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Safai Zadeh E, Prosch H, Ba-Ssalamah A, Findeisen H, Alhyari A, Raab N, Görg C. Contrast-enhanced ultrasound of the liver: basics and interpretation of common focal lesions. ROFO-FORTSCHR RONTG 2024; 196:807-818. [PMID: 38176437 DOI: 10.1055/a-2219-4726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Affiliation(s)
- Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Wien, Austria
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Wien, Austria
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Wien, Austria
| | - Hajo Findeisen
- Department for Internal Medicine, Red Cross Hospital Bremen, Germany
| | - Amjad Alhyari
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Gießen and Marburg Campus Marburg, Germany
| | - Nils Raab
- Department for Internal Medicine, West Mecklenburg Hospital Helene von Bülow, Ludwigslust, Germany
| | - Christian Görg
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Gießen and Marburg Campus Marburg, Germany
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Chan KM, Lee WC. Liver transplantation for advanced hepatocellular carcinoma: Controversy over portal vein tumor thrombosis. Biomed J 2024:100757. [PMID: 38942384 DOI: 10.1016/j.bj.2024.100757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/22/2024] [Accepted: 06/25/2024] [Indexed: 06/30/2024] Open
Abstract
Liver transplantation (LT) is considered the ideal treatment for hepatocellular carcinoma (HCC) concurrent with underlying cirrhotic liver disease. As well-known, LT for HCC based on the Milan criteria has shown satisfactory outcomes. However, numerous expanded transplantation criteria were proposed to benefit more patients for LT and showed comparable survivals as well. In addition, a modest expansion of transplantation criteria for HCC may be acceptable on the basis of the consensus within the transplantation community. Nonetheless, LT in patients with advanced HCC and portal vein tumor thrombosis (PVTT) recently has received attention and has been reported by many transplantation centers despite being contraindicated. Of those, the LT outcomes in certain HCC patients with PVTT were favorable. Additionally, the advancement of multimodality treatments and the evolution of systemic therapies have emerged as promising therapeutic options for downstaging advanced HCC prior to LT. Somehow, advanced HCC with PVTT could be downstaged to become eligible for LT through these multidisciplinary approaches. Although the available evidence of LT for HCC with PVTT is limited, it is hoped that LT may soon be more widely indicated for these patients. Nevertheless, several unknown factors associated with LT for HCC remain to be explored. Herein, this review aimed to update the developments in LT for patients with advanced HCC.
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Affiliation(s)
- Kun-Ming Chan
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Wei-Chen Lee
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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3
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Valla DC. Hepatic vein thrombosis and PVT: A personal view on the contemporary development of ideas. Clin Liver Dis (Hoboken) 2024; 23:e0246. [PMID: 38988821 PMCID: PMC11236412 DOI: 10.1097/cld.0000000000000246] [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: 03/11/2024] [Accepted: 05/10/2024] [Indexed: 07/12/2024] Open
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Georgescu D, Ancusa OE, Azoulay D, Lascu A, Ionita I, Calamar-Popovici D, Ionita M, Rosca CI, Brează GM, Reisz D, Lighezan D. Portal Vein Thrombosis in Patients with Liver Cirrhosis: What Went Wrong? Int J Gen Med 2023; 16:3889-3906. [PMID: 37662503 PMCID: PMC10473422 DOI: 10.2147/ijgm.s413438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/10/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose This study aimed to explore inflammatory biomarkers, stool's functional bacterial groups and their possible link to portal vein thrombosis (PVT) in patients with liver cirrhosis (LC). Materials and Methods An observational study of 300 participants: 200 inhospital cirrhotic patients, who met inclusion criteria, equally assigned into two groups, based on the presence or absence of PVT and 100 healthy controls was carried out. Results The PVT group displayed significant differences related to older age, cigarettes smoking history, emergency admission, higher Child-Pugh score, metabolic related disorders and nonalcoholic fatty liver disease, as well as non-obstructive aspects, with chronic thrombi. The PVT group exhibited significant differences related to biomarkers such as tumor necrosis factor (TNF)-alpha, C-reactive protein (CRP), D-dimers (D-D), as well as gut overall dysbiosis (DB) and alteration of different functional bacterial groups of the gut microbiota. Strong positive correlations were observed between PVT severity, and TNF-alpha, CRP, D-D as well as lipopolysaccharide (LPS) positive bacteria. Esophageal varices, age and abdominal pain were independent predictors for PVT severity as well as CRP, TNF-alpha and D-D. Conclusion Patients with LC and PVT displayed elevation of TNF-alpha, CRP, D-D alterations of the functional gut microbiota, as well as several morphological and clinical particularities. Although the LPS positive gut microbiota was linked to inflammatory biomarkers and PVT severity, it was not proven to be an independent predictor of the PVT severity like CRP, TNF-alpha and D-D.
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Affiliation(s)
- Doina Georgescu
- Center of Advanced Researches in Cardiovascular Diseases and Hemostaseology, Department of Internal Medicine I, “V Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Oana-Elena Ancusa
- Center of Advanced Researches in Cardiovascular Diseases and Hemostaseology, Department of Internal Medicine I, “V Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Daniel Azoulay
- Hepato-Biliary Center, Paul-Brousse Hospital, Paris-Saclay University, Villejuif, France
| | - Ana Lascu
- Department of Functional Sciences, “V Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Ioana Ionita
- Center of Advanced Researches in Cardiovascular Diseases and Hemostaseology, Department of Internal Medicine I, “V Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Despina Calamar-Popovici
- Center of Advanced Researches in Cardiovascular Diseases and Hemostaseology, Department of Internal Medicine I, “V Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Mihai Ionita
- Center of Advanced Researches in Cardiovascular Diseases and Hemostaseology, Department of Internal Medicine I, “V Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Ciprian Ilie Rosca
- Center of Advanced Researches in Cardiovascular Diseases and Hemostaseology, Department of Internal Medicine I, “V Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Gelu-Mihai Brează
- Department IX of Surgery I, Compartment of Hepatic-Biliary-Pancreatic Surgery, “V Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Daniela Reisz
- Department of Neurosciences, “V Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Daniel Lighezan
- Center of Advanced Researches in Cardiovascular Diseases and Hemostaseology, Department of Internal Medicine I, “V Babes” University of Medicine and Pharmacy, Timisoara, Romania
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Garg R, Mohammed A, Singh A, Siddiki H, Bhatt A, Sanaka MR, Jang S, Simons-Linares CR, Stevens T, Vargo J, Chahal P. Mortality Trends, Outcomes, and Predictors of Portal Vein Thrombosis in Acute Pancreatitis Patients: A Propensity-Matched National Study. Dig Dis Sci 2023; 68:2674-2682. [PMID: 37097368 DOI: 10.1007/s10620-023-07945-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/04/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Portal vein thrombosis (PVT) is a rare complication of acute pancreatitis (AP) and might be associated with worse outcomes. We aimed to study trends, outcomes, and predictors of PVT in AP patients. METHODS The National Inpatient Sample database was utilized to identify the adult patients (≥ 18 years) with primary diagnosis of AP from 2004 to 2013 using International Classification of Disease, Ninth Revision. Patients with and without PVT were entered into propensity matching model based on baseline variables. Outcomes were compared between both groups and predictors of PVT in AP were identified. RESULTS Among the total of 2,389,337 AP cases, 7046 (0.3%) had associated PVT. The overall mortality of AP decreased throughout the study period (p trend ≤ 0.0001), whereas mortality of AP with PVT remained stable (1-5.7%, p trend = 0.3). After propensity matching, AP patients with PVT patients had significantly higher in-hospital mortality (3.3% vs. 1.2%), AKI (13.4% vs. 7.7%), shock (6.9% vs. 2.5%), and need for mechanical ventilation (9.2% vs. 2.5%) along with mean higher cost of hospitalization and length of stay (p < 0.001 for all). Lower age (Odd ratio [OR] 0.99), female (OR 0.75), and gallstone pancreatitis (OR 0.79) were negative predictors, whereas alcoholic pancreatitis (OR 1.51), cirrhosis (OR 2.19), CCI > 2 (OR 1.81), and chronic pancreatitis (OR 2.28) were positive predictors of PVT (p < 0.001 for all) in AP patients. CONCLUSION PVT in AP is associated with significantly higher risk of death, AKI, shock, and need for mechanical ventilation. Chronic and alcoholic pancreatitis is associated with higher risk of PVT in AP.
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Affiliation(s)
- Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Abdul Mohammed
- Department of Gastroenterology and Hepatology, Advent Health, Orlando, FL, USA
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hassan Siddiki
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amit Bhatt
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Madhusudhan R Sanaka
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sunguk Jang
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - C Roberto Simons-Linares
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tyler Stevens
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John Vargo
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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Barah A, Al-Hashimi I, Kassamali R, Aldebyani Q, Almokdad O, Elmagdoub A, Khader M, Rehman SU, Omar A. Catheter-Directed Thrombolysis in the treatment of acute Portomesenteric Vein Thrombosis after Laparoscopic Sleeve Gastrectomy. Thromb J 2022; 20:57. [PMID: 36175959 PMCID: PMC9524041 DOI: 10.1186/s12959-022-00415-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 03/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Portomesenteric Vein Thrombosis (PMVT) following Laparoscopic Sleeve Gastrectomy (LSG) is an uncommon but potentially debilitating complication. Catheter-Directed Thrombolysis (CDT) has an evolving role in recanalizing the venous flow and preventing thrombus propagation. Therefore, it can be used as an alternative or in combination with systemic anticoagulants in selected patients. We report two trans-hepatic and trans-splenic CDT. The patient’s clinical details, radiological findings, safety, and efficacy are reported. Cases presentation Two patients presented to the Emergency Department (ED) within 14 days of surgery. The presenting complaints were generally nonspecific. The diagnosis of PMVT was established in both patients based on abdominal Contrast-Enhanced Computed Tomography (CECT). The two patients received a combined therapy of subcutaneous (SC) heparinization and CDT using a trans-hepatic approach in case 1 and a trans-splenic approach in case 2. Subsequent post-procedure venograms and CECT were performed and showed significant thrombus resolution. Both patients received oral anticoagulant therapy upon discharge with a successful overall recovery. Conclusion PMVT is an infrequent and severe post LSG complication. Various approaches for re-establishing the portal venous flow have been described according to the severity of venous thrombosis. This article describes CDT therapy as a safe and effective option for treating PMVT in symptomatic patients.
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Affiliation(s)
- Ali Barah
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar.
| | - Israa Al-Hashimi
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
| | - Rahil Kassamali
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
| | - Qayed Aldebyani
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
| | - Omran Almokdad
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
| | - Ayman Elmagdoub
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Khader
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
| | - Saad U Rehman
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Omar
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
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7
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Zhang SB, Hu ZX, Xing ZQ, Li A, Zhou XB, Liu JH. Portal vein thrombosis in a noncirrhotic patient after hemihepatectomy: A case report and review of literature. World J Clin Cases 2022; 10:7130-7137. [PMID: 36051122 PMCID: PMC9297407 DOI: 10.12998/wjcc.v10.i20.7130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/06/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Portal vein thrombosis (PVT) is a condition caused by hemodynamic disorders. It may be noted in the portal vein system when there is an inflammatory stimulus in the abdominal cavity. However, PVT is rarely reported after hepatectomy. At present, related guidelines and major expert opinions tend to consider vitamin K antagonists or low-molecular weight heparin (LMWH) as the standard treatment. But based on research, direct oral anticoagulants may be more effective and safe for noncirrhotic PVT and are also beneficial by reducing the recurrence rate of PVT.
CASE SUMMARY A 51-year-old woman without any history of disease felt discomfort in her right upper abdomen for 20 d, with worsening for 7 d. Contrast-enhanced computed tomography (CECT) of the upper abdomen showed right liver intrahepatic cholangiocarcinoma with multiple intrahepatic metastases but not to the left liver. Therefore, she underwent right hepatic and caudate lobectomy. One week after surgery, the patient underwent a CECT scan, due to nausea, vomiting, and abdominal distension. Thrombosis in the left branch and main trunk of the portal vein and near the confluence of the splenic vein was found. After using LMWH for 22 d, CECT showed no filling defect in the portal vein system.
CONCLUSION Although PVT after hepatectomy is rare, it needs to be prevented during the perioperative period.
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Affiliation(s)
- Shu-Bin Zhang
- Department of Hepatobiliary Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Zi-Xuan Hu
- Department of Hepatobiliary Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Zhong-Qiang Xing
- Department of Hepatobiliary Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Ang Li
- Department of Hepatobiliary Surgery, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Xin-Bo Zhou
- Department of Hepatobiliary Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Jian-Hua Liu
- Department of Hepatobiliary Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
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8
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Trad G, Sheikhan N, Nguyen A, Valenta J, Iraninezhad H. Portal Vein Thrombosis and Pyogenic Liver Abscess With Concomitant Bacteroides Bacteremia in a Patient With COVID-19 Infection: A Case Report and Brief Review. J Investig Med High Impact Case Rep 2022; 10:23247096221084513. [PMID: 35313738 PMCID: PMC8943445 DOI: 10.1177/23247096221084513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The 2019 coronavirus disease (COVID-19) can present with a wide variety of
clinical manifestations, including a hypercoagulable state leading to both
arterial and venous thrombosis. Portal vein thrombosis (PVT) in the setting of
COVID-19 has rarely been reported in the medical literature. Pylephlebitis with
concomitant liver abscess is a rare complication of intra-abdominal infection.
Here, we present the case of a 49-year-old man who initially presented with
intermittent fevers and generalized weakness of 1-month duration and was
subsequently found to have COVID-19 infection, PVT, and Bacteroides
fragilis bacteremia with associated pyogenic liver abscess. The
patient was treated with intravenous antibiotics and oral anticoagulation with
plan to follow up outpatient with gastroenterology in 3 months to ensure
resolution of PVT and liver abscess.
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Affiliation(s)
- George Trad
- Mountain View Medical Center, Las Vegas, NV, USA
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Alsannaa F, Albaqami F, Shalhoub M. Portomesenteric venous thrombosis in a prophylactically anticoagulated obese patient after laparoscopic sleeve gastrectomy: a case report. J Med Case Rep 2021; 15:623. [PMID: 34920760 PMCID: PMC8684121 DOI: 10.1186/s13256-021-03174-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 10/28/2021] [Indexed: 11/30/2022] Open
Abstract
Background Obesity is associated with an increased risk of morbidity and mortality, so weight reduction is important. Bariatric surgery is a well-tolerated approach for reducing body weight, with laparoscopic sleeve gastrectomy commonly performed. An uncommon and potentially fatal sequela of laparoscopic sleeve gastrectomy is portomesenteric vein thrombosis, which may result in severe bowel ischemia. Case report A 32-year-old Middle Eastern obese man (body mass index 33) presented to the emergency department with severe, generalized abdominal pain 2 weeks after laparoscopic sleeve gastrectomy. Computed tomography of the abdomen and pelvis revealed extensive acute on chronic portosplenic and superior mesenteric vein thrombosis with associated small bowel ischemia. Laparoscopic exploration was converted to midline laparotomy and an extensive ischemic small bowel resection. Conclusion Laparoscopic sleeve gastrectomy carries a risk of both morbidity and mortality. Venous thromboembolism is a well-known risk of bariatric surgery, but portomesenteric vein thrombosis is also a rare but sometimes serious complication. A high index of suspicion for portomesenteric vein thrombosis to prompt early detection is essential in patients who have undergone laparoscopic sleeve gastrectomy to minimize complications and optimize outcomes. Uncertainty still remains around the optimal dose and duration of anticoagulation after laparoscopic sleeve gastrectomy.
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Affiliation(s)
- Feras Alsannaa
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Mishary Shalhoub
- King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
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10
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Xu S, Guo X, Xu X, Wang L, Tacke F, Primignani M, He Y, Yin Y, Yi F, Qi X. Natural history and predictors associated with the evolution of portal venous system thrombosis in liver cirrhosis. Eur J Gastroenterol Hepatol 2021; 33:e423-e430. [PMID: 33731591 DOI: 10.1097/meg.0000000000002123] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Portal venous system thrombosis (PVST) will progress in some cases, indicating worse outcome and the necessity of antithrombotic treatment, but will spontaneously improve in others. It is crucial to understand the natural history of PVST in liver cirrhosis. However, the knowledge regarding how to predict the evolution of PVST in cirrhotic patients is very scant. METHODS Sixty-nine cirrhotic patients without malignancy, who had undergone repeated contrast-enhanced computed tomography or MRI to evaluate the severity of PVST at the first and last admissions, were included. Logistic regression analysis was performed to identify the risk factors for the evolution of PVST in liver cirrhosis. Odds ratios (ORs) were calculated. RESULTS Among 42 patients without PVST at the first admission, 10 (23.8%) developed PVST at the last admission. Serum albumin level (OR = 0.873), prothrombin time (OR = 1.619), activated partial thromboplastin time (OR = 1.169), Child-Pugh score (OR = 1.560) and model for end-stage liver disease (MELD) score (OR = 1.292) at the last admission were significant risk factors associated with the development of PVST. Among 27 patients with PVST at the first admission, 11 (40.7%), 4 (14.8%) and 12 (44.4%) had improvement, stabilization and progression of PVST at the last admission, respectively. ΔMELD score (OR = 0.714) was the only significant risk factor associated with the improvement of PVST; additionally, serum albumin level at the first admission (OR = 1.236) was the only significant risk factor associated with the progression of PVST. CONCLUSION Aggravation and amelioration of liver dysfunction may predict the development and improvement of PVST in liver cirrhosis, respectively.
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Affiliation(s)
- Shixue Xu
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area)
- Graduate School, China Medical University, Shenyang, China
| | - Xiaozhong Guo
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area)
| | - Xiangbo Xu
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area)
| | - Le Wang
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area)
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany
| | - Massimo Primignani
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC 'A.M. and A. Migliavacca' Center for Liver Disease, Milan, Italy
| | - Yanglan He
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area)
- Graduate School, China Medical University, Shenyang, China
| | - Yue Yin
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area)
| | - Fangfang Yi
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area)
| | - Xingshun Qi
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area)
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Bora Makal G, Yıldırım O. A Rare Cause of Abdominal Pain After Laparoscopic Sleeve Gastrectomy: Portomesenteric and Splenic Vein Thrombosis. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gül Bora Makal
- Department of General Surgery, Faculty of Medicine, Yuksek Ihtisas University, Ankara, Turkey
| | - Osman Yıldırım
- Department of General Surgery, Medical Park Batıkent Private Hospital, Ankara, Turkey
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12
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Zane KE, Makary MS. Locoregional Therapies for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis. Cancers (Basel) 2021; 13:5430. [PMID: 34771593 PMCID: PMC8582519 DOI: 10.3390/cancers13215430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 12/11/2022] Open
Abstract
Hepatocellular carcinoma is the fourth leading cause of cancer worldwide, and the fastest increasing cause of cancer mortality in the United States. Its propensity for vascular invasion leads to the presence of portal vein tumor thrombus in up to half of patients. PVTT results in a classification of advanced disease, given the risk recurrence secondary to intravascular spread, and formal guidelines recommend systemic therapy in these patients. However, recent advances in locoregional therapies including TACE, TARE, and ablation have demonstrated the potential to drastically improve overall survival in patients with HCC complicated by PVTT.
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Affiliation(s)
| | - Mina S. Makary
- Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
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13
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Yeo JW, Law MSN, Lim JCL, Ng CH, Tan DJH, Tay PWL, Syn N, Tham HY, Huang DQ, Siddiqui MS, Iyer S, Muthiah M. Meta-analysis and systematic review: Prevalence, graft failure, mortality, and post-operative thrombosis in liver transplant recipients with pre-operative portal vein thrombosis. Clin Transplant 2021; 36:e14520. [PMID: 34687558 DOI: 10.1111/ctr.14520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/25/2021] [Accepted: 10/16/2021] [Indexed: 12/22/2022]
Abstract
AIMS This study seeks to evaluate the association between pre-transplant portal vein thrombosis (PVT) and overall survival, graft failure, waitlist mortality, and post-operative PVT after liver transplantation. METHODS A conventional pairwise meta-analysis between patients with and without pre-transplant PVT was conducted using hazard ratios or odds ratios where appropriate. RESULTS Prevalence of preoperative PVT was 11.6% (CI 9.70-13.7%). Pre-operative PVT was associated with increased overall mortality (HR 1.45, 95% CI 1.27-1.65) and graft loss (HR 1.58, 95% CI 1.34-1.85). In particular, grade 3 (HR 1.59, 95% CI 1.00-2.51) and 4 (HR 2.24, 95% CI 1.45-3.45) PVT significantly increased mortality, but not grade 1 or 2 PVT. Patients with PVT receiving living donor (HR 1.54, 95% CI 1.24-1.91) and deceased donor (HR 1.52, 95% CI 1.21-1.92) liver transplantation had increased mortality, with no significant difference between transplant types (P = .13). Furthermore, pre-transplant PVT was associated with higher occurrence of post-transplant PVT (OR 5.06, 95% CI 3.89-6.57). Waitlist mortality was not significantly increased in patients with pre-transplant PVT. CONCLUSION Graft failure, mortality, and post-operative PVT are more common in pre-transplant PVT patients, especially in grade 3 or 4 PVT. Prophylactic anticoagulation can be considered to reduce re-thrombosis and improve survival.
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Affiliation(s)
- Jun Wei Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Michelle Shi Ni Law
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Joseph Chun Liang Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Phoebe Wen Lin Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Biostatistics & Modelling Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Hui Yu Tham
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - M Shadab Siddiqui
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Shridhar Iyer
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, National University Health System, Singapore, Singapore
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
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14
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Xu S, Guo X, Yang B, Romeiro FG, Primignani M, Méndez-Sánchez N, Yoshida EM, Mancuso A, Tacke F, Noronha Ferreira C, De Stefano V, Qi X. Evolution of Nonmalignant Portal Vein Thrombosis in Liver Cirrhosis: A Pictorial Review. Clin Transl Gastroenterol 2021; 12:e00409. [PMID: 34597281 PMCID: PMC8483868 DOI: 10.14309/ctg.0000000000000409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/22/2021] [Indexed: 02/07/2023] Open
Abstract
Portal vein thrombosis (PVT) is a common complication in liver cirrhosis, especially in advanced cirrhosis. It may be related to a higher risk of liver-related events and liver function deterioration. Imaging examinations can not only provide an accurate diagnosis of PVT, such as the extent of thrombus involvement and the degree of lumen occupied, but also identify the nature of thrombus (i.e., benign/malignant and acute/chronic). Evolution of PVT, mainly including development, recanalization, progression, stability, and recurrence, could also be assessed based on the imaging examinations. This article briefly reviews the pathophysiology, diagnosis, classification, and evolution of PVT with an emphasis on their computed tomography imaging features.
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Affiliation(s)
- Shixue Xu
- Liver Cirrhosis Study Group, Department of Gastroenterology, The General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, China
- Graduate School, China Medical University, Shenyang, China
| | - Xiaozhong Guo
- Liver Cirrhosis Study Group, Department of Gastroenterology, The General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, China
| | - Benqiang Yang
- Department of Radiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Fernando Gomes Romeiro
- Department of Internal Medicine, Botucatu Medical School, UNESP-Univ Estadual Paulista. Av. Prof. Mário Rubens Guimarães Montenegro, s/n Distrito de Rubião Jr, Botucatu, Brazil
| | - Massimo Primignani
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Nahum Méndez-Sánchez
- Liver Research Unit, Medica Sur Clinic and Foundation and Faculty of Medicine. National Autonomous University of Mexico, Mexico City, Mexico
| | - Eric M. Yoshida
- Division of Gastroenterology, University of British Columbia and Vancouver General Hospital, Vancouver, Canada
| | - Andrea Mancuso
- Medicina Interna 1, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico, Di Cristina-Benfratelli, Palermo, Italy
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Carlos Noronha Ferreira
- Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria-Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Valerio De Stefano
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Xingshun Qi
- Liver Cirrhosis Study Group, Department of Gastroenterology, The General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, China
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15
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Khan AR, Wei X, Xu X. Portal Vein Tumor Thrombosis and Hepatocellular Carcinoma - The Changing Tides. J Hepatocell Carcinoma 2021; 8:1089-1115. [PMID: 34522691 PMCID: PMC8434852 DOI: 10.2147/jhc.s318070] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/13/2021] [Indexed: 12/12/2022] Open
Abstract
Portal vein involvement is considered one of the most fearful complications of hepatocellular carcinoma (HCC). Portal vein tumor thrombosis (PVTT) is associated with aggressive tumor biology (high grade), high tumor burden (number and size of lesions), high levels of serum markers (AFP), poor liver function (deranged LFT), and poor performance status of patients. The Barcelona Clinic Liver Cancer staging system places HCC patients with PVTT in advanced stage (BCLC Stage-C). This group contains a fairly heterogeneous patient population, previously considered candidates for palliative systemic therapy with sorafenib. However, this provided modest overall survival (OS) benefit. The results of a recent Phase III (IMbrave150) trial favor the combination of atezolizumab and bevacizumab over sorafenib as a standard of care in advanced unresectable HCC. While only lenvatinib proved to be non-inferior against sorafenib in a phase III (REFLECT trial), regorafenib (RESORCE trial), ramucirumab (REACH-2), and cabozantinib (CELESTIAL) have been approved second-line therapy in phase III clinical trials. Recently, the data on the prospect of other modalities in the management of HCC with PVTT is mounting with favorable results. Targeting multiple pathways in the HCC cascade using a combination of drugs and other modalities such as RT, TACE, TARE, and HAIC appear effective for systemic and loco-regional control. The quest for the ideal combination therapy and the sequence set is still widely unanswered and prospective trials are lacking. With the armament of available therapeutic options and the advances and refinements in the delivery system, down-staging patients to make them eligible for curative resection has been reported. In a rapidly evolving treatment landscape, performing surgery when appropriate, in the form of LR and even LT to achieve cure does not seem farfetched. Likewise, adjuvant therapy and prompt management of the recurrences holds the key to prolong OS and DFS. This review discusses the management options of HCC patients with PVTT.
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Affiliation(s)
- Abdul Rehman Khan
- Department of Hepatobiliary and Pancreatic Surgery, The Center for Integrated Oncology and Precision Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People's Republic of China.,Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People's Republic of China.,NHC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou, 310003, People's Republic of China
| | - Xuyong Wei
- Department of Hepatobiliary and Pancreatic Surgery, The Center for Integrated Oncology and Precision Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People's Republic of China.,NHC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou, 310003, People's Republic of China.,Institute of Organ Transplantation, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Xiao Xu
- Department of Hepatobiliary and Pancreatic Surgery, The Center for Integrated Oncology and Precision Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People's Republic of China.,Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People's Republic of China.,NHC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou, 310003, People's Republic of China.,Institute of Organ Transplantation, Zhejiang University, Hangzhou, 310003, People's Republic of China
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16
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Chatelin S, Pop R, Giraudeau C, Ambarki K, Jin N, Séverac F, Breton E, Vappou J. Influence of portal vein occlusion on portal flow and liver elasticity in an animal model. NMR IN BIOMEDICINE 2021; 34:e4498. [PMID: 33634498 DOI: 10.1002/nbm.4498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
Hepatic fibrosis causes an increase in liver stiffness, a parameter measured by elastography and widely used as a diagnosis method. The concomitant presence of portal vein thrombosis (PVT) implies a change in hepatic portal inflow that could also affect liver elasticity. The main objective of this study is to determine the extent to which the presence of portal occlusion can affect the mechanical properties of the liver and potentially lead to misdiagnosis of fibrosis and hepatic cirrhosis by elastography. Portal vein occlusion was generated by insertion and inflation of a balloon catheter in the portal vein of four swines. The portal flow parameters peak flow (PF) and peak velocity magnitude (PVM) and liver mechanical properties (shear modulus) were then investigated using 4D-flow MRI and MR elastography, respectively, for progressive obstructions of the portal vein. Experimental results indicate that the reduction of the intrahepatic venous blood flow (PF/PVM decreases of 29.3%/8.5%, 51.0%/32.3% and 83.3%/53.6%, respectively) measured with 50%, 80% and 100% obstruction of the portal vein section results in a decrease of liver stiffness by 0.8% ± 0.1%, 7.7% ± 0.4% and 12.3% ± 0.9%, respectively. While this vascular mechanism does not have sufficient influence on the elasticity of the liver to modify the diagnosis of severe fibrosis or cirrhosis (F4 METAVIR grade), it may be sufficient to attenuate the increase in stiffness due to moderate fibrosis (F2-F3 METAVIR grades) and consequently lead to false-negative diagnoses with elastography in the presence of PVT.
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Affiliation(s)
- Simon Chatelin
- ICube, CNRS UMR 7357, University of Strasbourg, Strasbourg, France
| | - Raoul Pop
- IHU-Strasbourg, Institute for Image-Guided Surgery, Strasbourg, France
- Interventional Neuroradiology Department, University Hospital of Strasbourg, Strasbourg, France
| | - Céline Giraudeau
- IHU-Strasbourg, Institute for Image-Guided Surgery, Strasbourg, France
| | | | - Ning Jin
- Siemens Medical Solutions USA, Inc., Chicago, Illinois, USA
| | - François Séverac
- ICube, CNRS UMR 7357, University of Strasbourg, Strasbourg, France
- Public Healthcare Department, University Hospitals Strasbourg, Strasbourg, France
| | - Elodie Breton
- ICube, CNRS UMR 7357, University of Strasbourg, Strasbourg, France
| | - Jonathan Vappou
- ICube, CNRS UMR 7357, University of Strasbourg, Strasbourg, France
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17
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Transhepatic Pharmacomechanical Thrombectomy of Symptomatic Acute Noncirrhotic, Nonmalignant Portomesenteric Venous Thrombosis: Midterm Results. AJR Am J Roentgenol 2021; 217:418-425. [PMID: 34036807 DOI: 10.2214/ajr.20.23150] [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: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to evaluate the safety and efficacy of transhepatic pharmacomechanical thrombectomy of symptomatic acute portomesenteric venous thrombosis. MATERIALS AND METHODS. Transhepatic pharmacomechanical thrombectomy (catheter-directed thrombolysis with mechanical thrombectomy) was performed in the treatment of nine patients with symptomatic acute noncirrhotic, nonmalignant porto-mesenteric venous thrombosis. The medical records, imaging examinations, technique of transhepatic pharmacomechanical thrombectomy, and clinical outcomes were reviewed. RESULTS. The mean follow-up period was 23.1 months (range, 8-34) months. Successful recanalization of the portomesenteric venous thrombosis, restoration of hepatopetal portal flow, clinically significant improvement in the signs and symptoms of acute mesenteric ischemia, and prevention of bowel resection were achieved in all patients. The most frequent minor complication (in three patients) was minor hemorrhage through the transhepatic access track. No procedure-related major complications occurred during hospitalization. No patient had rethrombosis or complications related to portal hypertension due to portomesenteric venous thrombosis. One patient died of massive pulmonary embolism on the 7th day after treatment. Cavernous transformation of the right portal vein occurred in one patient. CONCLUSION. Transhepatic pharmacomechanical thrombectomy is a safe and effective method of treatment of symptomatic acute portomesenteric venous thrombosis and prevention of bowel infarction.
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18
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Clostridium Difficile and COVID-19: Novel Risk Factors for Acute Portal Vein Thrombosis. Case Rep Vasc Med 2021; 2021:8832638. [PMID: 33728091 PMCID: PMC7914382 DOI: 10.1155/2021/8832638] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 02/02/2021] [Accepted: 02/12/2021] [Indexed: 01/05/2023] Open
Abstract
The COVID-19 pandemic has created an unprecedented global health care crisis. COVID-19 patients are found to have increased thrombotic risk. Despite being on prophylactic anticoagulation, many develop serious arterial and venous thromboembolic events. Emerging reports indicate COVID-19 may be considered a novel risk factor for portal vein thrombosis. Although, intra-abdominal infections are identified as risk factors, clostridium difficile colitis has not been typically seen as a risk factor for PVT. We report a case of an elderly female with a recent diagnosis of COVID-19 and no prior history of cirrhosis or malignancy who presented with diarrhea due to clostridium difficile infection. She developed sudden onset severe abdominal pain during the course of hospitalization. Acute portal vein thrombosis was identified on CT imaging of the abdomen, and she improved well with therapeutic anticoagulation. Acute portal vein thrombosis usually results from a combination of local and systemic prothrombotic risk factors. The combination of local infection by clostridium difficile and COVID-19 coagulopathy led to development of portal vein thrombosis in our patient. To the best of our knowledge, this is the first case of portal vein thrombosis reported in a patient with clostridium difficile infection in the setting of COVID-19 coagulopathy. During the current pandemic, clinicians should strongly consider abdominal imaging in patients presenting with abdominal pain due to clostridium difficile infection in the setting of COVID-19 to rule out complications such as portal vein thrombosis. Early diagnosis and treatment of portal vein thrombosis prevent complications of portal hypertension and intestinal infarctions.
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19
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Takata H, Hirakata A, Ueda J, Yokoyama T, Maruyama H, Taniai N, Takano R, Haruna T, Makino H, Yoshida H. Prediction of portal vein thrombosis after hepatectomy for hepatocellular carcinoma. Langenbecks Arch Surg 2021; 406:781-789. [PMID: 33640991 DOI: 10.1007/s00423-021-02125-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/08/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Portal vein thrombosis (PVT) following hepatectomy is potentially life-threatening. We aimed to evaluate the incidence of PVT after hepatectomy for hepatocellular carcinoma and identify coagulation and fibrinolytic factors that could predict early-stage postoperative PVT. METHODS A retrospective analysis was conducted on 65 hepatocellular carcinoma patients who underwent radical hepatectomy. The risk factors for postoperative PVT were identified based on univariate and multivariate analyses, and the levels of coagulation and fibrinolytic factors were measured during the perioperative period. RESULTS The incidence of PVT after hepatectomy was 20.0%. The patients were divided into two groups: those with PVT (n=13; PVT group) and those without PVT (n=52; no-PVT group). The frequency of the use of the Pringle maneuver during surgery was higher in the PVT group than in the no-PVT group, and the postoperative/preoperative ratios of thrombin-antithrombin III complex (TAT) and of D-dimer were significantly higher in the PVT group. CONCLUSION A high incidence of PVT was found in hepatocellular carcinoma patients after hepatectomy. The frequency of the Pringle maneuver is a potential risk factor for postoperative PVT, and the postoperative/preoperative TAT and D-dimer ratios may be used as early predictors of PVT after hepatectomy for hepatocellular carcinoma.
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Affiliation(s)
- Hideyuki Takata
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan.
| | - Atsushi Hirakata
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Junji Ueda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan.,Department of Gastrointestinal Surgery, Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan
| | - Tadashi Yokoyama
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Hiroshi Maruyama
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Nobuhiko Taniai
- Department of Gastrointestinal Surgery, Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan
| | - Ryotaro Takano
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Takahiro Haruna
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Hiroshi Makino
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
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20
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Lim J, Kim HI, Kim E, Kim J, An J, Chang S, Kim SO, Lee HC, Lee YS, Shim JH. Variceal bleeding is aggravated by portal venous invasion of hepatocellular carcinoma: a matched nested case-control study. BMC Cancer 2021; 21:11. [PMID: 33402105 PMCID: PMC7786454 DOI: 10.1186/s12885-020-07708-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023] Open
Abstract
Background We hypothesized that portal vein tumor thrombosis (PVTT) in hepatocellular carcinoma (HCC) increases portal pressure and causes esophageal varices and variceal bleedings. We examined the incidence of high-risk varices and variceal bleeding and determined the indications for variceal screening and prophylaxis. Methods This study included 1709 asymptomatic patients without any prior history of variceal hemorrhage or endoscopic prophylaxis who underwent upper endoscopy within 30 days before or after initial anti-HCC treatment. Of these patients, 206 had PVTT, and after 1:2 individual matching, 161 of them were matched with 309 patients without PVTT. High-risk varices were defined as large/medium varices or small varices with red-color signs and variceal bleeding. Bleeding rates from the varices were compared between matched pairs. Risk factors for variceal bleeding in the entire set of patients with PVTT were also explored. Results In the matched-pair analysis, the proportion of high-risk varices at screening (23.0% vs. 13.3%; P = 0.003) and the cumulative rate of variceal bleeding (4.5% vs. 0.4% at 1 year; P = 0.009) were significantly greater in the PVTT group. Prolonged prothrombin time, lower platelet count, presence of extrahepatic metastasis, and Vp4 PVTT were independent risk factors related to high-risk varices in the total set of 206 patients with PVTT (Adjusted odds ratios [95% CIs], 1.662 [1.151–2.401]; 0.985 [0.978–0.993]; 4.240 [1.783–10.084]; and 3.345 [1.457–7.680], respectively; Ps < 0.05). During a median follow-up of 43.2 months, 10 patients with PVTT experienced variceal bleeding episodes, 9 of whom (90%) had high-risk varices. Presence of high-risk varices and sorafenib use for HCC treatment were significant predictors of variceal bleeding in the complete set of patients with PVTT (Adjusted hazard ratios [95% CIs], 26.432 [3.230–216.289]; and 5.676 [1.273–25.300], respectively; Ps < 0.05). Conclusions PVTT in HCC appears to increase the likelihood of high-risk varices and variceal bleeding. In HCC patients with PVTT, endoscopic prevention could be considered, at least in high-risk variceal carriers taking sorafenib.
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Affiliation(s)
- Jihye Lim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Ha Il Kim
- Gastroenterology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Eunju Kim
- Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
| | - Jiyoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jihyun An
- Gastroenterology, Hanyang University College of Medicine, Guri, Gyeonggi-do, Republic of Korea
| | - Seheon Chang
- Internal Medicine, Myongji St. Mary's Hospital, Seoul, Republic of Korea
| | - Seon-Ok Kim
- Biostatistics and Clinical Epidemiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Han Chu Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.,Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yung Sang Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.,Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ju Hyun Shim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea. .,Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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21
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Lee HA, Park S, Seo YS, Yoon WS, Shin I, Rim CH. Surgery versus external beam radiotherapy for hepatocellular carcinoma involving the inferior vena cava or right atrium: A systematic review and meta‐analysis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 28:1031-1046. [DOI: 10.1002/jhbp.865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/25/2020] [Accepted: 10/29/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Han Ah Lee
- Department of Gastroenterology Korea University Anam Hospital Korea University Medical College Seoul Korea
| | - Sunmin Park
- Department of Radiation Oncology Korea University Ansan Hospital Korea University Medical College Ansan Korea
| | - Yeon Seok Seo
- Department of Gastroenterology Korea University Anam Hospital Korea University Medical College Seoul Korea
| | - Won Sup Yoon
- Department of Radiation Oncology Korea University Ansan Hospital Korea University Medical College Ansan Korea
| | - In‐Soo Shin
- Graduation School of Education Dongguk University Seoul Korea
| | - Chai Hong Rim
- Department of Radiation Oncology Korea University Ansan Hospital Korea University Medical College Ansan Korea
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22
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Abstract
PURPOSE OF THE REVIEW Non-cirrhotic portal hypertension (NCPH) includes a heterogeneous group of conditions. The aim of this paper is to make an overview on the denominations, diagnostical features and management of porto-sinusoidal vascular disease (PSVD) and chronic portal vein thrombosis (PVT) being the main causes of NCPH in the Western world. RECENT FINDINGS The management of NCPH consists in the treatment of associated diseases and of portal hypertension (PH). PH due to PSVD or PVT is managed similarly to PH due to cirrhosis. TIPS placement and liver transplantation are considerable options in patients with refractory variceal bleeding/ascites and with progressive liver failure. Anticoagulation is a cornerstone both in the treatment of thrombosis in PSVD and in the prevention of thrombosis recurrence in patients with portal cavernoma. Physicians should be aware of the existence of PSVD and chronic PVT and actively search them in particular settings. To now, the management of portal hypertension-related complications in NCPH is the same of those of cirrhosis. Large cooperative studies on the natural history of NCPH are necessary to better define its management.
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23
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Cohen O, Ageno W. The safety of anticoagulant therapy in the treatment of splanchnic vein thrombosis associated with acute pancreatitis. Intern Emerg Med 2020; 15:929-931. [PMID: 32285348 DOI: 10.1007/s11739-020-02336-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Omri Cohen
- National Hemophilia Center, Institute of Thrombosis and Hemostasis and the Amalia Biron Research Institute, Sheba Medical Center, Tel-Hashomer, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Medicine and Surgery, University of Insubria, Varese, Italy.
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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24
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Pagliari D, Cianci R, Brizi MG, Mancarella FA, Musso M, Cintoni M, Franza L, Flore RA, Gasbarrini A, Tondi P. Anticoagulant therapy in the treatment of splanchnic vein thrombosis associated to acute pancreatitis: a 3-year single-centre experience. Intern Emerg Med 2020; 15:1021-1029. [PMID: 31916010 DOI: 10.1007/s11739-019-02271-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/23/2019] [Indexed: 12/12/2022]
Abstract
Splanchnic vein thrombosis (SVT) is a possible complication of acute pancreatitis (AP). There are no precise guidelines on the use of anticoagulant therapy (AT) in these patients. The aim of the study was to determine the safety and the efficacy of AT in AP-associated SVT. Two hundred twenty-one patients were retrospectively and consecutively enrolled from the Pancreatic Outpatient Clinic of the "A. Gemelli" hospital. Patients had a diagnosis of AP and a diagnostic imaging to evaluate whether they had or not SVT. Twenty-seven out of 221 AP patients had SVT (12.21%) and AT therapy was administered to 16 patients (59.3%), for 5.2 ± 2.2 months. A therapeutic dose of low molecular weight heparin was administered (100 UI/kg b.i.d.) at the diagnosis, with fondaparinux 7.5 mg/day, or vitamin K antagonist, or the novel direct oral anti-coagulants, upon discharge. The presence of SVT resulted significantly associated to male sex (p = 0.002). The recanalization rates were 11/16 (68.7%) in patients who received AT, and 3/11 (27.3%) in patients who did not receive it. There was a significant difference between the recanalization rates with and without AT (p = 0.03, OR 5.87). No SVT recurrence was registered during follow-up. No treated patient developed haemorrhagic complications after AT. No deaths were recorded, either in the group undergoing AT or in the one that was not. In conclusion, AT in AP-associated SVT appears to be safe and effective; yet prospective clinical trials are needed to confirm our results.
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Affiliation(s)
- Danilo Pagliari
- Division of Internal Medicine and Gastroenterology and Pancreatic Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy.
- Internal Medicine and Angiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Rossella Cianci
- Institute of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Gabriella Brizi
- Department of Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Antonio Mancarella
- Division of Internal Medicine and Gastroenterology and Pancreatic Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Massimiliano Musso
- Division of Internal Medicine and Gastroenterology and Pancreatic Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Marco Cintoni
- Division of Internal Medicine and Gastroenterology and Pancreatic Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Laura Franza
- Institute of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberto Antonio Flore
- Internal Medicine and Angiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gasbarrini
- Division of Internal Medicine and Gastroenterology and Pancreatic Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Paolo Tondi
- Internal Medicine and Angiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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25
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Glowka TR, Kalff JC, Manekeller S. Update on Shunt Surgery. Visc Med 2020; 36:206-211. [PMID: 32775351 DOI: 10.1159/000507125] [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: 12/11/2019] [Accepted: 03/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background Bleeding from esophagogastric varices is a life-threatening complication from portal hypertension. It occurs in 15% of patients and has a mortality rate of 20-35%. Summary The primary therapy for variceal bleeding is medical. In cases of recurrent bleeding, a definitive therapy is required. In cases of parenchymal decompensation, liver transplantation is the causal therapy, but if liver function is preserved, portal decompression is the therapy of choice. The use of the transjugular intrahepatic portosystemic shunt (TIPS) has achieved widespread acceptance, although evidence for surgical shunts is comparable or better in patients with good hepatic reserve. The type of surgical shunt depends on the patent veins of the portomesenteric system. If total occlusion is present, a devascularization procedure might be indicated. Key Messages Therapy, taking into account liver function, morphology of the portovenous system, and imminent liver transplantation, should be performed by an interdisciplinary team of gastroenterologists, interventional radiologists, and gastrointestinal surgeons.
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Affiliation(s)
- Tim R Glowka
- Department of Surgery, University of Bonn, Bonn, Germany
| | - Jörg C Kalff
- Department of Surgery, University of Bonn, Bonn, Germany
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26
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Portal vein stent for symptomatic malignant portal vein stenosis: A single-center experience. Curr Probl Cancer 2020; 44:100476. [DOI: 10.1016/j.currproblcancer.2019.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 04/23/2019] [Indexed: 01/27/2023]
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27
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Hurley CM, Hechtl D, Ng KC, McHugh J, Sehgal R, Regan MC. Biofilm-sealed perforation of the gastric body: a rare sequela of gastric band erosion. J Surg Case Rep 2019; 2019:rjz263. [PMID: 31807272 PMCID: PMC6889854 DOI: 10.1093/jscr/rjz263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/11/2019] [Indexed: 12/01/2022] Open
Abstract
Laparoscopic Adjustable Gastric Banding is one of the cardinal bariatric interventions and due to its early safety profile, became the mainstay. Major long-term complications of gastric banding include pouch-herniation-dilation and gastric erosion. A 59-year-old female presented to the emergency department with a 2-week history of progressive central abdominal pain and distention on a background history of a laparoscopic adjustable band insertion 11 years previously. Subsequent computed tomography demonstrated an intragastric band erosion. An exploratory laparotomy demonstrated a gastric band eroded through the stomach sealed by a biofilm. Secondary findings included small bowel ischemia and portal vein thrombosis. The gastric band was extracted, and the stomach was repaired. The ischemic small bowel was resected with primary anastomosis. The patient recovered uneventfully. Gastric band erosion should be considered in all patients presenting with abdominal pain and previous weight loss surgery. Prompt recognition may avoid fatal consequences.
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Affiliation(s)
- Ciaran M Hurley
- Department of General and Colorectal Surgery, University Hospital Galway, Galway, Ireland
| | - Daniel Hechtl
- Department of General and Colorectal Surgery, University Hospital Galway, Galway, Ireland
| | - Kin Cheung Ng
- Department of General and Colorectal Surgery, University Hospital Galway, Galway, Ireland
| | - Jack McHugh
- Department of General and Colorectal Surgery, University Hospital Galway, Galway, Ireland
| | - Rishabh Sehgal
- Department of General and Colorectal Surgery, University Hospital Galway, Galway, Ireland
| | - Mark C Regan
- Department of General and Colorectal Surgery, University Hospital Galway, Galway, Ireland
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28
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Manigrasso M, Milone M, Velotti N, Vertaldi S, Schettino P, Musella M, Aprea G, Gennarelli N, Maione F, Sarnelli G, Venetucci P, De Palma GD, Milone F. Incidence and risk factors of portomesenteric venous thrombosis after colorectal surgery for cancer in the elderly population. World J Surg Oncol 2019; 17:195. [PMID: 31744485 PMCID: PMC6865040 DOI: 10.1186/s12957-019-1739-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/31/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Although it is known that portomesenteric venous thrombosis (PMVT) is associated with total colectomy and proctocolectomy in young patients with inflammatory bowel disease, little is known about incidence and risk factors of PMVT among the elderly population undergoing colorectal surgery for cancer. METHODS Data of elderly patients (> 70 years) undergoing surgery for colorectal cancer were retrospectively registered. The occurrence of PMVT was correlated with the patients' characteristics and operative variables. Data collected included age, sex, obesity, ASA score, tumor degree, type of surgical resection, surgical approach (laparoscopic or open), and duration of surgery (from skin incision to the application of dressings). RESULTS A total of 137 patients > 70 years who underwent surgery for colorectal cancer and developed an acute intraabdominal process with suggestive symptoms, needing a CT scan, were included. Three of these patients (2.1%) had portomesenteric venous thrombosis during the study period, which was proved with CT scan. There were no significant patients' characteristics or operative variables between patients with or without the occurrence of PMVT after surgery. Of interest, only operative time was significantly higher in patients with PMVT after surgery (256 ± 40 vs 140 ± 41, p < 0.001). CONCLUSIONS PMVT as a cause of abdominal pain after colorectal surgery for cancer in the elderly population is uncommon. An index of suspicion for PMVT in an elderly postoperative colorectal cancer patient with sudden onset of abdominal pain must be maintained.
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Affiliation(s)
- Michele Manigrasso
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy. .,Department of Gastroenterology, Endocrinology and Surgical Endoscopy, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy.
| | - Nunzio Velotti
- Department of Advanced Biomedical Sciences, University "Federico II" of Naples, Naples, Italy
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - Pietro Schettino
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - Mario Musella
- Department of Advanced Biomedical Sciences, University "Federico II" of Naples, Naples, Italy
| | - Giovanni Aprea
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - Nicola Gennarelli
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - Francesco Maione
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - Pietro Venetucci
- Department of Advanced Biomedical Sciences, University "Federico II" of Naples, Naples, Italy
| | | | - Francesco Milone
- Department of Advanced Biomedical Sciences, University "Federico II" of Naples, Naples, Italy
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29
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Zhang B, Kim M, Griffiths C, Shi Q, Duceppe E, Ruo L, Serrano PE. Incidence of Splanchnic Vein Thrombosis After Abdominal Surgery: A Systematic Review and Meta-analysis. J Surg Res 2019; 245:500-509. [PMID: 31446192 DOI: 10.1016/j.jss.2019.07.086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/19/2019] [Accepted: 07/21/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Abdominal surgery may increase the risk of splanchnic vein thrombosis (SVT). We determined the incidence of SVT after abdominal surgery and identified groups at highest risk. MATERIALS AND METHODS MEDLINE and Embase were searched for clinical studies evaluating the incidence of postoperative SVT after abdominopelvic surgery. Study selection, data abstraction, and risk of bias assessment were carried out independently by two reviewers. Clinical heterogeneity was explored by subgroup analyses (i.e., type of intra-abdominal procedure and organ group). RESULTS Of 5549 abstracts screened, 48 were analyzed. Pooled incidence of SVT (n = 50,267) was 2.68% [95% confidence interval (CI), 2.24 to 3.11] (1347 events), I2 = 96%. Pooled incidence of SVT in high-risk procedures were splenectomy with devascularization (24%), hepatectomy in patients with cirrhosis (9%), and pancreatectomy with venous resection (5%). Pooled incidence of symptomatic and asymptomatic SVT was 1.02% (95% CI: 0.97% to 1.07%) and 0.98% (95% CI 0.88% to 1.07%), respectively. Most common causes of SVT-related mortality were irreversible thrombosis, bowel ischemia, liver failure, and gastrointestinal bleed. Most studies included were at a high risk of bias due to lack of prospective data collection and lack of SVT screening for all participants. CONCLUSIONS Incidence of SVT after abdominal surgery is low but remains a relevant complication. Patients undergoing procedures involving surgical manipulation of the venous system and splenectomy are at the highest risk. Given the life-threatening risks associated with SVT, there is a need for larger prospective studies on the incidence and impact of SVT after abdominal surgery.
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Affiliation(s)
- Betty Zhang
- DeGroote School of Medicine, McMaster University, Hamilton Ontario, Canada
| | - Minji Kim
- Department of Surgery, McMaster University, Hamilton Ontario, Canada
| | | | - Qian Shi
- DeGroote School of Medicine, McMaster University, Hamilton Ontario, Canada
| | - Emmanuelle Duceppe
- Department of Medicine, University of Montreal, Montreal, Qeubec, Canada; Centre de Recherche du Centre Hospitalier Universitaire de Montreal, Montreal, Qeubec, Canada
| | - Leyo Ruo
- Department of Surgery, McMaster University, Hamilton Ontario, Canada
| | - Pablo E Serrano
- Department of Surgery, McMaster University, Hamilton Ontario, Canada.
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30
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Ponnatapura J, Kielar A, Burke LM, Lockhart ME, Abualruz AR, Tappouni R, Lalwani N. Hepatic complications of oral contraceptive pills and estrogen on MRI: Controversies and update - Adenoma and beyond. Magn Reson Imaging 2019; 60:110-121. [DOI: 10.1016/j.mri.2019.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 12/17/2022]
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31
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Mickevičius A, Valantinas J, Stanaitis J, Jucaitis T, Mašalaitė L. Changes in the Velocity of Blood in the Portal Vein in Mild Acute Pancreatitis-A Preliminary Clinical Study. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E211. [PMID: 31130704 PMCID: PMC6571583 DOI: 10.3390/medicina55050211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/18/2019] [Accepted: 05/20/2019] [Indexed: 12/12/2022]
Abstract
Background and objective: Portal vein thrombosis is associated with a decrease in the main blood velocity in this vessel. While most studies examine etiological factors of portal vein thrombosis after its occurrence, we aimed to evaluate portal vessels and assess whether mild acute pancreatitis affects blood flow in the portal vein and increases the risk of thrombosis. Materials and methods: This prospective single centered follow-up study enrolled 66 adult participants. Fifty of them were diagnosed with mild acute pancreatitis based on the Revised Atlanta classification, and 16 healthy participants formed the control group. All participants were examined three times. The first examination was carried out at the beginning of the disease and the next two at three-month intervals. Blood samples were taken and color Doppler ultrasound performed the first time, whereas ultrasound alone was performed during the second and third visits. Mean and maximal blood velocities and resistivity index in the main portal vein and its left and right branches were evaluated. Results: Mean velocity of the blood flow in the main portal vein and its right and left branches was not significantly different from healthy individuals during the acute pancreatitis phase: 23.1 ± 8.5 cm/s vs. 24.5 ± 8.2 cm/s (p = 0.827); 16.4 ± 7.9 cm/s vs. 16.4 ± 8.1 cm/s (p = 1.000); and 8 ± 3.4 cm/s vs. 7.4 ± 2.5 cm/s (p = 0.826), respectively. The same was observed when comparing the maximal blood flow velocity: 67.9 ± 29 cm/s vs. 67.5 ± 21 cm/s (p > 0.05); 45.4 ± 27 cm/s vs. 44 ± 23.8 cm/s (p = 0.853); and 22.2 ± 9.8 cm/s vs. 20 ± 7.3 cm/s (p = 0.926), respectively. Changes in venous blood velocities were not significant during the follow-up period in separate study groups. Conclusions: Portal blood flow velocities do not change during mild acute pancreatitis in the inflammatory and postinflammatory periods. This observation suggests that mild acute pancreatitis does not increase the risk of portal vein thrombosis.
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Affiliation(s)
- Artautas Mickevičius
- Vilnius University Faculty of Medicine, Clinic of Gastroenterology, Nephro-Urology and Surgery, Biomedical Sciences, Vilnius LT-03101, Lithuania.
- Centre of Hepatology, Gastroenterology and Dietetics, Vilnius University Hospital Santaros Clinics, Vilnius LT-08661, Lithuania.
| | - Jonas Valantinas
- Vilnius University Faculty of Medicine, Clinic of Gastroenterology, Nephro-Urology and Surgery, Biomedical Sciences, Vilnius LT-03101, Lithuania.
- Centre of Hepatology, Gastroenterology and Dietetics, Vilnius University Hospital Santaros Clinics, Vilnius LT-08661, Lithuania.
| | - Juozas Stanaitis
- Centre of Hepatology, Gastroenterology and Dietetics, Vilnius University Hospital Santaros Clinics, Vilnius LT-08661, Lithuania.
| | - Tomas Jucaitis
- Centre of Hepatology, Gastroenterology and Dietetics, Vilnius University Hospital Santaros Clinics, Vilnius LT-08661, Lithuania.
| | - Laura Mašalaitė
- Vilnius University Faculty of Medicine, Clinic of Gastroenterology, Nephro-Urology and Surgery, Biomedical Sciences, Vilnius LT-03101, Lithuania.
- Centre of Hepatology, Gastroenterology and Dietetics, Vilnius University Hospital Santaros Clinics, Vilnius LT-08661, Lithuania.
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Simonetto DA, Liu M, Kamath PS. Portal Hypertension and Related Complications: Diagnosis and Management. Mayo Clin Proc 2019; 94:714-726. [PMID: 30947834 DOI: 10.1016/j.mayocp.2018.12.020] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/11/2018] [Accepted: 12/21/2018] [Indexed: 02/06/2023]
Abstract
Portal hypertension is a major complication of cirrhosis, and its consequences, including ascites, esophageal varices, hepatic encephalopathy, and hepatorenal syndrome, lead to substantial morbidity and mortality. The past several decades have seen major improvements in the clinical management of complications of portal hypertension, resulting in substantial gains in patient outcomes. However, important challenges remain. This review focuses on the pathophysiology and diagnosis of portal hypertension and discusses general approaches in the management of patients with ascites as a result of portal hypertension.
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Affiliation(s)
| | - Mengfei Liu
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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Al Saeed M, Al-Jiffry B, Younes A, Badr S, Abdel-Rahman T, Hatem M, El-Meteini M. Risk factors, pattern of presentation, methods of diagnosis, and results of treatment of acute portal vein thrombosis: A multicenter study. SAUDI JOURNAL FOR HEALTH SCIENCES 2019. [DOI: 10.4103/sjhs.sjhs_77_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lai CMS, Liu SYW, Wong JKT, Wong SKH, Ng EKW. Portomesenteric vein thrombosis following laparoscopic greater curve plication for morbid obesity. Obes Res Clin Pract 2018; 12:578-582. [PMID: 30413266 DOI: 10.1016/j.orcp.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/15/2018] [Accepted: 10/01/2018] [Indexed: 11/17/2022]
Abstract
Portomesenteric venous thrombosis (PMVT) is an uncommon condition associated with intra-abdominal visceral ischemia that is often difficult to manage. While postoperative PMVT has been rarely reported following laparoscopic abdominal surgery, its occurrence in morbidly obese patients is gaining increasing concern due to its relatively higher incidence after laparoscopic bariatric surgery. Diagnosis of PMVT can be readily accomplished by computed tomography scan. Although prompt treatment with recanalisation of portovenous system and reversal of mesenteric venous ischemia can be potentially life-saving, the overall mortality of postoperative PMVT can only be controlled by understanding the underlying etiologies and preventing its occurrence. Here, we report a case of PMVT in a morbidly obese lady who presented at 10days after an uneventful laparoscopic greater curve plication. The potential etiology and management of this rare complication are elucidated in details.
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Affiliation(s)
- Carol Man-Sze Lai
- Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Shirley Yuk-Wah Liu
- Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Jeffrey Ka-Tak Wong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Simon Kin-Hung Wong
- Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Enders Kwok-Wai Ng
- Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
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35
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Parras García de León N, Martinón Torres G, Esquinas Requena JL, Martín Márquez J, Muñiz Alonso R. [Ascites as first manifestation of superior mesenteric and portal vein thrombosis secondary to protein S deficiency]. Rev Esp Geriatr Gerontol 2018; 53:304-305. [PMID: 29439833 DOI: 10.1016/j.regg.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/17/2017] [Accepted: 11/27/2017] [Indexed: 06/08/2023]
Affiliation(s)
| | | | | | - Jacinta Martín Márquez
- Servicio de Geriatría, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Rosa Muñiz Alonso
- Servicio de Urgencias, Hospital General Universitario de Ciudad Real, Ciudad Real, España
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36
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Gioia S, Nardelli S, Pasquale C, Pentassuglio I, Nicoletti V, Aprile F, Merli M, Riggio O. Natural history of patients with non cirrhotic portal hypertension: Comparison with patients with compensated cirrhosis. Dig Liver Dis 2018; 50:839-844. [PMID: 29429910 DOI: 10.1016/j.dld.2018.01.132] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The knowledge of natural history of patients with portal hypertension (PH) not due to cirrhosis is less well known than that of cirrhotic patients. AIM To describe the clinical presentation and the outcomes of 89 patients with non-cirrhotic PH (25 with non-cirrhotic portal hypertension, INCPH, and 64 with chronic portal vein thrombosis, PVT) in comparison with 77 patients with Child A cirrhosis. METHODS The patients were submitted to a standardized clinical, laboratory, ultrasonographic and endoscopic follow-up. Variceal progression, incidence of variceal bleeding, portal vein thrombosis, ascites and survival were recorded. RESULTS At presentation, the prevalence of varices, variceal bleeding and ascites was similar in the 3 groups. During follow-up, the rate of progression to varices at risk of bleeding (p < 0.0001) and the incidence of first variceal bleeding (p = 0.02) were significantly higher in non-cirrhotic then in cirrhotic patients. A PVT developed in 32% of INCPH patients and in 18% of cirrhotics (p = 0.02). CONCLUSIONS In the patients with non-cirrhotic PH variceal progression is more rapid and bleeding more frequent than in cirrhotics. Patients with INCPH are particularly prompt to develop PVT. This observational study suggests that the management of patients with non-cirrhotic PH should take into consideration the natural history of portal hypertension in these patients and cannot be simply derived by the observation of cirrhotic patients.
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Affiliation(s)
- Stefania Gioia
- Dept. of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, Rome, Italy.
| | - Silvia Nardelli
- Dept. of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, Rome, Italy.
| | - Chiara Pasquale
- Dept. of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, Rome, Italy.
| | - Ilaria Pentassuglio
- Dept. of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, Rome, Italy
| | - Valeria Nicoletti
- Dept. of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, Rome, Italy
| | - Francesca Aprile
- Dept. of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, Rome, Italy.
| | - Manuela Merli
- Dept. of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, Rome, Italy
| | - Oliviero Riggio
- Dept. of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, Rome, Italy
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37
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Huang R, Gao ZH, Tang A, Sebastiani G, Deschenes M. Transient elastography is an unreliable marker of liver fibrosis in patients with portal vein thrombosis. Hepatology 2018; 68:783-785. [PMID: 29572884 DOI: 10.1002/hep.29893] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 02/24/2018] [Accepted: 03/19/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Ruiyao Huang
- Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Zu-Hua Gao
- Division of Pathology, Royal Victoria Hospital, McGill University Health Center, Montreal, QC, Canada
| | - An Tang
- Division of Radiology, Hôpital Saint-Luc, Université de Montréal, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Marc Deschenes
- Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Center, Montreal, QC, Canada
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38
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Cytomegalovirus-associated splanchnic vein thrombosis in immunocompetent patients: A systematic review. Thromb Res 2018; 168:104-113. [DOI: 10.1016/j.thromres.2018.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/18/2018] [Accepted: 06/16/2018] [Indexed: 02/07/2023]
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39
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Elnaggar AS, Griesemer AD, Bentley-Hibbert S, Brown RS, Martinez M, Lobritto SJ, Kato T, Emond JC. Liver atrophy and regeneration in noncirrhotic portal vein thrombosis: Effect of surgical shunts. Liver Transpl 2018; 24:881-887. [PMID: 29377486 DOI: 10.1002/lt.25024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/10/2017] [Accepted: 01/17/2018] [Indexed: 02/07/2023]
Abstract
The goal of the study is to characterize the relationship between portal vein thrombosis (PVT) and hepatic atrophy in patients without cirrhosis and the effect of various types of surgical shunts on liver regeneration and splenomegaly. Patients without cirrhosis with PVT suffer from presinusoidal portal hypertension, and often hepatic atrophy is a topic that has received little attention. We hypothesized that patients with PVT have decreased liver volumes, and shunts that preserve intrahepatic portal flow enhance liver regeneration. Sixty-four adult and pediatric patients with PVT who underwent surgical shunt placement between 1998 and 2011 were included in a retrospective study. Baseline liver volumes from adult patients were compared with standard liver volume (SLV) as well as a group of healthy controls undergoing evaluation for liver donation. Clinical assessment, liver function tests, and liver and spleen volumes from cross-sectional imaging were compared before and after surgery. A total of 40 patients received portal flow-preserving shunts (32 mesoportal and 8 selective splenorenal), whereas 24 received portal flow-diverting shunts (16 nonselective splenorenal and 8 mesocaval). Baseline adult liver volumes were 26% smaller than SLV (1248 versus 1624 cm3 ; P = 0.02) and 20% smaller than the control volumes (1248 versus 1552 cm3 ; P = 0.02). Baseline adult spleen volumes were larger compared with controls (1258 versus 229 cm3 ; P < 0.001). Preserving shunts were associated with significant increase in liver volumes (886 versus 1131 cm3 ; P = 0.01), whereas diverting shunts were not. Diverting shunts significantly improved splenomegaly. In conclusion, we have demonstrated that patients without cirrhosis with PVT have significant liver atrophy and splenomegaly. Significant liver regeneration was achieved after portal flow-preserving shunts. Liver Transplantation 24 881-887 2018 AASLD.
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Affiliation(s)
- Abdulrhman S Elnaggar
- Center for Liver Disease and Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY
| | - Adam D Griesemer
- Center for Liver Disease and Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY
| | - Stuart Bentley-Hibbert
- Center for Liver Disease and Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY
| | - Robert S Brown
- Center for Liver Disease and Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY
| | - Mercedes Martinez
- Center for Liver Disease and Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY
| | - Steven J Lobritto
- Center for Liver Disease and Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY
| | - Tomoaki Kato
- Center for Liver Disease and Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY
| | - Jean C Emond
- Center for Liver Disease and Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY
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Nishimura E, Misawa T, Kitamura H, Fujioka S, Akiba T, Yanaga K. A case of portal vein thrombosis caused by blunt abdominal trauma in a patient with low protein C activity. Clin J Gastroenterol 2018; 11:507-513. [PMID: 29923164 DOI: 10.1007/s12328-018-0879-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/10/2018] [Indexed: 11/28/2022]
Abstract
Portal vein thrombosis (PVT) is caused by several conditions including infection, malignancies, surgery, medications, and coagulation disorders. However, PVT caused by low-energy injury is very rare. A 51-year-old man visited a clinic with a 2-day history of abdominal pain following blunt abdominal trauma. Contrast-enhanced computed tomography (CT) revealed thrombosis in both the portal vein and splenic vein, and he was transferred to our hospital with a diagnosis of PVT. Anticoagulant therapy was initiated using unfractionated heparin. A repeat CT scan revealed enlargement of the thrombus, which occluded the main trunk and first right branch of the portal vein. Laboratory data before heparin administration suggested low protein C activity. Anticoagulation therapy was continued with intermittent assessment of the size of the thrombus and degree of coagulation. On day 23, enhanced CT showed marked shrinkage of the thrombus compared with that on day 8. On day 30, the patient was discharged with a therapeutic prothrombin time-international normalized ratio. Here we present a case of PVT caused by low-energy trauma of the upper abdomen in a patient with a background of low protein C activity that was successfully treated without invasive surgery.
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Affiliation(s)
- Erica Nishimura
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan
| | - Takeyuki Misawa
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan.
| | - Hiroaki Kitamura
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan
| | - Shuichi Fujioka
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan
| | - Tadashi Akiba
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan
| | - Katsuhiko Yanaga
- Department of Surgery, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan
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Rim CH, Kim CY, Yang DS, Yoon WS. External beam radiation therapy to hepatocellular carcinoma involving inferior vena cava and/or right atrium: A meta-analysis and systemic review. Radiother Oncol 2018; 129:123-129. [PMID: 29606524 DOI: 10.1016/j.radonc.2018.02.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/25/2018] [Accepted: 02/26/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE Hepatocellular carcinoma (HCC) involving inferior vena cava (IVC) and/or right atrium (RA) is a very rare but serious disease. The objective of this meta-analysis was to assess efficacy and safety of external beam radiotherapy (EBRT) for HCC involving IVC and/or RA. MATERIALS AND METHODS Systematic search of Pubmed, MEDLINE, EMBASE, and Cochrane library published was performed. Primary endpoints were 1-year overall survival (OS) rate and 2-year OS rates. Secondary endpoints were response rate, local control (LC) rate, and grade ≥3 toxicities. According to heterogeneity evaluated with Cochran Q test and I2 statistics, meta-analysis was performed using either random or fixed model. RESULTS A total of 8 studies and 9 cohorts were included, encompassing 164 patients. Pooled 1- and 2-year OS rates were 53.6% (95% CI: 45.7-61.3%) and 36.9% (95% CI: 27.2-42.4%), respectively. Pooled response rate and LC rate were 59.2% (95% CI: 39.0-76.7%) and 83.8% (95% CI: 78.8-97.1%), respectively. Only one study reported 2 grade ≥3 toxicities, an esophageal rupture and a pulmonary embolism cases. The overall rate of possible grade ≥3 complications was 1.2% (2 of 164). CONCLUSIONS EBRT is a feasible and safe option to palliate HCC with IVC and/or RA invasion.
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Affiliation(s)
- Chai Hong Rim
- Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Republic of Korea
| | - Chul Yong Kim
- Department of Radiation Oncology, Anam Hospital, Korea University Medical College, Seoul, Republic of Korea
| | - Dae Sik Yang
- Department of Radiation Oncology, Guro Hospital, Korea University Medical College, Seoul, Republic of Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Republic of Korea.
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Vascular liver diseases on the clinical side: definitions and diagnosis, new concepts. Virchows Arch 2018; 473:3-13. [PMID: 29572606 DOI: 10.1007/s00428-018-2331-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/21/2018] [Accepted: 02/27/2018] [Indexed: 12/17/2022]
Abstract
The components of the hepatic vascular system (hepatic arteries, portal and hepatic veins, sinusoids, and lymphatics) can be damaged by various types of injury. Each of the resulting conditions is rare, which has limited knowledge and awareness. In the last two decades, international collaborations have allowed to reach critical masses of data, which has driven significant progresses in understanding and management of vascular disorders of the liver. The present paper discusses definitions, denominations, and diagnosis of such vascular disorders with the exception of those affecting hepatic arteries. Evolving pathogenic or pathophysiologic views relevant to the clinical aspects are also overviewed.
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Tan SBM, Greenslade J, Martin D, Talbot M, Loi K, Hopkins G. Portomesenteric vein thrombosis in sleeve gastrectomy: a 10-year review. Surg Obes Relat Dis 2018; 14:271-275. [DOI: 10.1016/j.soard.2017.12.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/30/2017] [Accepted: 12/08/2017] [Indexed: 12/13/2022]
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Factors associated with portomesenteric venous thrombosis after total colectomy with ileorectal anastomosis or end ileostomy. Am J Surg 2018; 215:62-65. [DOI: 10.1016/j.amjsurg.2017.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 05/09/2017] [Accepted: 10/03/2017] [Indexed: 02/06/2023]
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A Rare Finding of Falciform Ligament Thrombosis as a Sequel of Acute Pancreatitis. Case Rep Radiol 2017; 2017:2879568. [PMID: 29403671 PMCID: PMC5748311 DOI: 10.1155/2017/2879568] [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: 09/16/2017] [Accepted: 11/23/2017] [Indexed: 01/16/2023] Open
Abstract
Falciform ligament (remnant of umbilical vein) is an anatomical structure that connects the liver to the anterior abdominal wall. This case reports a rare clinical presentation of falciform ligament thrombosis as a consequence of acute gallstone pancreatitis, in a patient with noncirrhotic liver. A 55-year-old female with a history of cholelithiasis was admitted with abdominal pain. Biochemistry profile showed hyperamylasemia and deranged liver function tests. Computerized Tomography (CT) revealed a 3 cm attenuated structure that can be traced up to the left portal vein, which represents an acute thrombosis of the falciform ligament. The patient was treated with Tinzaparin and subsequently anticoagulated. She subsequently had a laparoscopic cholecystectomy and made an uneventful recovery. We suspect that pancreatitis caused thrombophlebitis subsequently leading to recanalization and thrombosis of the umbilical vein. Falciform ligament thrombosis is a rare and poorly described complication following pancreatitis which clinicians and radiologists should be aware of.
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Muneuchi J, Matsuoka R, Nagatomo Y, Iida C, Okada S, Shirouzu H, Watanabe M. Complications in transcatheter closure of congenital portosystemic venous shunt using Amplatzer Vascular Plug. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bildgebende Darstellung viszeraler Gefäße. Internist (Berl) 2017; 58:775-786. [DOI: 10.1007/s00108-017-0286-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lv Y, He C, Wang Z, Guo W, Wang J, Bai W, Zhang L, Wang Q, Liu H, Luo B, Niu J, Li K, Tie J, Yin Z, Fan D, Han G. Association of Nonmalignant Portal Vein Thrombosis and Outcomes after Transjugular Intrahepatic Portosystemic Shunt in Patients with Cirrhosis. Radiology 2017; 285:999-1010. [PMID: 28682164 DOI: 10.1148/radiol.2017162266] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose To assess the effects of preexisting nonmalignant portal vein thrombosis (PVT) on mortality, clinical relapse, shunt dysfunction, and overt hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) placement. Materials and Methods This retrospective study was approved by the institutional ethics committee, and written informed consent was obtained from all patients. From March 2001 to December 2014, 1171 consecutive patients with cirrhosis (762 men, 409 women; mean age, 50.0 years ± 12.8) and PVT (n = 212; 18%) or without PVT (n = 959; 82%) who underwent TIPS placement were included. The association between PVT and outcomes after TIPS placement was measured by using Fine and Gray competing risk regression model after adjusting for important baseline characteristics or by using propensity score. The Wald test was used to assess the homogeneity of the effects of PVT across different strata (stratified PVT according to the stages, degrees, and extents) and major subgroups. Results During a median follow-up period of 28.4 months, 507 (43%) patients died, 373 (32%) experienced clinical relapse, 217 (19%) developed shunt dysfunction, and 475 (41%) experienced overt HE. Compared with patients without PVT, patients with PVT had a similar risk of mortality (adjusted hazard ratio, 0.82; 95% confidence interval [CI]: 0.63, 1.09; P = .17), clinical relapse (adjusted hazard ratio, 1.24; 95% CI: 0.92, 1.69; P = .15), shunt dysfunction (adjusted hazard ratio, 1.03; 95% CI: 0.70, 1.51; P = .43), and overt HE (adjusted hazard ratio, 0.88; 95% CI: 0.70, 1.11; P = .29). Furthermore, the effects of PVT were consistent across the relevant strata and subgroups. Conclusion There was no evidence that preexisting PVT was associated with an improved or worsened outcome after TIPS. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Yong Lv
- From the Department of Liver Diseases and Digestive Interventional Radiology (Y.L., C.H., Z.W., W.G., W.B., L.Z., Q.W., H.L., B.L., J.N., K.L., J.T., Z.Y., G.H.), Department of Ultrasound (J.W.), and State Key Laboratory of Cancer Biology (D.F.), National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an 710032, China
| | - Chuangye He
- From the Department of Liver Diseases and Digestive Interventional Radiology (Y.L., C.H., Z.W., W.G., W.B., L.Z., Q.W., H.L., B.L., J.N., K.L., J.T., Z.Y., G.H.), Department of Ultrasound (J.W.), and State Key Laboratory of Cancer Biology (D.F.), National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an 710032, China
| | - Zhengyu Wang
- From the Department of Liver Diseases and Digestive Interventional Radiology (Y.L., C.H., Z.W., W.G., W.B., L.Z., Q.W., H.L., B.L., J.N., K.L., J.T., Z.Y., G.H.), Department of Ultrasound (J.W.), and State Key Laboratory of Cancer Biology (D.F.), National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an 710032, China
| | - Wengang Guo
- From the Department of Liver Diseases and Digestive Interventional Radiology (Y.L., C.H., Z.W., W.G., W.B., L.Z., Q.W., H.L., B.L., J.N., K.L., J.T., Z.Y., G.H.), Department of Ultrasound (J.W.), and State Key Laboratory of Cancer Biology (D.F.), National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an 710032, China
| | - Jianhong Wang
- From the Department of Liver Diseases and Digestive Interventional Radiology (Y.L., C.H., Z.W., W.G., W.B., L.Z., Q.W., H.L., B.L., J.N., K.L., J.T., Z.Y., G.H.), Department of Ultrasound (J.W.), and State Key Laboratory of Cancer Biology (D.F.), National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an 710032, China
| | - Wei Bai
- From the Department of Liver Diseases and Digestive Interventional Radiology (Y.L., C.H., Z.W., W.G., W.B., L.Z., Q.W., H.L., B.L., J.N., K.L., J.T., Z.Y., G.H.), Department of Ultrasound (J.W.), and State Key Laboratory of Cancer Biology (D.F.), National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an 710032, China
| | - Lei Zhang
- From the Department of Liver Diseases and Digestive Interventional Radiology (Y.L., C.H., Z.W., W.G., W.B., L.Z., Q.W., H.L., B.L., J.N., K.L., J.T., Z.Y., G.H.), Department of Ultrasound (J.W.), and State Key Laboratory of Cancer Biology (D.F.), National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an 710032, China
| | - Qiuhe Wang
- From the Department of Liver Diseases and Digestive Interventional Radiology (Y.L., C.H., Z.W., W.G., W.B., L.Z., Q.W., H.L., B.L., J.N., K.L., J.T., Z.Y., G.H.), Department of Ultrasound (J.W.), and State Key Laboratory of Cancer Biology (D.F.), National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an 710032, China
| | - Haibo Liu
- From the Department of Liver Diseases and Digestive Interventional Radiology (Y.L., C.H., Z.W., W.G., W.B., L.Z., Q.W., H.L., B.L., J.N., K.L., J.T., Z.Y., G.H.), Department of Ultrasound (J.W.), and State Key Laboratory of Cancer Biology (D.F.), National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an 710032, China
| | - Bohan Luo
- From the Department of Liver Diseases and Digestive Interventional Radiology (Y.L., C.H., Z.W., W.G., W.B., L.Z., Q.W., H.L., B.L., J.N., K.L., J.T., Z.Y., G.H.), Department of Ultrasound (J.W.), and State Key Laboratory of Cancer Biology (D.F.), National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an 710032, China
| | - Jing Niu
- From the Department of Liver Diseases and Digestive Interventional Radiology (Y.L., C.H., Z.W., W.G., W.B., L.Z., Q.W., H.L., B.L., J.N., K.L., J.T., Z.Y., G.H.), Department of Ultrasound (J.W.), and State Key Laboratory of Cancer Biology (D.F.), National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an 710032, China
| | - Kai Li
- From the Department of Liver Diseases and Digestive Interventional Radiology (Y.L., C.H., Z.W., W.G., W.B., L.Z., Q.W., H.L., B.L., J.N., K.L., J.T., Z.Y., G.H.), Department of Ultrasound (J.W.), and State Key Laboratory of Cancer Biology (D.F.), National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an 710032, China
| | - Jun Tie
- From the Department of Liver Diseases and Digestive Interventional Radiology (Y.L., C.H., Z.W., W.G., W.B., L.Z., Q.W., H.L., B.L., J.N., K.L., J.T., Z.Y., G.H.), Department of Ultrasound (J.W.), and State Key Laboratory of Cancer Biology (D.F.), National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an 710032, China
| | - Zhanxin Yin
- From the Department of Liver Diseases and Digestive Interventional Radiology (Y.L., C.H., Z.W., W.G., W.B., L.Z., Q.W., H.L., B.L., J.N., K.L., J.T., Z.Y., G.H.), Department of Ultrasound (J.W.), and State Key Laboratory of Cancer Biology (D.F.), National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an 710032, China
| | - Daiming Fan
- From the Department of Liver Diseases and Digestive Interventional Radiology (Y.L., C.H., Z.W., W.G., W.B., L.Z., Q.W., H.L., B.L., J.N., K.L., J.T., Z.Y., G.H.), Department of Ultrasound (J.W.), and State Key Laboratory of Cancer Biology (D.F.), National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an 710032, China
| | - Guohong Han
- From the Department of Liver Diseases and Digestive Interventional Radiology (Y.L., C.H., Z.W., W.G., W.B., L.Z., Q.W., H.L., B.L., J.N., K.L., J.T., Z.Y., G.H.), Department of Ultrasound (J.W.), and State Key Laboratory of Cancer Biology (D.F.), National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an 710032, China
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The Best Anticoagulation Strategy for Cirrhotic Patients who Underwent Splenectomy: A Network Meta-Analysis. Gastroenterol Res Pract 2017; 2017:9216172. [PMID: 28676822 PMCID: PMC5476877 DOI: 10.1155/2017/9216172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 05/10/2017] [Indexed: 12/13/2022] Open
Abstract
Objective To determine the best anticoagulation strategy for the patients who underwent splenectomy with cirrhosis through network meta-analysis. Methods We conducted a systematic review of the literature in PubMed, Embase, and the Cochrane Library database. We extracted data on incidence of Portal vein system thrombosis (PVST) from studies that compared various anticoagulation strategies for use with patients who underwent splenectomy with cirrhosis. Network meta-analysis was conducted in ADDIS by evaluating the different incidence of PVST. Consistency and inconsistency models were developed to identify differences among the therapeutic strategies. Cumulative probability was utilized to rank the strategies under examination. Results. A total of 11 studies containing 1153 patients were included in the network meta-analysis. The results revealed that the application of Antithrombin III was the best anticoagulation option for patients who underwent splenectomy with cirrhosis (P = 0.59). The data of consistency and inconsistency models exhibited basically consistent and showed good convergence. Conclusions Application of Antithrombin III seemed to be the best anticoagulation strategy for cirrhotic patients who underwent splenectomy and should be considered a first-choice clinical reference.
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Shim DJ, Shin JH, Ko GY, Kim Y, Han K, Gwon DI, Ko HK. Portal vein stent placement with or without varix embolization of jejunal variceal bleeding after hepatopancreatobiliary surgery. Acta Radiol 2017; 58:423-429. [PMID: 27307028 DOI: 10.1177/0284185116654329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Extrahepatic portal hypertension after surgery involving the duodenum or jejunum might result in massive ectopic variceal bleeding. Purpose To report the results of portal vein stent placement with the addition of variceal embolization. Material and Methods Between January 2000 and June 2015, portal vein stent placement was attempted in 477 patients. Of these, 22 patients (age, 63 ± 10 years) with jejunal variceal bleeding caused by portal vein obstruction after surgery were included in this study. Computed tomography (CT) findings before and after treatment and the rates of technical and clinical success, complications, and clinical outcomes were retrospectively evaluated. Results Stent placement was successful in 19 of 22 patients. Additional variceal embolization was performed in five cases. Clinical success, defined as the cessation of bleeding without recurrence within 1 month, was achieved in 18 of 19 patients with technical success. One patient developed recurrent bleeding 4 days after stent placement and was successfully treated with additional variceal embolization. There were no procedure-related complications. A regression of the jejunal varices was noted in 14 of 19 patients on follow-up CT scans. During the follow-up period (258 days; range, 7-1196 days), stent occlusion and recurrent bleeding occurred in six and four patients, respectively, of the 19 patients who achieved technical success. Statistical analyses revealed no significant differences regarding stent patency between benign and malignant strictures. Conclusion Percutaneous, transhepatic, portal vein stent placement with or without jejunal variceal embolization appears to be a safe and effective treatment for jejunal variceal bleeding after surgery.
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Affiliation(s)
- Dong Jae Shim
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yook Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kichang Han
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Dong-Il Gwon
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Heung-Kyu Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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