scholarly journals Spontaneous thrombosis of large splenorenal shunt during balloon-occluded retrograde transvenous obliteration in a patient with chronic persistent hepatic encephalopathy. Is this catheter assisted trans-venous occlusion?

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Lijesh Kumar ◽  
Cyriac Abby Philips ◽  
Prakash Zacharias ◽  
Sudarshan Patil ◽  
Philip Augustine
Keyword(s):  
Hepatic Encephalopathy ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Hepatic Dysfunction ◽  
Venous Occlusion ◽  
Splenorenal Shunt ◽  
Chronic Hepatic Encephalopathy ◽  
Vein Thrombosis ◽  
Portosystemic Shunts ◽  
First Time

Large spontaneous portosystemic shunts in cirrhosis are implicated in recurrent and/or chronic persistent hepatic encephalopathy. In long standing cases, these shunts lead to portal vein thrombosis and hepatic dysfunction. Balloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular technique that is usually employed for shunt closure in the patients manifesting the features of chronic hepatic encephalopathy. There are several reports documenting systemic and portal vein thrombosis as a part of the procedure. We report first time a patient in whom the difficult and partial BRTO procedure led to the extensive thrombosis of the large splenorenal shunt itself without sclerosant instillation.

scholarly journals Portal vein thrombosis following selective distal splenorenal shunt: A new syndrome

1978 ◽  
Vol 75 (5) ◽  
pp. 985
Author(s):  
L.E. Rotstein ◽  
B. Langer ◽  
L. Makowka ◽  
R.M. Stone ◽  
L.M. Blendis
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Splenorenal Shunt ◽  
Distal Splenorenal Shunt ◽  
Vein Thrombosis

Relationship between underlying causes of HCC and its complications.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13123-e13123
Author(s):  
Daniel Kyung ◽  
Stuthi Perimbeti ◽  
Bolanle Adepoju ◽  
Shaun Bryan Hanson ◽  
Michael Joseph McCormack ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Bivariate Analysis ◽  
Chi Square ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Vein Thrombosis ◽  
The Us ◽  
Chi Square Test

e13123 Background: Hepatocellular carcinoma (HCC) remains the 4th leading cause of cancer mortality in the US. While mortality varies by stage, the presence of certain HCC-related complications contribute to increased mortality. In this study, we assessed whether the underlying cause for HCC influenced the frequency of common complications. Methods: The National Inpatient Sample between 1999 and 2014 was analyzed using ICD-9 codes. The ICD-9 code for HCC was used to extract all admissions from the years 1999-2014 and weighted to approximate the full inpatient population of the US over the 16 year interval. The prevalence of HCC-related complications were calculated for portal vein thrombosis (PVT), erythrocytosis, peritonitis, esophageal variceal bleeding (EVB), portal hypertension (Portal HTN) and hepatic encephalopathy (HE). Bivariate analysis using Chi square test was performed to compare the percentages of each complication with underlying risk factors for HCC (HBV, HCV, NASH and alcohol). Results: Total of 131,115 admissions (weighted = 648,732) was identified to have HCC. Conclusions: Portal HTN was the most common complication associated with HCV and NASH, whereas hepatic encephalopathy was most frequently seen with alcohol and PVT with HBV, respectively. Alcohol was associated with the highest rate of HCC-complications with the exception of portal vein thrombosis. HBV was associated with the lowest frequencies of complications except for PVT, for which it was the highest. Future studies might look at whether disease modifying measures such as cessation of alcohol and eradication of active HBV, HCV would impact the natural history of HCC.[Table: see text][Table: see text]

scholarly journals Comparison of Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Cirrhosis With or Without Portal Vein Thrombosis: A Retrospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Hong-Liang Wang ◽  
Wei-Jie Lu ◽  
Yue-Lin Zhang ◽  
Chun-Hui Nie ◽  
Tan-Yang Zhou ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Variceal Bleeding ◽  
Meld Score ◽  
Refractory Ascites ◽  
Complication Rates ◽  
Vein Thrombosis ◽  
Portosystemic Shunts ◽  
Shunt Dysfunction ◽  
End Stage

Aim: The purpose of our study was to conduct a retrospective analysis to compare the effectiveness of transjugular intrahepatic portosystemic shunts (TIPS) in the treatment of patients with cirrhosis with or without portal vein thrombosis (PVT).Methods: We included a total of 203 cirrhosis patients successfully treated with TIPS between January 2015 and January 2018, including 72 cirrhosis patients with PVT (35.5%) and 131 without PVT (64.5%). Our subjects were followed for at least 1 year after treatment with TIPS. Data were collected to estimate the mortality, shunt dysfunction, and complication rates after TIPS creation.Results: During the mean follow-up time of 19.5 ± 12.8 months, 21 (10.3%) patients died, 15 (7.4%) developed shunt dysfunction, and 44 (21.6%) experienced overt hepatic encephalopathy (OHE). No significant differences in mortality (P = 0.134), shunt dysfunction (P = 0.214), or OHE (P = 0.632) were noted between the groups. Age, model for end-stage liver disease (MELD) score, and refractory ascites requiring TIPS were risk factors for mortality. A history of diabetes, percutaneous transhepatic variceal embolization (PTVE), 8-mm diameter stent, and platelet (PLT) increased the risk of shunt dysfunction. The prevalence of variceal bleeding and recurrent ascites was comparable between the two groups (16.7 vs. 16.7% P = 0.998 and 2.7 vs. 3.8% P = 0.678, respectively).Conclusions: Transjugular intrahepatic portosystemic shunts are feasible in the management of cirrhosis with PVT. No significant differences in survival or shunt dysfunction were noted between the PVT and no-PVT groups. The risk of recurrent variceal bleeding, recurrent ascites, and OHE in the PVT group was generally similar to that in the no-PVT group. TIPS represents a potentially feasible treatment option in cirrhosis patients with PVT.

scholarly journals Cognitive Impairement in Non-Cirrhotic Portal Hypertension: Highlights on Physiopathology, Diagnosis and Management

2021 ◽  
Vol 11 (1) ◽  
pp. 101
Author(s):  
Stefania Gioia ◽  
Silvia Nardelli ◽  
Oliviero Riggio ◽  
Jessica Faccioli ◽  
Lorenzo Ridola
Keyword(s):  
Portal Hypertension ◽  
Hepatic Encephalopathy ◽  
Portal Vein ◽  
Vascular Disease ◽  
Portal Vein Thrombosis ◽  
Case Reports ◽  
Diagnostic Tools ◽  
Western World ◽  
Type B ◽  
Vein Thrombosis

Hepatic encephalopathy (HE) is one of the most frequent complications of cirrhosis. Several studies and case reports have shown that cognitive impairment may also be a tangible complication of portal hypertension secondary to chronic portal vein thrombosis and to porto-sinusoidal vascular disease (PSVD). In these conditions, representing the main causes of non-cirrhotic portal hypertension (NCPH) in the Western world, both overt and minimal/covert HE occurs in a non-neglectable proportion of patients, even lower than in cirrhosis, and it is mainly sustained by the presence of large porto-systemic shunt. In these patients, the liver function is usually preserved or only mildly altered, and the development of porto-systemic shunt is either spontaneous or iatrogenically frequent; HE is an example of type-B HE. To date, in the absence of strong evidence and large cooperative studies, for the diagnosis and the management of HE in NCPH, the same approach used for HE occurring in cirrhosis is applied. The aim of this paper is to provide an overview of type B hepatic encephalopathy, focusing on its pathophysiology, diagnostic tools and management in patients affected by porto-sinusoidal vascular disease and chronic portal vein thrombosis.

High Frequency of Thrombogenic Markers in Polytransfused HbE-Thalassemia.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3983-3983
Author(s):  
Vineeta Sharma ◽  
Bijender Kumar ◽  
Rajesh Ahuja ◽  
Renu Saxena
Keyword(s):  
Deep Vein Thrombosis ◽  
Portal Vein ◽  
Iron Overload ◽  
Portal Vein Thrombosis ◽  
Protein C ◽  
Hepatic Dysfunction ◽  
Protein S ◽  
C Protein ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Thromboembolic complications have been well documented in HbE thalassemia Patients. Thrombophelic complications may be either due to genetic factors, hemostatic abnormality or due to hepatic dysfunction. The main objective of this study was to search for the actual cause of thrombophelic complication and to estimate the overall frequency of Protein C, Protein S, APCR, ATIII and MTHFR (677 C-T and 1298A-C) polymorphism in HbE-thalassemia patients. Protein C, protein S, APCR and ATIII were measured in 50 HbE thalassemia patients and 35 controls while MTHFR polymorphisms were studied in 40 HbE thalassemia patients and 35 controls. Levels of Protein C, Protein S, APCR and ATIII were reduced in 14%, 32%, 8% and 46% of HbE-Thal patients respectively and 677het*(CT), 677hom**(TT), 1298het(AC), 1298hom(CC) were 7.5%, 2.5%, 22.5% and 10% respectively. These were more frequent in older Splenectomized patients in comparison to non spelenectomized patients When the values were compared with those of controls Protein C, Protein S and ATIII showed the significant difference(P=0.001) while APCR, 677CT, 677TT, 1298AC, 1298CC showed nonsignificant difference (P= >0.05). However APCR showed significant difference when splenectomoized patients were compared with controls(P=0.01) and non splenectomized patients(P=0.03). Hepatic dysfunction as evidenced by Serum transaminase level of more than 55 IU/L and Serum albumin level less than 3g% were present in 7(14%) patients. Serum Ferritin >1000 ng/ml was observed in 7(14%) patients. Protein C and Protein S showed no correlation with Iron overload and Hepatic dysfunction, however ATIII showed significant correlation with hepatic dysfunction and APCR showed significant correlation with Iron overload. Clinically evident thrombosis was detected in 8(16%) patients. One Patient had recurrent pulmonary thromboembolism, one had developed Portal vein thrombosis Two had Cerebral vascular thrombosis and four had Deep Vein Thrombosis. Six of them were splenectomized. Although APCR and MTHFR Polymorphisms were not significant when compared with controls, two patients developed Deep vein thrombosis due to APCR while one patient having portal vein thrombosis was found to be homozygous for 677C-T. It is evident from this study that genetic factors and haemostatic alterations along with hepatic dysfunction and iron overload play a role in the development of thrombotic complications in HbE-thalassemia patients. * het = heterozygous, **homo =homozygous. Features of Thrombotic Patients Siteof thrombosis Ferritin(ng/ml) SGPT/Alb (IU/l/g %) Pro.C (%) Pro.S (%) APCR(%) ATIII(%) MTHFR polymorphism *= Low level, **= Normal level, DVT=Deep Vein Thrombosis, PVT=Portal Vein Thrombosis, PTE=Pulmonary Thromboembolism, CVT=Cerebral vascular Thrombosis PVT 690 48/3.8 78** 60** 140** 98** 677TT(homo) DVT 1200 50/4.4 75** 58** 80* 110** Negative CVT 754 26/3.6 50* 45* 160** 40* Negative DVT 1000 60/2.1 39* 64** 110* 92** Negative DVT 490 45/4.8 38* 40* 200** 89** Negative DVT 1400 35/3.4 78** 49* 129** 60* Negative CVT 489 29/3.7 80** 40* 130** 70* Negative PTE 645 58/2.8 46* 39* 130** 82* Negative

scholarly journals Successful Treatment for Hepatic Encephalopathy Aggravated by Portal Vein Thrombosis with Balloon-Occluded Retrograde Transvenous Obliteration

2011 ◽  
Vol 5 (2) ◽  
pp. 366-371 ◽  
Author(s):  
Naotaka Hashimoto ◽  
Tomohiko Akahoshi ◽  
Tetsuya Shoji ◽  
Morimasa Tomikawa ◽  
Norifumi Tsutsumi ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Successful Treatment ◽  
Vein Thrombosis

scholarly journals Anticoagulation Increases Bleeding Rates in Portal Vein Thrombosis: A National Database Study

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5860-5860
Author(s):  
Omar Ali Alaber ◽  
Apoorva Krishna Chandar ◽  
Basma Ali Dahash ◽  
Sohi N Mistry ◽  
Stanley Martin Cohen ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Current Evidence ◽  
National Database ◽  
Insurance Status ◽  
Vein Thrombosis ◽  
Cirrhotic Patients ◽  
Newer Anticoagulants ◽  
First Time

Introduction: Liver cirrhosis is being increasingly recognized as a hypercoagulable state, mainly due to disproportionate reduction in antithrombotic factors (protein C, S and anti-thrombin III). Portal vein thrombosis (PVT) is a frequent sequala of liver cirrhosis that can lead to numerous complications and potential exclusion from transplant lists, at least until the resolution of the thrombus. The current evidence for anticoagulation (AC) for PVT in liver cirrhosis is limited to small retrospective studies. Major liver societies recommend limited anticoagulation with enoxaparin based on expert opinion (Category C). We sought to examine the incidence of bleeding after AC in cirrhotic patients with PVT. Methods: Data were obtained from a commercial de-identified database (Explorys, IBM, Inc.) that integrates electronic health records from 27 major integrated U.S. healthcare systems from 1999 to July 2019. Cases were defined as adult patients aged >=18 years having a new Systematized Nomenclature of Medicine Clinical Terms (SNOMED) diagnosis of PVT, had been anticoagulated for the first time following PVT and had experienced bleeding for the first time following AC. Controls were adults who had a diagnosis of PVT and did not get AC. We included older anticoagulants (warfarin and enoxaparin) as well as newer anticoagulants (apixaban, fondaparinux and rivaroxaban). We compared the incidence of bleeding (defined as bleeding from any site) in those with PVT who received AC to those with PVT who did not receive AC. In addition, we also compared the incidence of bleeding between older and newer anticoagulants, and also examined whether there were differences in gender, race, and insurance status for those who bled while on AC. Analysis comprised of calculating odds ratios (OR) and confidence intervals (CI) for the OR. Results: A total of 213,810 patients had liver cirrhosis and out of those, 7,570 (3.5%) patients had PVT. Four hundred and ten cases out of 1,430 patients who received AC bled for the first time whereas 980 cases out of 3,880 patients who did not receive AC bled for the first time. Cases on AC had 1.18 times higher odds of bleeding when compared to controls who did not receive AC (CI = 1.04 - 1.36). Newer AC were less likely to increase bleeding when compared to older AC (OR = 0.6, CI = 0.4 - 0.9). Females were significantly more likely to be first time bleeders on AC when compared to male first-time bleeders on AC (Table 1). However, race and insurance status did not seem to affect bleeding rates (Table 1). Conclusion: Anticoagulation for PVT in liver cirrhosis increases bleeding events. Newer AC were significantly less likely to increase bleeding when compared to older AC. Females were more likely to bleed on newer AC than males, but race and insurance status did not affect bleeding rates. Limitations of the study include the retrospective nature of the analysis that relied on diagnosis coding, and smaller numbers in our subgroup analyses which limits generalizability. Clinicians should be aware of the significant risk of bleeding when prescribing AC, particularly older AC to cirrhotic patients with PVT. Disclosures No relevant conflicts of interest to declare.

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