1
|
Koumar L, Senthamizhselvan K, Barathi D, Verma A, Rao P, Selvaraj J, Sanker V. Portal Vein Thrombosis in Patients With Cirrhosis of the Liver: Prevalence and Risk Factors. Cureus 2023; 15:e50134. [PMID: 38186444 PMCID: PMC10771608 DOI: 10.7759/cureus.50134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION Chronic liver disease very often culminates into cirrhosis and its associated complications. One of the serious complications is portal venous thrombosis, which can occur due to a variety of risk factors. One significant factor contributing to portal hypertension is portal vein thrombosis (PVT). In this study, we aimed to investigate the prevalence of PVT among patients with liver cirrhosis in a tertiary hospital and identify the factors associated with this complication. METHODOLOGY This was a cross-sectional observational study of 93 diagnosed liver cirrhosis patients treated at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) hospital in southern India between June 2020 and January 2021. A thorough evaluation of the clinical condition of the patients and associated comorbidities was done. The patients then underwent Doppler ultrasound/CECT/MRI to look for PVT and its extent. The collected data were analyzed using Statistical Product and Service Solutions (SPSS, version 24) (IBM SPSS Statistics for Windows, Armonk, NY). Comparison between two proportions was done using two two-tailed Z-test/Fisher's exact tests. RESULTS Our study found a PVT prevalence of 17.2% in cirrhotic patients, with a higher prevalence of acute PVT than chronic PVT. Ascitic fluid infection, longer duration of cirrhosis, and increased cirrhosis severity were significantly associated with PVT development. We found no significant associations between PVT and gender, hypertension, smoking, diabetes, or the duration of alcohol intake. CONCLUSION This study highlights the importance of early screening for PVT using Doppler USG in all patients diagnosed with cirrhosis. Additionally, anticoagulation therapy for acute PVT may be considered in patients without bleeding risks.
Collapse
Affiliation(s)
- Lokesh Koumar
- Cardiology, Wolverhampton Heart and Lung Centre, New Cross Hospital, Wolverhampton, GBR
| | - Kuppusamy Senthamizhselvan
- Medical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Deepak Barathi
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Amogh Verma
- Medicine, Rama Medical College Hospital and Research Centre, Hapur, IND
| | - Pallavi Rao
- Internal Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, IND
| | - Jayachandran Selvaraj
- General Internal Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Vivek Sanker
- General Surgery, Noorul Islam Institute of Medical Science and Research Foundation (NIMS Medicity), Trivandrum, IND
| |
Collapse
|
2
|
Layton BM, Lapsia SK. The Portal Vein: A Comprehensive Review. Radiographics 2023; 43:e230058. [PMID: 37856316 DOI: 10.1148/rg.230058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Radiologists are familiar with the appearances of a normal portal vein; variations in its anatomy are commonplace and require careful consideration due to the implications for surgery. These alterations in portal vein anatomy have characteristic appearances that are clearly depicted on CT, MR, and US images. Similarly, there are numerous congenital and acquired disorders of the portal vein that are deleterious to its function and can be diagnosed by using imaging alone. Some of these conditions have subtle imaging features, and some are conspicuous at imaging but poorly understood or underrecognized. The authors examine imaging appearances of the portal vein, first by outlining the classic and variant anatomy and then by describing each of the disorders that impact portal vein function. The imaging appearances of portal vein abnormalities discussed in this review include (a) occlusion from and differentiation between bland thrombus and tumor in vein and the changes associated with resultant hepatic artery buffer response changes, cavernous transformation of the portal vein, and portal biliopathy; (b) ascending thrombophlebitis of the portal vein (pylephlebitis); (c) portal hypertension and its causes and sequelae; (d) the newly described disease entity portosinusoidal vascular disorder; and (e) intra- and extrahepatic shunts of the portal system, both congenital and acquired (including Abernethy malformations), and the associated risks. Current understanding of the pathophysiologic processes of each of these disorders is considered to aid the approach to reporting. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
Collapse
Affiliation(s)
- Benjamin M Layton
- From the Department of Radiology, East Lancashire Hospitals Trust, Royal Blackburn Hospital, Haslingden Rd, Blackburn, BB2 3HH, England (B.M.L., S.K.L.)
| | - Snehal K Lapsia
- From the Department of Radiology, East Lancashire Hospitals Trust, Royal Blackburn Hospital, Haslingden Rd, Blackburn, BB2 3HH, England (B.M.L., S.K.L.)
| |
Collapse
|
3
|
Gadani S, Partovi S, Levitin A, Zerona N, Sengupta S, D’Amico G, Diago Uso T, Menon KVN, Quintini C. Narrative review of portal vein thrombosis in cirrhosis: pathophysiology, diagnosis, and management from an interventional radiology perspective. Cardiovasc Diagn Ther 2022; 12:135-146. [PMID: 35282661 PMCID: PMC8898691 DOI: 10.21037/cdt-21-98] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 10/25/2021] [Indexed: 09/01/2023]
Abstract
OBJECTIVE This paper examines the incidence, clinical presentation, and pathophysiology of portal vein thrombosis (PVT) in cirrhosis. Additionally, we have reviewed the literature regarding the current status of medical and interventional radiology management of PVT and have proposed a novel algorithm for the management given different clinical scenarios. Lastly two representative cases displaying endovascular treatment options are provided. BACKGROUND Portal vein thrombus in the setting of cirrhosis is an increasingly recognized clinical issue with debate on its pathophysiology, natural course, and optimal treatment. Approximately one-third of patients are asymptomatic, and detection of the thrombus is an incidental finding on imaging performed for other reasons. In 30% to 50% of patients, PVT resolves spontaneously. However, there is increased post-transplant mortality in patients with completely occlusive PVT, therefore effective early revascularization strategies are needed for patients with complete PVT who are expected to undergo liver transplant. Additionally, no consensus has been reached regarding PVT treatment in terms of timing and type of interventions as well as type and duration of anticoagulation. METHODS Computerized literature search as well as discussion with experts in the field. CONCLUSIONS Management of PVT is complex, as many variables affect which treatments can be used. Anticoagulation appears to be the optimal first-line treatment in patients with acute PVT but without bleeding varices or mesenteric ischemia. Minimally invasive treatments include various methods of mechanical thrombectomy, chemical thrombolysis, and transjugular intrahepatic portosystemic shunt (TIPS) placement with or without variceal embolization. Definitive recommendations are difficult due to lack of high quality data and continued research is needed to evaluate the efficacy of different anticoagulants as well as the timing and use of various minimally invasive therapies in specific circumstances.
Collapse
Affiliation(s)
- Sameer Gadani
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sasan Partovi
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Abraham Levitin
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nicholas Zerona
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Shreya Sengupta
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Giuseppe D’Amico
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Teresa Diago Uso
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - K. V. Narayanan Menon
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Cristiano Quintini
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| |
Collapse
|
4
|
Kim J, Randhawa H, Sands D, Lambe S, Puglia M, Serrano PE, Pinthus JH. Muscle-Invasive Bladder Cancer in Patients with Liver Cirrhosis: A Review of Pertinent Considerations. Bladder Cancer 2021. [DOI: 10.3233/blc-211536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The incidence of liver cirrhosis is increasing worldwide. Patients with cirrhosis are generally at a higher risk of harbouring hepatic and non-hepatic malignancies, including bladder cancer, likely due to the presence of related risk factors such as smoking. Cirrhosis can complicate both the operative and non-surgical management of bladder cancer. For example, cirrhotic patients undergoing abdominal surgery generally demonstrate worse postoperative outcomes, and chemotherapy in patients with cirrhosis often requires dose reduction due to its direct hepatotoxic effects and reduced hepatic clearance. Multiple other considerations in the peri-operative management for cirrhosis patients with muscle-invasive bladder cancer must be taken into account to optimize outcomes in these patients. Unfortunately, the current literature specifically related to the treatment of cirrhotic bladder cancer patients remains sparse. We aim to review the literature on treatment considerations for this patient population with respect to perioperative, surgical, and adjuvant management.
Collapse
Affiliation(s)
- John Kim
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - David Sands
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Shahid Lambe
- Division of Urology, McMaster University, Hamilton, ON, Canada
- McMaster Institute of Urology, St. Joseph’s Hospital, Hamilton, ON, Canada
| | - Marco Puglia
- Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
| | | | - Jehonathan H. Pinthus
- Division of Urology, McMaster University, Hamilton, ON, Canada
- Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
| |
Collapse
|
5
|
Liu C, Wu H, Fu Z, Tang M, Ruan H, Zhang L. Superior mesenteric arteriovenous fistula presenting as diarrhea: a case report and literature review. Am J Transl Res 2021; 13:8172-8178. [PMID: 34377302 PMCID: PMC8340185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Superior mesenteric arteriovenous fistula (SMAVF) is a very rare disease and mainly manifests as abdominal pain, diarrhea, anorexia, and other portal hypertension symptoms. The diagnosis of the disease mainly relies on abdominal enhanced CT+3D reconstruction or digital subtraction angiography, and the treatment is mainly vascular interventional fistula occlusion. CASE SUMMARY a 17-year-old female with a history of abdominal trauma and surgery was admitted to our hospital for diarrhea and abdominal distension. The patient was diagnosed with a superior mesenteric arteriovenous fistula after abdominal enhanced CT + 3D reconstruction. The patient was satisfied with the results after the superior mesenteric artery angiography + covered stent implantation. No discomfort symptoms occurred during the two-year follow-up. CONCLUSION A history of abdominal trauma or surgery and clinical manifestations in combination with a radiological analysis are important indicators in the diagnosis of SMAVF. Interventional therapy is the preferred treatment.
Collapse
Affiliation(s)
- Changjiang Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan, China
| | - Haixia Wu
- Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan, China
| | - Zhongbiao Fu
- Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan, China
| | - Mingliang Tang
- Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan, China
| | - Hailan Ruan
- Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan, China
| | - Liyuan Zhang
- Department of Infectious Diseases, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan, China
| |
Collapse
|
6
|
Bert J, Geerts A, Vanlander A, Abreu de Carvalho L, Degroote H, Berrevoet F, Rogiers X, van Vlierberghe H, Verhelst X. Up to 50% of portal vein thrombosis remains undiagnosed until liver transplantation. Clin Transplant 2020; 34:e14107. [PMID: 33030231 DOI: 10.1111/ctr.14107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/03/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Impact of portal vein thrombosis (PVT) on the clinical course in liver transplant candidates remains unclear. This study aims to identify prevalence and risk factors for PVT, assess outcome after liver transplantation (LT) in patients with PVT and study the effect of anticoagulation. METHODS This single-center retrospective cohort study was performed from January 2006 until June 2016. Patients were stratified according to presence of PVT. Risk factors and outcome were assessed using logistic regression and survival analysis. RESULTS Among 390 adults who underwent orthotopic LT, PVT occurred in 40 (10.3%). In, respectively, 10 (25%), 7 (17.5%), and 23 (57.5%) patients, PVT was identified at time of evaluation for transplantation, on the waiting list and during transplantation. A beneficial trend was present favoring the use of anticoagulation for PVT resolution (n = 3/7 vs 0/9; p = .062). Patient and graft survival were similar between the groups after a median follow-up of 5 years. However, 1-year patient survival was significantly lower (p = .031) in patients with PVT. CONCLUSION Portal vein thrombosis occurred in 10% of patients awaiting LT was undiagnosed in 50% until moment of LT and had a deleterious effect on 1-year survival. Anticoagulation showed a beneficial trend on recanalization of PVT and survival rate.
Collapse
Affiliation(s)
- Josephine Bert
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium
| | - Anja Geerts
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium.,General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium.,European Reference Network (ERN) Rare Liver Disease, Ghent, Belgium
| | - Aude Vanlander
- General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium.,Department of General and Hepatobiliary Surgery, Liver Transplant Unit, Ghent University Hospital, Ghent, Belgium
| | - Luis Abreu de Carvalho
- General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium.,Department of General and Hepatobiliary Surgery, Liver Transplant Unit, Ghent University Hospital, Ghent, Belgium
| | - Helena Degroote
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium.,General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium.,European Reference Network (ERN) Rare Liver Disease, Ghent, Belgium
| | - Frederik Berrevoet
- General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium.,Department of General and Hepatobiliary Surgery, Liver Transplant Unit, Ghent University Hospital, Ghent, Belgium
| | - Xavier Rogiers
- General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium.,Department of General and Hepatobiliary Surgery, Liver Transplant Unit, Ghent University Hospital, Ghent, Belgium
| | - Hans van Vlierberghe
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium.,General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium.,European Reference Network (ERN) Rare Liver Disease, Ghent, Belgium
| | - Xavier Verhelst
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium.,General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium.,European Reference Network (ERN) Rare Liver Disease, Ghent, Belgium
| |
Collapse
|
7
|
Ghazaleh S, Beran A, Aburayyan K, Nehme C, Patel D, Khader Y, Sharma S, Aziz M, Abdel-Aziz Y, Hammad T, Nawras A. Efficacy and safety of anticoagulation in non-malignant portal vein thrombosis in patients with liver cirrhosis: a systematic review and meta-analysis. Ann Gastroenterol 2020; 34:104-110. [PMID: 33414629 PMCID: PMC7774659 DOI: 10.20524/aog.2020.0544] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/31/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The role of anticoagulation in treating non-malignant portal vein (PV) thrombosis (PVT) in patients with liver cirrhosis remains unclear. In our meta-analysis, we aimed to evaluate the efficacy and safety of anticoagulation for the treatment of non-malignant PVT in these patients. METHODS We conducted a meta-analysis to estimate the effects of anticoagulation on non-malignant PVT in patients with liver cirrhosis. We assessed the rates of PV recanalization, variceal bleeding, and any bleeding. RESULTS We included 9 observational studies which involved 474 patients. The rate of PV recanalization was significantly higher in patients who received anticoagulation compared to those who did not: 65.2% vs. 25.2%; relative risk (RR) 2.31, 95% confidence interval (CI) 1.80-2.96; P<0.00001. Variceal bleeding was significantly lower in patients who received anticoagulation: 0.1% vs. 18.5%; RR 0.15, 95%CI 0.04-0.55; P=0.004. Any bleeding was similar between patients who received anticoagulation and those who did not: 10.3% vs. 22.7%; RR 0.43, 95%CI 0.09-1.99; P=0.28. CONCLUSIONS Anticoagulation use increased the rate of PV recanalization in cirrhotic patients with non-malignant PVT. Anticoagulation decreased the rate of variceal bleeding and did not increase the rate of any bleeding.
Collapse
Affiliation(s)
- Sami Ghazaleh
- Department of Internal Medicine, University of Toledo, Toledo, OH (Sami Ghazaleh, Azizullah Beran, Kanana Aburayyan, Christian Nehme, Dipen Patel, Yasmin Khader, Sachit Sharma, Muhammad Aziz)
| | - Azizullah Beran
- Department of Internal Medicine, University of Toledo, Toledo, OH (Sami Ghazaleh, Azizullah Beran, Kanana Aburayyan, Christian Nehme, Dipen Patel, Yasmin Khader, Sachit Sharma, Muhammad Aziz)
| | - Kanana Aburayyan
- Department of Internal Medicine, University of Toledo, Toledo, OH (Sami Ghazaleh, Azizullah Beran, Kanana Aburayyan, Christian Nehme, Dipen Patel, Yasmin Khader, Sachit Sharma, Muhammad Aziz)
| | - Christian Nehme
- Department of Internal Medicine, University of Toledo, Toledo, OH (Sami Ghazaleh, Azizullah Beran, Kanana Aburayyan, Christian Nehme, Dipen Patel, Yasmin Khader, Sachit Sharma, Muhammad Aziz)
| | - Dipen Patel
- Department of Internal Medicine, University of Toledo, Toledo, OH (Sami Ghazaleh, Azizullah Beran, Kanana Aburayyan, Christian Nehme, Dipen Patel, Yasmin Khader, Sachit Sharma, Muhammad Aziz)
| | - Yasmin Khader
- Department of Internal Medicine, University of Toledo, Toledo, OH (Sami Ghazaleh, Azizullah Beran, Kanana Aburayyan, Christian Nehme, Dipen Patel, Yasmin Khader, Sachit Sharma, Muhammad Aziz)
| | - Sachit Sharma
- Department of Internal Medicine, University of Toledo, Toledo, OH (Sami Ghazaleh, Azizullah Beran, Kanana Aburayyan, Christian Nehme, Dipen Patel, Yasmin Khader, Sachit Sharma, Muhammad Aziz)
| | - Muhammad Aziz
- Department of Internal Medicine, University of Toledo, Toledo, OH (Sami Ghazaleh, Azizullah Beran, Kanana Aburayyan, Christian Nehme, Dipen Patel, Yasmin Khader, Sachit Sharma, Muhammad Aziz)
| | - Yousef Abdel-Aziz
- Department of Gastroenterology and Hepatology, University of Tennessee, Memphis, TN (Yousef Abdel-Aziz)
| | - Tariq Hammad
- Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX (Tariq Hammad)
| | - Ali Nawras
- Department of Gastroenterology and Hepatology, University of Toledo, Toledo, OH (Ali Nawras), USA
| |
Collapse
|
8
|
Intraoperative Challenge for Vascular Reconstruction in Orthotopic Liver Transplantation Because of Extensive Portal Thrombosis and Intimal Dissection of the Hepatic Artery. ACG Case Rep J 2020; 7:e00390. [PMID: 32656292 PMCID: PMC7319335 DOI: 10.14309/crj.0000000000000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/10/2020] [Indexed: 11/17/2022] Open
|
9
|
Guo B, Pan J, Shen Y, Zhang Q, Wang Z, Huang L, Yu Q. Platelet's Rule of Change and Clinical Significance before and after Splenectomy. Am Surg 2020. [DOI: 10.1177/000313481908501138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Portal vein system thrombosis (PVST) is a form of venous thrombosis, which behaves as a common and potentially life-threatening complication after splenectomy. Numerous studies have been made to investigate the mechanism and the risk factors of PVST. However, the research on the prevention and treatment of PVST associated with platelet's (PLT) rule of change is rare. This work mainly investigates the PLT's rule of change and its correlativity with the formation of PVST after splenectomy. The retrospective study included 117 patients who underwent splenectomy from August 2014 to June 2018 and monitored by blood routine, D-dimer (D-D), and portal vein system ultrasound routinely after splenectomy. The changes of PLT and D-D were recorded and compared before and after each operation. We analyzed the changes of PLTand D-D as well as the incidence of PVST postoperatively. Most of the patients’ PLT increased significantly after splenectomy. On the first day after operation, there were 80 patients’ (68.38%) PLTrecovered to normal or above normal. The proportion of patients with abnormally high PLT value on the seventh and fourteenth day were 60.68 per cent and 81.20 per cent, respectively. Thereinto, there were 67 patients’ (57.26%) PLT beyond 500 x 109/L on the 14th day. The D-D of all patients exceeded the normal range on the first, seventh, and fourteenth day after operation, and the difference was statistically significant ( P < 0.05), which behaved similar like PLT. Meanwhile, our color Doppler ultrasonography showed that the incidence of PVST was 70.79 per cent. Among the patients with PVST, 82 (100%) patients’ PLT was increased after operation. The PLT of patients increased obviously after splenectomy. The increased blood viscosity caused by the consecutive elevation of PLT may result in a higher PVST incidence. Early intervention and treatment are needed clinically for PVST after splenectomy.
Collapse
Affiliation(s)
- Binbin Guo
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China and
| | - Jinfang Pan
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China and
- Chinese Medicine Surgery Institute of Anhui Provincial Academy of Traditional Chinese Medicine, Hefei, China
| | - Yi Shen
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China and
- Chinese Medicine Surgery Institute of Anhui Provincial Academy of Traditional Chinese Medicine, Hefei, China
| | - Qi Zhang
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China and
- Chinese Medicine Surgery Institute of Anhui Provincial Academy of Traditional Chinese Medicine, Hefei, China
| | - Zhen Wang
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China and
- Chinese Medicine Surgery Institute of Anhui Provincial Academy of Traditional Chinese Medicine, Hefei, China
| | - Long Huang
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China and
- Chinese Medicine Surgery Institute of Anhui Provincial Academy of Traditional Chinese Medicine, Hefei, China
| | - Qingsheng Yu
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China and
- Chinese Medicine Surgery Institute of Anhui Provincial Academy of Traditional Chinese Medicine, Hefei, China
| |
Collapse
|
10
|
Brown MA, Donahue L, Gueyikian S, Hu J, Huffman S. Endovascular transsplenic recanalization with angioplasty and stenting of an occluded main portal vein in an adult liver transplant recipient. Radiol Case Rep 2020; 15:615-623. [PMID: 32256922 PMCID: PMC7096736 DOI: 10.1016/j.radcr.2020.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 12/29/2022] Open
Abstract
Endovascular transshepatic access has limitations that
can be exacerbated in the posttransplantation setting. Although several
techniques are available for portal venous system catheterization, the
transsplenic approach offers a direct pathway for accessing the portal venous
system, as well as associated varices or shunts, while avoiding potential injury
to the liver transplant. The purpose of this report is to present the diagnostic
and interventional management of main portal vein occlusion in a 56-year-old
female after liver transplantation. Endovascular transsplenic recanalization
with stenting and shunt embolization is a viable method for treatment of main
portal vein thrombosis in an adult liver transplant recipient.
Collapse
|
11
|
Imaging and implications of tumor thrombus in abdominal malignancies: reviewing the basics. Abdom Radiol (NY) 2020; 45:1057-1068. [PMID: 31696267 DOI: 10.1007/s00261-019-02282-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Extension of tumor tissue within a vein is a recognized prognostic factor in abdominal malignancy because of its influence on tumor staging and selection of therapeutic management. With the advent of newer surgical techniques, and variable treatment strategies, imaging plays a crucial role in categorizing patients according to the tumor resectability and vascular reconstruction techniques during surgery. Understanding the clinical impact of tumor thrombus increases the awareness of the radiologist about the key findings in tumor staging and decision-making of surgical approach. Ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) can be used individually and in combination to accurately assess the tumor thrombus. In our pictorial review, we will discuss the imaging findings and clinical consequences of tumor thrombosis in abdominal malignancies, including hepatocellular carcinoma, pancreatic neuroendocrine tumor, renal cancer, and adrenal cortical carcinoma.
Collapse
|
12
|
Wang M, Ding L, Xu M, Xie J, Wu S, Xu S, Yao Y, Liu Q. A novel method detecting the key clinic factors of portal vein system thrombosis of splenectomy & cardia devascularization patients for cirrhosis & portal hypertension. BMC Bioinformatics 2019; 20:720. [PMID: 31888439 PMCID: PMC6936084 DOI: 10.1186/s12859-019-3233-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Portal vein system thrombosis (PVST) is potentially fatal for patients if the diagnosis is not timely or the treatment is not proper. There hasn't been any available technique to detect clinic risk factors to predict PVST after splenectomy in cirrhotic patients. The aim of this study is to detect the clinic risk factors of PVST for splenectomy and cardia devascularization patients for liver cirrhosis and portal hypertension, and build an efficient predictive model to PVST via the detected risk factors, by introducing the machine learning method. We collected 92 clinic indexes of splenectomy plus cardia devascularization patients for cirrhosis and portal hypertension, and proposed a novel algorithm named as RFA-PVST (Risk Factor Analysis for PVST) to detect clinic risk indexes of PVST, then built a SVM (support vector machine) predictive model via the detected risk factors. The accuracy, sensitivity, specificity, precision, F-measure, FPR (false positive rate), FNR (false negative rate), FDR (false discovery rate), AUC (area under ROC curve) and MCC (Matthews correlation coefficient) were adopted to value the predictive power of the detected risk factors. The proposed RFA-PVST algorithm was compared to mRMR, SVM-RFE, Relief, S-weight and LLEScore. The statistic test was done to verify the significance of our RFA-PVST. RESULTS Anticoagulant therapy and antiplatelet aggregation therapy are the top-2 risk clinic factors to PVST, followed by D-D (D dimer), CHOL (Cholesterol) and Ca (calcium). The SVM (support vector machine) model built on the clinic indexes including anticoagulant therapy, antiplatelet aggregation therapy, RBC (Red blood cell), D-D, CHOL, Ca, TT (thrombin time) and Weight factors has got pretty good predictive capability to PVST. It has got the highest PVST predictive accuracy of 0.89, and the best sensitivity, specificity, precision, F-measure, FNR, FPR, FDR and MCC of 1, 0.75, 0.85, 0.92, 0, 0.25, 0.15 and 0.8 respectively, and the comparable good AUC value of 0.84. The statistic test results demonstrate that there is a strong significant difference between our RFA-PVST and the compared algorithms, including mRMR, SVM-RFE, Relief, S-weight and LLEScore, that is to say, the risk indicators detected by our RFA-PVST are statistically significant. CONCLUSIONS The proposed novel RFA-PVST algorithm can detect the clinic risk factors of PVST effectively and easily. Its most contribution is that it can display all the clinic factors in a 2-dimensional space with independence and discernibility as y-axis and x-axis, respectively. Those clinic indexes in top-right corner of the 2-dimensional space are detected automatically as risk indicators. The predictive SVM model is powerful with the detected clinic risk factors of PVST. Our study can help medical doctors to make proper treatments or early diagnoses to PVST patients. This study brings the new idea to the study of clinic treatment for other diseases as well.
Collapse
Affiliation(s)
- Mingzhao Wang
- School of Computer Science, Shaanxi Normal University, Xi'an, 710062, People's Republic of China.,College of Life Sciences, Shaanxi Normal University, Xi'an, 710062, People's Republic of China
| | - Linglong Ding
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China.,Department of General Surgery, 513 Hospital of PLA, Lanzhou, 732750, People's Republic of China
| | - Meng Xu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Juanying Xie
- School of Computer Science, Shaanxi Normal University, Xi'an, 710062, People's Republic of China.
| | - Shengli Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China.
| | - Shengquan Xu
- College of Life Sciences, Shaanxi Normal University, Xi'an, 710062, People's Republic of China.
| | - Yingmin Yao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Qingguang Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China.
| |
Collapse
|
13
|
Alzubaidi S, Patel I, Saini A, Knuttinen G, Naidu S, Kriegshuaser S, Albadawi H, Oklu R. Current concepts in portal vein thrombosis: etiology, clinical presentation and management. Abdom Radiol (NY) 2019; 44:3453-3462. [PMID: 31407054 DOI: 10.1007/s00261-019-02174-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this article is to focus on etiology, risk factors, clinical presentation and classification systems of acute and chronic PVT as well as focusing on current diagnostic and therapeutic options for the management of acute and chronic PVT. RESULTS PVT represents a serious clinical concern in cirrhotic patients and in those with specific local or systemic risk factors. The rate and extent of thrombus formation can significantly impact patient presentation and the resulting clinical outcomes. The presentation of acute PVT can range from abdominal pain to intestinal ischemia/infarction and even death, while chronic PVT can remain clinically silent. A number of imaging modalities including US, CT and MRI can be used to confirm the diagnosis. In addition to addressing underlying risk factors, AC therapy forms a cornerstone of treatment and has demonstrated efficacy in both acute and chronic settings. Proper caution should be used when initiating AC therapy in cirrhotic patients given their underlying coagulopathic status with attention now being paid to NOACs and LMWH. For patients with bowel ischemia, extensive thrombosis, contraindications or poor response to AC, or for those with co-morbidities that preclude AC, minimally invasive endovascular techniques offer alternative treatment options. CONCLUSION Familiarity with the etiology, clinical presentation and classification of PVT optimize early detection and incorporate effective therapeutic options, the management of these complex patients should be undertaken by a multidisciplinary team. Minimally invasive catheter-based therapies and endovascular portosystemic shunt creation demonstrated efficacy in the treatment of AC-resistant patients and for patients with extensive or complicated disease.
Collapse
|
14
|
Kiang SC, Rakoski MO, Tomihama RT. Retrograde Transvenous Obliteration Resolves Portal Vein Thrombosis without Systemic Anticoagulation. J Vasc Interv Radiol 2019; 30:1631-1633. [PMID: 31056451 DOI: 10.1016/j.jvir.2018.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/16/2018] [Accepted: 09/17/2018] [Indexed: 10/26/2022] Open
Affiliation(s)
- Sharon C Kiang
- Department of Surgery, Division of Vascular Surgery, Section of Vascular and Interventional Radiology, Loma Linda University School of Medicine, 11234 Anderson Street, Suite MC-2605E Loma Linda, CA 92354
| | - Mina O Rakoski
- Department of Hepatology, Section of Vascular and Interventional Radiology, Loma Linda University School of Medicine, 11234 Anderson Street, Suite MC-2605E Loma Linda, CA 92354
| | - Roger T Tomihama
- Radiology, Section of Vascular and Interventional Radiology, Loma Linda University School of Medicine, 11234 Anderson Street, Suite MC-2605E Loma Linda, CA 92354
| |
Collapse
|
15
|
Cagin YF, Bilgic Y, Berber İ, Yildirim O, Erdogan MA, Firat F, Arslan AK, Colak C, Seckin Y, Harputluoglu M. The risk factors of portal vein thrombosis in patients with liver cirrhosis. Exp Ther Med 2019; 17:3189-3194. [PMID: 30936992 DOI: 10.3892/etm.2019.7300] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 11/23/2018] [Indexed: 12/17/2022] Open
Abstract
This study was designed to identify and assess risk factors for portal vein thrombosis (PVT) in patients with cirrhosis. A total of 98 cirrhosis patients with PVT were identified and 101 cirrhosis patients without PVT were chosen as the control group in this retrospective study. Several variables were measured and the two groups PVT and non-PVT were compared statistically. PVT was identified in 98 patients (10%). Significant differences in hematocrit, international normalized ratio, albumin, bilirubin and glucose were determined between the groups (P<0.05). Out of the thrombophilic risk factors in the patients with PVT factor V Leiden was identified in 8.8%, prothrombin gene 6.6% and methylenetetrahydrofolate reductase 2.2%. There was no difference in survival time between groups (P>0.05).
Collapse
Affiliation(s)
- Yasir Furkan Cagin
- Department of Gastroenterology, Medical Faculty, Inonu University, 44280 Malatya, Turkey
| | - Yilmaz Bilgic
- Department of Gastroenterology, Medical Faculty, Inonu University, 44280 Malatya, Turkey
| | - İlhami Berber
- Clinic of Hematology, Malatya Training and Education Hospital, 44330 Malatya, Turkey
| | - Oguzhan Yildirim
- Department of Gastroenterology, Medical Faculty, Inonu University, 44280 Malatya, Turkey
| | - Mehmet Ali Erdogan
- Department of Gastroenterology, Medical Faculty, Inonu University, 44280 Malatya, Turkey
| | - Feyza Firat
- Department of Internal Medicine, Medical Faculty, Inonu University, 44280 Malatya, Turkey
| | - Ahmet Kadir Arslan
- Department of Biostatistics and Medical Informatics, Medical Faculty, Inonu University, 44280 Malatya, Turkey
| | - Cemil Colak
- Department of Biostatistics and Medical Informatics, Medical Faculty, Inonu University, 44280 Malatya, Turkey
| | - Yuksel Seckin
- Department of Gastroenterology, Medical Faculty, Inonu University, 44280 Malatya, Turkey
| | - Murat Harputluoglu
- Department of Gastroenterology, Medical Faculty, Inonu University, 44280 Malatya, Turkey
| |
Collapse
|
16
|
Acuna-Villaorduna A, Tran V, Gonzalez-Lugo JD, Azimi-Nekoo E, Billett HH. Natural history and clinical outcomes in patients with portal vein thrombosis by etiology: A retrospective cohort study. Thromb Res 2019; 174:137-140. [DOI: 10.1016/j.thromres.2018.12.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/23/2018] [Accepted: 12/18/2018] [Indexed: 01/28/2023]
|
17
|
Transjugular intrahepatic portosystemic shunt creation for cirrhotic portal hypertension is well tolerated among patients with portal vein thrombosis. Eur J Gastroenterol Hepatol 2018; 30:668-675. [PMID: 29462027 DOI: 10.1097/meg.0000000000001097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Portal vein thrombosis (PVT) develops in cirrhotic patients because of stagnation of blood flow. Transjugular intrahepatic portosystemic shunt (TIPS) creates a low-resistance conduit that restores portal venous patency and blood flow. AIM The effect of PVT on transplant-free survival in cirrhotic patients undergoing TIPS creation was evaluated. PATIENTS AND METHODS A multicenter, retrospective cohort study of patients who underwent TIPS creation for cirrhotic portal hypertension was carried out. A Cox model with propensity score adjustment was developed to evaluate the effect of PVT on 90-day and 3-year transplant-free survival. A subgroup analysis examining mortality of those with superior and inferior PVT was also carried out. RESULTS A total of 252 consecutive TIPS creations were assessed, including 65 in patients with PVT. Survival of patients with high Model for End-stage Liver Disease scores (≥18) and PVT was not statistically different compared with patients with low Model for End-stage Liver Disease scores (<18) and no PVT at 90 days (P=0.46) and 3 years (P=0.42). Those with superior PVT had improved 90-day and 3-year survival both compared with patients with a inferior PVT and those without a PVT (P<0.01, all cases). CONCLUSION The presence of PVT does not impair the prognosis of patients following TIPS creation, particularly in patients with superior portal occlusion.
Collapse
|
18
|
Bleeding during and after dental extractions in patients with liver cirrhosis. Int J Oral Maxillofac Surg 2018; 47:1543-1549. [PMID: 29705406 DOI: 10.1016/j.ijom.2018.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/01/2018] [Accepted: 04/08/2018] [Indexed: 02/06/2023]
Abstract
Little is known about the prevention and management of acquired coagulopathies, such as those affecting cirrhotic patients. The objective of this analytic retrospective observational study was to evaluate patients on the liver transplant waiting list according to the following outcomes: (1) presence of unusual intraoperative bleeding (>10min after routine haemostatic procedures); and (2) presence of postoperative haemorrhagic complications. The outcomes were analysed according to clinical and laboratory variables. A total of 190 visits were performed for extraction of 333 teeth (ranging from 1 to 9 teeth per visit), with platelet count ranging from 16,000 to 216,000 and international normalized ratio (INR) below 3. Twelve cases (6.31%) had unusual intraoperative bleeding and 12 had postoperative haemorrhagic complications. All the events were controlled by local measures. Intraoperative bleeding was associated with low count of platelets (P=0.026). However, this counting could explain only 16% (adjusted R2=0.16) of the cases of bleeding (P=0.44), meaning that platelet function changes might be involved. Our results show that cirrhotic patients presenting platelet count above 16,000 and INR below 3 need no previous blood transfusion, with local measures being enough to manage haemorrhagic events.
Collapse
|
19
|
Loffredo L, Pastori D, Farcomeni A, Violi F. Effects of Anticoagulants in Patients With Cirrhosis and Portal Vein Thrombosis: A Systematic Review and Meta-analysis. Gastroenterology 2017; 153:480-487.e1. [PMID: 28479379 DOI: 10.1053/j.gastro.2017.04.042] [Citation(s) in RCA: 247] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/13/2017] [Accepted: 04/26/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Liver cirrhosis is complicated by bleeding from portal hypertension but also by portal vein thrombosis (PVT). PVT occurs in approximately 20% to 50% of patients with cirrhosis, and is a warning sign for poor outcome. It is a challenge to treat patients with cirrhosis using anticoagulants, because of the perception that the coexistent coagulopathy could promote bleeding. We performed a systematic review and meta-analysis to determine the effects of anticoagulant therapy in patients with cirrhosis and PVT. METHODS We searched the PubMed, ISI Web of Science, SCOPUS, and Cochrane databases through February 14, 2017, for studies that assessed the effect of anticoagulant therapy vs no treatment in patients with cirrhosis and PVT. We performed a meta-analysis to estimate the effect of anticoagulant treatment vs no therapy on recanalization and progression of PVT in patients with cirrhosis. We also assessed variceal and nonvariceal bleeding. RESULTS We analyzed data from 8 studies, comprising 353 patients, that assessed the effects of anticoagulant therapy (low-weight heparin or warfarin vs no therapy) in patients with cirrhosis and PVT; these studies reported rates of complete and partial recanalization. A significantly higher proportion of patients treated with anticoagulants underwent PVT recanalization than patients who did not receive anticoagulants (71% vs 42%, respectively; P < .0001). From 6 studies (comprising 217 patients), 53% of patients treated with anticoagulants vs 33% of patients who did not receive anticoagulants had complete PVT recanalization (P = .002). From 6 studies (comprising 225 patients), PVT progressed in 9% of patients treated with anticoagulants vs 33% of patients who did not receive these drugs (P < .0001). Six studies (257 patients) reported rates of any bleeding; there was no difference in the proportions of patients with major or minor bleeding between groups that did vs did not receive anticoagulants (11% for both groups). Four studies (comprising 158 patients) reported rates of spontaneous variceal bleeding, which occurred in a significantly lower proportion of patients who received anticoagulants vs those who did not (P = .04). CONCLUSIONS Based on a systematic review and meta-analysis, patients with cirrhosis and PVT who receive anticoagulant therapy have increased recanalization and reduced progression of thrombosis, compared with patients who do not receive anticoagulants, with no excess of major and minor bleedings and less incidence of variceal bleeding.
Collapse
Affiliation(s)
- Lorenzo Loffredo
- Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Daniele Pastori
- Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy; Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessio Farcomeni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Francesco Violi
- Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy.
| |
Collapse
|
20
|
Hsu N, Wang T, Friedman O, Barjaktarevic I. Medical Management of Pulmonary Embolism: Beyond Anticoagulation. Tech Vasc Interv Radiol 2017; 20:152-161. [PMID: 29029709 DOI: 10.1053/j.tvir.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pulmonary embolism (PE) is a common medical condition that carries significant morbidity and mortality. Although diagnosis, anticoagulation, and interventional clot-burden reduction strategies represent the focus of clinical research and care in PE, appropriate risk stratification and supportive care are crucial to ensure good outcomes. In this chapter, we will discuss the medical management of PE from the time of presentation to discharge, focusing on the critical care of acute right ventricular failure, anticoagulation of special patient populations, and appropriate follow-up testing after acute PE.
Collapse
Affiliation(s)
- Nancy Hsu
- Division of Pulmonary and Critical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Tisha Wang
- Division of Pulmonary and Critical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Oren Friedman
- Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| |
Collapse
|
21
|
|
22
|
Bai DS, Qian JJ, Chen P, Xia BL, Jin SJ, Zuo SQ, Jiang GQ. Laparoscopic azygoportal disconnection with and without splenectomy for portal hypertension. Int J Surg 2016; 34:116-121. [PMID: 27568650 DOI: 10.1016/j.ijsu.2016.08.519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/06/2016] [Accepted: 08/17/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Laparoscopic splenectomy and azygoportal disconnection (LSD) has been reported to be safe, feasible, and minimally invasive for cirrhotic patients with portal hypertension. There is still controversy as to whether it is necessary to perform synchronous splenectomy for patients with moderate hypersplenism who undergo azygoportal disconnection for esophagogastric variceal hemorrhage (EGVB). METHODS We retrospectively evaluated the outcomes in 51 cirrhotic patients with EGVB and moderate hypersplenism (PLT ≥50 × 109/L) who underwent LSD (n = 28) or laparoscopic azygoportal disconnection (LD) (n = 23) between January 2014 and October 2015. Their demographic, intraoperative, and postoperative variables were compared. RESULTS LSD and LD were successful in all the patients. When compared with LSD, LD had a significantly shorter operation time, less intraoperative blood loss, shorter postoperative hospital stay, fewer days of postoperative body temperature >38.0 °C, lower rate of fever postoperatively, and lower C-reactive protein concentration and procalcitonin concentration on postoperative day (POD) 7 (all P < 0.05). The incidences of portal vein system thrombosis in the LD group on PODs 7, 30, and 90 were significantly lower than those in the LSD group at all the time points (all P < 0.05). According to the postoperative serum proportions of CD4+ and CD8+ and the CD4+/CD8+ ratio (all P < 0.05), the LSD group had significantly lower immune function than the LD group on POD 90. CONCLUSIONS LD is safe and effective for EGVB with moderate hypersplenism secondary to portal hypertension in selected patients.
Collapse
Affiliation(s)
- Dou-Sheng Bai
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu 225000, China
| | - Jian-Jun Qian
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu 225000, China
| | - Ping Chen
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu 225000, China
| | - Bing-Lan Xia
- Department of Ultrasound, Clinical Medical College of Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu 225000, China
| | - Sheng-Jie Jin
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu 225000, China
| | - Si-Qin Zuo
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu 225000, China
| | - Guo-Qing Jiang
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu 225000, China.
| |
Collapse
|
23
|
Bai DS, Yang KS, Jiang GQ, Qian JJ, Chen P, Jin SJ. Individualized Laparoscopic Therapy for Portal Hypertension: A Preliminary Single Center Experience. J Laparoendosc Adv Surg Tech A 2016; 27:121-127. [PMID: 27715476 DOI: 10.1089/lap.2016.0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To investigate the effects and technical points of several individualized laparoscopic therapies for patients suffering from cirrhotic portal hypertension. METHODS In total, 385 cirrhotic patients who underwent the treatment of individualized laparoscopic therapy from February 2012 to December 2015 at the Clinical Medical College of Yangzhou University were enrolled in this study. We retrospectively analyzed the clinical data and the key technical points. RESULTS Individualized laparoscopic therapies were successfully performed on 379 of 385 cases. Six cases were converted to a laparotomy (the rate of conversion to laparotomy was 1.6%). Modified laparoscopic splenectomy (MLS) for cirrhotic patients with hypersplenism was successfully performed on 103 of 105 cases. Laparoscopic azygoportal disconnection for cirrhotic patients with esophagogastric variceal bleeding (EGVB) or F3 varices was successfully performed on 61 of 62 cases, and modified laparoscopic splenectomy and azygoportal disconnection (MLSD) for cirrhotic patients with hypersplenism and EGVB or F3 varices was successfully performed on 196 of 201 cases. Synchronous MLS and laparoscopic partial hepatectomy (SLSH) for cirrhotic patients with hypersplenism and hepatocellular carcinoma (HCC) and synchronous MLSD and laparoscopic partial hepatectomy (SLSDH) for cirrhotic patients with hypersplenism, EGVB or F3 varices and HCC were all successfully implemented on 12 and 5 patients, respectively. From May 2013, we used the intraoperative autologous cell salvage during each individualized laparoscopic procedure. CONCLUSIONS An individualized laparoscopic therapy was beneficial for different state of selected cirrhotic patients with portal hypertension with or without HCC.
Collapse
Affiliation(s)
- Dou-Sheng Bai
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University , Yangzhou, China
| | - Kui-Sheng Yang
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University , Yangzhou, China
| | - Guo-Qing Jiang
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University , Yangzhou, China
| | - Jian-Jun Qian
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University , Yangzhou, China
| | - Ping Chen
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University , Yangzhou, China
| | - Sheng-Jie Jin
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University , Yangzhou, China
| |
Collapse
|
24
|
Cagin YF, Atayan Y, Erdogan MA, Dagtekin F, Colak C. Incidence and clinical presentation of portal vein thrombosis in cirrhotic patients. Hepatobiliary Pancreat Dis Int 2016; 15:499-503. [PMID: 27733319 DOI: 10.1016/s1499-3872(16)60092-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Portal vein thrombosis (PVT) is due to many risk factors, but its pathogenesis is still not clearly understood. To identify the risk factors for PVT, we analyzed the clinical characteristics and complications associated with PVT in cirrhotic patients. METHODS We studied patients with liver cirrhosis who were admitted to our unit from April 2009 to December 2014. The patients were divided into the PVT and non-PVT groups, and were compared by variables including gender, age, the etiology of cirrhosis, stage of cirrhosis, complications, imaging, and treatment. RESULTS PVT was found in 45 (9.8%) of 461 cirrhotic patients admitted to our hospital. Most patients (45.9%) had hepatitis B virus (HBV)-related cirrhosis, with a similar distribution of etiologies between the groups. However, there was no positive relationship between PVT and etiologies of cirrhosis. Most patients (71.5%) were in the stage of hepatic decompensation. No statistically significant differences were found in complications including esophageal varices, ascites, and hepatic encephalopathy between the groups. However, there was a significant positive correlation between hepatocellular carcinoma (HCC) and PVT (P<0.01). In 30 patients with PVT, thrombosis occurred in the portal vein and/or portal branches, 37.8% were diagnosed on ultrasound. CONCLUSIONS The incidence of PVT was 9.8%, mainly in patients with HBV-related cirrhosis. The development of PVT was associated with the severity of liver disease and HCC.
Collapse
Affiliation(s)
- Yasir Furkan Cagin
- Division of Gastroenterology, Medical Faculty, Inonu University, Malatya 44280, Turkey.
| | | | | | | | | |
Collapse
|
25
|
Use of Left Gastric Vein as an Alternative for Portal Flow Reconstruction in Liver Transplantation. Case Rep Surg 2016; 2016:8289045. [PMID: 27595034 PMCID: PMC4993930 DOI: 10.1155/2016/8289045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/18/2016] [Indexed: 02/07/2023] Open
Abstract
Portal vein thrombosis is observed in up to 10% of liver transplant candidates, hindering execution of the procedure. A dilated gastric vein is an alternative to portal vein reconstruction and decompression of splanchnic bed. We present two cases of patients with portal cavernoma and dilated left gastric vein draining splanchnic bed who underwent liver transplantation. The vein was dissected and sectioned near the cardia; the proximal segment was ligated with suture and the distal segment was anastomosed to the donor portal vein. Gastroportal anastomosis is an excellent option for portal reconstruction in the presence of thrombosis or hypoplasia. It allows an adequate splanchnic drainage and direction of hepatotrophic factors to the graft.
Collapse
|
26
|
Characterization of Portal Vein Thrombosis (Neoplastic Versus Bland) on CT Images Using Software-Based Texture Analysis and Thrombus Density (Hounsfield Units). AJR Am J Roentgenol 2016; 207:W81-W87. [PMID: 27490095 DOI: 10.2214/ajr.15.15928] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the role of CT texture analysis and thrombus density (measured in Hounsfield units) in distinguishing between neoplastic and bland portal vein thrombosis (PVT) on portal venous phase CT. MATERIALS AND METHODS In this retrospective study, 117 contrast-enhanced CT studies of 109 patients were included for characterization of PVT. Assessment of PVT was performed by estimation of CT textural features using CT texture analysis software and measurement of attenuation values. For CT texture analysis, filtered and unfiltered images were assessed to quantify heterogeneity using a set of predefined histogram-based texture parameters. The Mann-Whitney U test and binary logistic regression were applied for statistical significance. ROC curves were used to identify accuracy and optimal cutoff values. RESULTS Of the 117 CT studies, 63 neoplastic thrombi and 54 bland thrombi were identified on the images. The two most discriminative CT texture analysis parameters to differentiate neoplastic from bland thrombus were mean value of positive pixels (without filtration, p < 0.001) and entropy (with fine filtration, p < 0.001). Mean thrombus density values could also reliably distinguish neoplastic (81.39 HU) and bland (32.88 HU) thrombi (p < 0.001). The AUCs were 0.97 for mean value of positive pixels (p < 0.001), 0.93 for entropy (p < 0.001), 0.99 for the model combining mean value of positive pixels and entropy (p < 0.001), 0.91 for thrombus density (p < 0.001), and 0.61 for the radiologist's subjective evaluation (p = 0.037). The optimal cutoffs values were 56.9 for mean value of positive pixels, 4.50 for entropy, and 54.0 HU for thrombus density. CONCLUSION CT texture analysis and CT attenuation values allow reliable differentiation between neoplastic and bland thrombi on a single portal venous phase CT examination.
Collapse
|
27
|
Jiang GQ, Bai DS, Chen P, Qian JJ, Jin SJ, Wang XH. Risk Factors for Portal Vein System Thrombosis After Laparoscopic Splenectomy in Cirrhotic Patients with Hypersplenism. J Laparoendosc Adv Surg Tech A 2016; 26:419-23. [PMID: 26953863 DOI: 10.1089/lap.2015.0481] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Guo-qing Jiang
- Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Dou-sheng Bai
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Ping Chen
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Jian-jun Qian
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Sheng-jie Jin
- Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xue-hao Wang
- Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
28
|
|
29
|
Pinter M, Trauner M, Peck-Radosavljevic M, Sieghart W. Cancer and liver cirrhosis: implications on prognosis and management. ESMO Open 2016; 1:e000042. [PMID: 27843598 PMCID: PMC5070280 DOI: 10.1136/esmoopen-2016-000042] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/06/2016] [Indexed: 12/11/2022] Open
Abstract
Liver cirrhosis, the end-stage of every chronic liver disease, is not only the major risk factor for the development of hepatocellular carcinoma but also a limiting factor for anticancer therapy of liver and non-hepatic malignancies. Liver cirrhosis may limit surgical and interventional approaches to cancer treatment, influence pharmacokinetics of anticancer drugs, increase side effects of chemotherapy, render patients susceptible for hepatotoxicity, and ultimately result in a competitive risk for morbidity and mortality. In this review, we provide a concise overview about the impact of liver cirrhosis on the management and prognosis of patients with primary liver cancer or non-hepatic malignancies.
Collapse
Affiliation(s)
- Matthias Pinter
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Harvard Medical School & Massachusetts General Hospital, Boston, USA
| | - Michael Trauner
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III , Medical University of Vienna , Vienna , Austria
| | - Markus Peck-Radosavljevic
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Department of Gastroenterology & Hepatology, Endocrinology and Nephrology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Wolfgang Sieghart
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Austrian Society of Gastroenterology & Hepatology, Working Group GI-Oncology
| |
Collapse
|
30
|
Yang XY, Sun CY, Yuan X, Cui XS. Comparison of efficacy of terlipressin and somatostatin in treatment of hepatogenic diarrhea. Shijie Huaren Xiaohua Zazhi 2015; 23:5539-5543. [DOI: 10.11569/wcjd.v23.i34.5539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To observe the correlation of the Child-Pugh grade with diarrhea frequency in hepatogenic diarrhea patients and evaluate the curative efficacy of terlipressin and somatostatin in hepatogenic diarrhea patients.
METHODS: A total of 52 hepatogenic diarrhea patients were enrolled in this study and divided into two groups according to different medications, including 22 patients who received terlipressin (1 mg q8h), and 30 patients who were treated with somatostatin (250 µg/h, continuous intravenous drip), and the treatment course was 7 d. Diarrhea was assessed daily before and after treatment, and Child-Pugh grade and the width of the portal vein were assessed before treatment.
RESULTS: Higher Child-Pugh grade and greater width of portal vein were associated with more times of diarrhea per day in hepatogenic diarrhea patients. Among all hepatogenic diarrhea patients, 20 in each group showed a response. The difference in the effective rate between the two groups was statistically significant (91% vs 67%, P < 0.05).
CONCLUSION: Terlipressin can effectively reduce portal hypertension and treat hepatogenous diarrhea, and the curative effect of terlipressin is better than that of somatostatin.
Collapse
|
31
|
Rathi S, Dhiman RK. Hepatobiliary quiz (answers)-13 (2015). J Clin Exp Hepatol 2015; 5:100-4. [PMID: 25941440 PMCID: PMC4415289 DOI: 10.1016/j.jceh.2015.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 03/18/2015] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Radha K. Dhiman
- Address for correspondence: Radha K. Dhiman, Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| |
Collapse
|
32
|
Qi X, De Stefano V, Li H, Dai J, Guo X, Fan D. Anticoagulation for the treatment of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis of observational studies. Eur J Intern Med 2015; 26:23-9. [PMID: 25566699 DOI: 10.1016/j.ejim.2014.12.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/03/2014] [Accepted: 12/09/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Systematic review and meta-analysis were performed to evaluate the safety and efficacy of anticoagulation for the treatment of portal vein thrombosis (PVT) in cirrhotic patients. METHODS The PubMed, EMBASE, Cochrane Library, and ScienceDirect databases were searched. The rates of bleeding complications and portal vein recanalization in patients who received anticoagulant therapy were pooled. The odds ratio (OR) with 95% confidence interval (CI) was calculated to express the difference in the rate of portal vein recanalization between anticoagulation and non-anticoagulation groups. All meta-analyses were conducted by using a random-effects model. RESULTS Sixteen of 960 initially identified papers were included. Two studies reported a low incidence of major anticoagulation-related complications (4% [2/55] and 3% [1/33]), but no lethal complications occurred. The rate of anticoagulation-related bleeding ranged from 0% to 18% with a pooled rate of 3.3% (95% CI=1.1%-6.7%). The heterogeneity was not significant in the meta-analysis. The total rate of portal vein recanalization ranged from 37% to 93% with a pooled rate of 66.6% (95% CI=54.7%-77.6%). The rate of complete portal vein recanalization ranged from 0% to 75% with a pooled rate of 41.5% (95% CI=29.2%-54.5%). However, the heterogeneity was significant in the 2 meta-analyses. The rate of complete portal vein recanalization was significantly higher in anticoagulation group than in non-anticoagulation group (OR=4.16, 95% CI=1.88-9.20, P=0.0004). The heterogeneity was not significant in the meta-analysis. CONCLUSION Anticoagulation could achieve a relatively high rate of portal vein recanalization in cirrhotic patients with PVT. Given that only a small number of non-randomized comparative studies are reported, randomized controlled trials are warranted to confirm the risk-to-benefit of anticoagulation in such patients, especially anticoagulation-related bleeding.
Collapse
Affiliation(s)
- Xingshun Qi
- Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China; Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
| | | | - Hongyu Li
- Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China.
| | - Junna Dai
- Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China.
| | - Xiaozhong Guo
- Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China.
| | - Daiming Fan
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
| |
Collapse
|