Portal Venous Aneurysms Research Articles

The natural history of portal venous system aneurysms.

Portal venous system aneurysms (PVAs) are increasingly diagnosed on cross-sectional computed tomography imaging. However, the natural history of these aneurysms is poorly understood, and reports are limited to small case series. Terms relevant to PVAs were searched in radiology reports (2010-2022), with PVA presence confirmed by manual review. PVA were defined as a diameter greater than 1.5cm in patients without cirrhosis and 1.9cm in those with cirrhosis. Aneurysm growth was defined as greater than 20% increase in size, whereas aneurysm regression was defined as greater than 20% decrease in size. Patient demographics, comorbid conditions, and PVA outcomes were abstracted. Univariate statistics were used to compare groups. Thirty-eight aneurysms with radiographic follow up were identified in 35 patients, involving the portal vein (n= 18; 47.4%), splenic vein (n= 10; 26.3%), superior mesenteric vein (n= 3; 7.9%), and portal confluence (n= 7; 18.4%). Although 12 (31.6%) were idiopathic, the remaining 26 (68.4%) were associated with portal hypertension (n= 20; 52.6%) and prior liver transplant (n= 4; 10.5%). The median growth was 0.2cm (range,-2.6 to 2.4cm) over median follow up over 5.0years (range, 0.3-16.6 years). Five PVAs (13.2%) regressed and were largely idiopathic (80.0%; P= .03). Thirteen PVAs (34.2%) grew and were associated with portal hypertension (n= 11; 84.6%; P= .003) and thrombosis (n= 6; 46.2%; P= .05). Nine PVAs (23.7%) thrombosed, predominantly in males (n=7; 77.8%). The median growth was 1.0cm (range,-0.7 to 1.9cm). Three patients (33.3%) were symptomatic from PVA thrombosis including abdominal pain (n= 2; 22.2%), intestinal ischemia (n= 1; 11.1%), and variceal bleeding (n= 2; 22.2%). Four patients (44.4%) were treated with anticoagulation. No aneurysms ruptured. Of the 58 PVAs initially identified with and without radiographic follow up, five (8.6%) underwent intervention with a median diameter of 4.0cm (range, 3.4-5cm). Intervention included vein ligation (n= 1; 20.0%), aneurysmorrhaphy (n= 1; 20.0%), and aneurysmectomy (n= 3; 60.0%). There was one case of aneurysm recurrence 20years following resection and one postoperative mortality. Two-thirds of PVAa, including those with size greater than 3cm, remain stable on surveillance. Although annual surveillance is initially recommended to confirm PVA stability, interval imaging can be subsequently extended given low growth rates. Over 20% of PVAs thrombosed, but none ruptured. Although we did not observe any cases of rupture, the devastating consequences of rupture necessitate consideration of surgical intervention for large symptomatic PVAs.

Aneurisma da veia porta

Portal venous aneurysms are a rare condition characterized by dilatation of the portal venous system. These aneurysms can be congenital or acquired and usually do not require any treatment unless they are symptomatic–symptoms depend on the aneurysm size, location and complications, such as thrombosis.We report a case of a 68 year‐old man, who was incidentally diagnosed with an asymptomatic 37mm portal vein aneurysm, with the involvement of the splenic vein confluence with the superior mesenteric vein. A conservative approach with annual monitoring by Doppler ultrasound was recommended.

Operative Interventions for Extrahepatic Portomesenteric Venous Aneurysms and Long-Term Outcomes

Extrahepatic portal venous aneurysms (PVAs) are rare, and the pathogenesis is not fully understood. The optimum management of these patients is unknown. Consecutive patients with PVA were identified over an 18-year period (1992-2010). A retrospective review was conducted. Clinical presentation, modality of diagnosis, surgical treatment, 30-day morbidity and mortality, and follow-up are reported. Four patients were identified who underwent surgical management of an extrahepatic PVA. Operative technique using left renal vein, femoral vein panel graft, polytetrafluoroethylene (ePTFE) graft, and segmental aneurysm wall resected with aneurysmorrhaphy is described. Early complications occurred in 1 patient with an ePTFE graft. The patient returned to the operating room for bleeding. In addition, the same patient had a late graft thrombosis 6 years postoperatively when the anticoagulation was discontinued for pregnancy. The remainder of the patients recovered without complication, and their repairs are still patent with a mean follow-up of 78months (17-144months). There were no mortalities in the series. Operative intervention for portomesenteric venous aneurysm can be done safely in select patients and should be considered in those with symptoms, rapid growth, mural thrombus, or aneurysms ≥4cm in diameter. Repair with an autogenous interposition graft affords good long-term patency. Aneurysmorrhaphy may be performed if the remaining venous wall is of good quality.

Hemodynamic analysis and treatment of an enlarging extrahepatic portal aneurysm: report of a case

Aneurysms in the portal venous system are relatively rare. We report the case of an extrahepatic portal venous aneurysm, detected incidentally by ultrasonography. The patient, a 75-year-old woman, was initially observed over 18 months, during which time, the aneurysm grew from 36 mm × 32 mm to 51 mm × 37 mm in size, without symptoms. Hemodynamic analysis employing computational flow dynamics technique showed obvious turbulence in the aneurysm, and the wall shear stress (WSS) against that part of the aneurysmal wall was greater than in other sites. To prevent complications such as spontaneous rupture and portal vein thrombosis, the aneurysm was resected, with reconstruction of the portal trunk. While careful follow-up is sufficient for most portal venous aneurysms, its enlargement could indicate possible spontaneous rupture. The increased WSS against part of the aneurysmal wall most likely accounts for the aneurysm enlargement in this case.

Contrast-enhanced ultrasound in portal venous system aneurysms: a multi-center study.

To investigate contrast-enhanced ultrasound (CEUS) findings in portal venous system aneurysms (PVSAs). In this multi-center, retrospective, case series study, we evaluated CEUS features of seven cases of PVSAs that were found incidentally on conventional ultrasound in the period 2007-2013. Three Ultrasound Centers were involved (Chieti, Italy, Bad Mergentheim, Germany, and Cluj-Napoca, Romania). All patients underwent CEUS with Sonovue(®) (Bracco, Milan, Italy) at a standard dose of 2.4 mL, followed by 10 mL of 0.9% saline solution. The examinations were performed using multifrequency transducers and low mechanical index. We considered aneurysmal a focal dilatation of the portal venous system with a size that was significantly greater than the remaining segments of the same vein, and that was equal or larger than 21 mm for the extrahepatic segments of portal venous system, main portal vein and bifurcation, and 9 mm for the intrahepatic branches. After contrast agent injection, all PVSAs were not enhanced in the arterial phase (starting 8-22 s). All PVSAs were then rapidly enhanced in the early portal venous phase (starting three to five seconds after the arterial phase, 11-30 s), with persistence and slow washout of the contrast agent in the late phase (starting 120 s). In all patients, CEUS confirmed the presence of a "to-and-fro" flow by showing a swirling pattern within the dilatation in the early portal venous phase. CEUS also improved the delineation of the lumen, and was reliable in showing its patency degree and integrity of walls. In one patient, CEUS showed a partial enhancement of the lumen with a uniformly nonenhancing area in the portal venous and late phases, suggesting thrombosis. In our case series, we found that CEUS could be useful in the assessment and follow-up of a PVSA. Further studies are needed to validate its diagnostic accuracy.

Extra-hepatic portal vein aneurysm: A case report, overview of the literature and suggested management algorithm

INTRODUCTIONPortal venous aneurysms are a rare finding. The reported incidence is on the rise with increasing use of modern imaging techniques in clinical practice. However, there is still much to be elicited regarding their aetiology, natural history, and management. PRESENTATION OF CASEAn 80-year-old woman presented with abdominal pain and nausea. Investigations showed a hypoechoic area in the region of the head of pancreas on ultrasound, which was found to be a portal venous aneurysm on CT. In view of her multiple comorbidities, a conservative approach was taken. DISCUSSIONPortal venous aneurysms represent approximately 3% of all venous aneurysms with a reported prevalence of 0.43%. They may be congenital, due to failure of complete regression of the right vitelline vein, or acquired secondary to portal hypertension. The primary presentation of portal vein aneurysm is abdominal pain, followed by incidental detection on imaging, with a minority of patients presenting with gastrointestinal bleeding. Complications of PVA include thrombosis, biliary tract obstruction, inferior vena cava obstruction, and duodenal compression. On the whole PVAs are stable and have a low risk of complications with 88% of patients showing no progression of aneurysm size or complications on subsequent follow up scans. CONCLUSIONWe recommend that portal venous aneurysms be assessed using colour Doppler ultrasonography in the first instance with CT scans reserved for indeterminate cases or symptomatic patients. Due to the slow progression of such aneurysms, surgery is recommended only for symptomatic patients or those with complications secondary to portal venous aneurysms.

Congenital Portal Venous System Aneurysms Associated With Caput Medusae Δ

Congenital Portal Venous System Aneurysms Associated With Caput Medusae Δ

Complete spontaneous regression of an extrahepatic portal vein aneurysm

Primary portal venous aneurysms are rare; however, they are the most common visceral venous aneurysms, and their pathogenesis is not fully understood. Complications include thrombosis, rupture, and mass effect on adjacent structures. The optimal management of these patients is not known. We describe a patient whose large (6-cm) portal vein aneurysm underwent complete spontaneous regression over several years of serial observation. To our knowledge, this observation has not been reported in the English literature.

Portal Venous Aneurysms—Report of 4 Cases

Portal venous aneurysms are rare and are usually discovered as incidental findings on abdominal imaging studies. Although most are asymptomatic, they may occasionally cause symptoms of compression of an adjacent structure, thrombosis, or bleeding. Treatment is usually not necessary and conservative follow-up is suggested. We present four patients with portal system aneurysms. One patient had a 10.5 cm thrombosed aneurysm, one had a right 3.5 cm intrahepatic portal aneurysm, one patient had a symptomatic 4 cm splenic artery aneurysm, which was repaired, and one patient had a 4 cm aneurysm at the confluence of the splenic and portal veins.

Blunt abdominal trauma - An important cause of portal venous pseuodoaneurysm

Aneurysms and pseudoaneurysms of the portal venous system are rarely seen following abdominal trauma but clinicians need to be aware of them as possible vascular complications following blunt trauma. This case report of a 10 year old boy following a handlebar injury demonstrates a clear causal relationship between trauma and portal venous pseudoaneurysm. Portal venous aneurysms have a prevalence of less than 0.4% and most are found in patients with underlying hepatocellular disease. Many are asymptomatic in which case surveillance is an accepted management strategy, with Doppler ultrasound proving useful. Complications including thrombosis, distal embolism, compression of the biliary tree and haemorrhage are usually indications for surgical management. Portal venous pseudoaneurysms may be managed conservatively but transcatheter embolisation can be used if there are ongoing complications or haemorrhage.

Visceral Venous Aneurysms: Clinical Presentation, Natural History and Their Management: A Systematic Review

Aneurysms of the visceral veins are considered rare clinical entities. The aim is to assess their clinical presentation, natural history and management. An electronic search of the pertinent English and French literature was undertaken. All studies reporting on aneurysms of visceral veins were considered. Cases describing patients with arterial-venous fistulae and extrahepatic or intra-hepatic portosystemic venous shunts were excluded. Ninety-three reports were identified, including 176 patients with 198 visceral venous aneurysms. Patients' age ranges from 0 to 87 years, and there is no apparent male/female preponderance. The commonest location of visceral venous aneurysms is the portal venous system (87 of 93 reports, 170 of 176 patients, 191 of 198 aneurysms). Aneurysms of the renal veins and inferior mesenteric vein are also described. Portal system venous aneurysms were present with abdominal pain in 44.7% of the patients, gastrointestinal bleeding in 7.3%, and are asymptomatic in 38.2%. Portal hypertension is reported in 30.8% and liver cirrhosis in 28.3%. Thrombosis occurred in 13.6% and rupture in 2.2% of the patients. Adjacent organ compression is reported in 2.2% (organs compressed: common bile duct, duodenum, inferior vena cava). The management ranged from watchful waiting to intervention. In 94% of the cases, aneurysm diameter remained stable and no complications occurred during follow-up. In most of the cases, indications for operation were symptoms and complications. Six cases of renal vein aneurysm are reported; three of them were asymptomatic. Three of these patients were treated surgically. The most frequent location of visceral venous aneurysms is the portal venous system. They are often associated with cirrhosis and portal hypertension. They may be asymptomatic or present with abdominal pain and other symptoms. Watchful waiting is an appropriate treatment, except when complications occur. Most common complications are aneurysm thrombosis and rupture. Other visceral venous aneurysms are extremely rare.

Portal vein aneurysm due to traumatic etiology

Portal vein aneurysm is a rare clinical entity. We describe a case of portal vein aneurysm due to traumatic etiology. Our patient had no signs suggestive of portal hypertension; the lesion was incidentally detected by ultrasound. It appears that these aneurysms can be found at any age and that there is no sexual preference. This pathology is increasingly encountered with the frequent use of radiological imaging modalities. INTRODUCTION Portal vein aneurysm is a rare clinical entity, with only 41 published cases in the English-language literature. Twentyfive of them were congenital(1). Portal venous aneurysms are described as focal dilatations of the portal venous system(2).Generally it was incidentally diagnosed during an investigation for dyspepsia(1). CASE PRESENTATION Our case was a 65-year-old male. He was suffering from flatulance and dyspepsia for 2 years. His past medical history was significant for a blunt trauma to the right upper quadrant of the abdomen he had experienced 19 years ago due to a traffic accident. Upper abdominal ultrasound imaging was carried out for a possible diagnosis of cholelithiasis. A venous aneurysm of 28x24 mm corresponding to the proximal zone of left branch of portal vein next to the falciform ligament. (Figures 1 and 2). Figure 1 Figure 1 Portal vein aneurysm due to traumatic etiology 2 of 4 Figure 2 Figure 2 Color Doppler ultrasound imaging revealed venous aneurysmal dilation with continuous flow pattern as in the case with portal flow (Figure 3).

Portal Venous System Aneurysms: Imaging, Clinical Findings, and a Possible New Etiologic Factor

The aims of this study were to present the prevalence, imaging and clinical findings, and possible causes of portal venous system aneurysms. From 1998 to 2006, a total of 38 portal venous system aneurysms identified in 25 patients were retrospectively reviewed. The data of seven patients diagnosed using color Doppler sonography or CT before March 2004 were not consecutive, but the data recorded thereafter comprised the analysis of 4,186 consecutive patients who underwent routine abdominal MDCT. The patients were 14 men and 11 women (mean age -/+ SD, 53 -/+ 17 years). The prevalence of portal venous system aneurysm among 4,186 consecutive patients was 0.43%. There were no differences with respect to patient age, patient sex, and intrahepatic or extrahepatic location of aneurysm between those with and those without portal venous system aneurysm. Seven of the 25 patients with portal venous system aneurysm were symptomatic because of portal vein thrombosis, and six of them had recurrence. These patients had significantly larger aneurysms than those without symptoms. Four of those seven symptomatic patients evaluated for thrombophilia had an underlying defect. Other associated findings were splenomegaly (n = 16), portal hypertension (n = 8), cirrhosis (n = 3), psoriasis (n = 2), portal vein variation (n = 1), chronic pancreatitis (n = 1), and cutis laxa (n =1). Portal venous system aneurysms were rare in our study group but occurred more frequently than previously thought. All thrombosed aneurysms, most with a recurrence, were symptomatic and larger in patients with symptoms of portal venous system aneurysm than in those without symptoms. There were no differences among patients with portal venous system aneurysm and those without portal venous system aneurysm with respect to patient age and patient sex. Among those with aneurysms, there was no difference between subjects with intrahepatic versus extrahepatic aneurysms. A thrombophilic defect probably played a role in development of thrombosis in the portal venous system aneurysm.

Intrahepatic venous and portal venous aneurysms examined by color Doppler flow imaging.

Thirteen cases with liver cystic lesions, which were suspected to communicate with intrahepatic vessels on the basis of ordinary sonography, were examined by color Doppler flow imaging. By this method, blood flow within the cystic lesion was detected in 5 of these cases, and the communication to the intrahepatic vessel confirmed. Information about the hemodynamics of aneurysms was obtained. Two of these lesions were diagnosed as an aneurysmal porta-hepatic venous fistula, another 2 as a portal venous aneurysm, and the remaining 1 as a hepatic venous aneurysm.