearly complete disappearance of PV-SMV thrombosis in 29 patients (64.4%) and partial recanalization of PV-SMV thrombosis in 16 patients (35.6%). They were discharged at 9 - 20 days (mean: 12 ± 6) post-admission. The mean post-discharge duration of follow-up was 48 ± 20 months. Recurrent episodes of PV and SMV thrombosis were observed in 2 (4.4%) patients at 6 months and 5 years respectively post-discharge and they were treated successfully with urokinase infusion. The transcatheter SMA urokinase infusion therapy via a transradial approach for plus anticoagulation is both safe and effective for the management of patients with acute extensive PV-SMV thrombosis.

Splanchnic vein thrombosis

ZusammenfassungDie Venenthrombose im Splanchnikusgebiet – einschließlich Thrombosen der Pfortader, der Mesenterial-, Milz- und suprahepatischen Venen – ist eine unterdiagnostizierte Erkrankung mit einem heterogenen klinischen Bild und einer nicht unbeträchtlichen Quote an Zufallsbefunden.Die Hauptrisikofaktoren umfassen abdominelle Erkrankungen oder Eingriffe (z.B. Infektionen, Zirrhose, abdominelle Krebserkrankungen oder chirurgische Maßnahmen), hämatologischeStörungen (insbesondere myeloproliferative Neoplasien), hereditäre Thrombophilien und hormonelle Störungen. Kürzlich wurden neue Biomarker für subklinische Erkrankungen identifiziert: die JAK2-Mutation und die Durchflusszytometrie für CD55 und CD59. Die klinische Manifestation ist gewöhnlich unspezifisch. In der akuten Phase können als wichtigste Symptome Bauchschmerzen, gas-trointestinale Blutungen und Aszites auftre-ten; zu den langfristigen Folgen hingegen gehören die Leberzirrhose und die portale Hypertonie.Fortschritte bei der nicht invasiven Gefäßdarstellung (Doppler-Ultraschall, Gefäß-Computertomografie und Magnetresonanztomogra-fie) haben die Diagnostik der splanchnischen Venenthrombose verbessert. Auffällige Blutbefunde können auf eine zugrunde liegende hämatologische oder hepatische Störung hinweisen.Die optimale Behandlung der splanchnischen Venenthrombose ist noch eine offene Frage, da große klinische Studien fehlen. Experten empfehlen übereinstimmend, die akute, symptomatische, nicht zirrhotische Pfortaderthrombose im akuten Stadium mittels parenteraler Antikoagulation zu behandeln und an-schließend über mindestens 3 Monate orale Antikoagulanzien zu geben; bei persistieren-den prothrombotischen Faktoren wird jedoch eine lebenslange Behandlung empfohlen. Bei einem Budd-Chiari-Syndrom wird für alle Pa-tienten ohne größere Kontraindikationen eine Antikoagulation empfohlen. Allerdings muss das Nutzen-/Risikoverhältnis einer gerinnungshemmenden Therapie sowohl für die Akutbehandlung als auch für die langfristige Sekundärprävention noch besser untersucht werden.

Predicting early mortality in patients with cirrhosis of the liver

Aim: To determine the natural history of acute portal venous thrombosis (PVT) and acute mesenteric venous thrombosis (MVT) with specific reference to mortality and the development of portal hypertension. Methods: Retrospective analysis of patients who fulfilled criteria for acute PVT or acute MVT. Patients had symptoms of abdominal pain of less than 6 weeks' duration, and thrombosis was confirmed on ultrasonography, computerized tomography, angiography, or surgery. When information was unavailable, a questionnaire was mailed to the patients for follow-up. Special coagulation tests were carried out at the initial admission and specific etiologies predisposing to thrombophilia investigated. Patients were advised long-term anticoagulation. Results: Eighty-six patients fulfilled criteria for acute portal or acute mesenteric venous thrombosis. A specific etiology (malignancy, hematological disease, inflammatory bowel disease, or surgery) was found in 47 of the patients. The remaining 39 patients were classified as idiopathic thrombosis. There was no difference in gender, age, clinical presentation, radiological findings, or time to diagnosis between the two groups. Three patients in each group had recurrent thrombosis. No patient of isolated mesenteric venous thrombosis either extended the thrombus into the portal vein or had variceal bleeding on long-term follow-up. Significant differences in presentation, as well as in follow-up between the two groups are given in the table. Conclusions: Patients with idiopathic acute mesenteric or portal vein thrombosis have a more favorable short-term, as well as long-term prognosis. 1056

Relationship between portal venous and hepatic arterial blood flows: spectrum of response

The relationship between portal tributary blood flow (PBF) and hepatic arterial blood flow (HAF) was studied in awake, unrestrained rats with the radiolabeled microsphere technique. Six distinct patterns of response emerged. In group A (PBF+, HAF 0), ethanol, acetate, glucagon, prostacyclin, and a mixed diet increased PBF without a change in HAF; in group B (PBF+, HAF+), adenosine and histamine increased both PBF and HAF; in group C (PBF 0, HAF+), isoflurane and triiodothyronine did not change PBF but increased HAF; and in group D (PBF-, HAF+), halothane and vasopressin decreased PBF and increased HAF. Acute partial portal vein ligation decreased PBF (56%) and increased HAF (436%). Hypoxia (7.5% O2) decreased PBF (28%) and increased HAF (110%). In group E (PBF+, HAF-), acute hepatic artery ligation increased PBF (35%) and reduced HAF (74%), while in group F (PBF-, HAF-), thyroidectomy reduced PBF and HAF (36 and 47%, respectively). All blood flow responses were accompanied by the expected changes in both portal tributary and hepatic arterial vascular resistances. The data suggest that the portal and hepatic arterial vascular territories have regulatory mechanisms that allow for independent changes.