Portal vein thrombosis surgery: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Portal vein thrombosis}} | {{Portal vein thrombosis}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{F.K}} | ||
==Overview== | ==Overview== | ||
Surgery is not the first-line treatment option for patients with portal vein thrombosis. [[Surgery]] is usually reserved for patients with either medical failed therapy, [[liver failure]], and [[cirrhosis]]. | |||
Surgery is not the first-line treatment option for patients with | |||
==Indications== | ==Indications== | ||
*Surgery is not the first-line treatment option for patients with | *Surgery is not the first-line treatment option for patients with portal vein thrombosis. Surgery is usually reserved for patients with either:<ref name="pmid25941431">{{cite journal |vauthors=Chawla YK, Bodh V |title=Portal vein thrombosis |journal=J Clin Exp Hepatol |volume=5 |issue=1 |pages=22–40 |year=2015 |pmid=25941431 |pmc=4415192 |doi=10.1016/j.jceh.2014.12.008 |url=}}</ref> | ||
**[ | *Failed medical therapy | ||
* | *[[Liver failure]] | ||
*[[Cirrhosis]] | |||
==Surgery== | ==Surgery== | ||
Surgery procedures of portal vein thrombosis include:<ref name="pmid20066733">{{cite journal |vauthors=Ponziani FR, Zocco MA, Campanale C, Rinninella E, Tortora A, Di Maurizio L, Bombardieri G, De Cristofaro R, De Gaetano AM, Landolfi R, Gasbarrini A |title=Portal vein thrombosis: insight into physiopathology, diagnosis, and treatment |journal=World J. Gastroenterol. |volume=16 |issue=2 |pages=143–55 |year=2010 |pmid=20066733 |pmc=2806552 |doi= |url=}}</ref><ref name="ParikhShah2010">{{cite journal|last1=Parikh|first1=Sameer|last2=Shah|first2=Riddhi|last3=Kapoor|first3=Prashant|title=Portal Vein Thrombosis|journal=The American Journal of Medicine|volume=123|issue=2|year=2010|pages=111–119|issn=00029343|doi=10.1016/j.amjmed.2009.05.023}}</ref><ref name="pmid20103016">{{cite journal |vauthors=Parikh S, Shah R, Kapoor P |title=Portal vein thrombosis |journal=Am. J. Med. |volume=123 |issue=2 |pages=111–9 |year=2010 |pmid=20103016 |doi=10.1016/j.amjmed.2009.05.023 |url=}}</ref><ref name="pmid18345318">{{cite journal |vauthors=Lendoire J, Raffin G, Cejas N, Duek F, Barros Schelotto P, Trigo P, Quarin C, Garay V, Imventarza O |title=Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome |journal=HPB (Oxford) |volume=9 |issue=5 |pages=352–6 |year=2007 |pmid=18345318 |pmc=2225512 |doi=10.1080/13651820701599033 |url=}}</ref><ref name="pmid16968480">{{cite journal |vauthors=Paskonis M, Jurgaitis J, Mehrabi A, Kashfi A, Fonouni H, Strupas K, Büchler MW, Kraus TW |title=Surgical strategies for liver transplantation in the case of portal vein thrombosis--current role of cavoportal hemitransposition and renoportal anastomosis |journal=Clin Transplant |volume=20 |issue=5 |pages=551–62 |year=2006 |pmid=16968480 |doi=10.1111/j.1399-0012.2006.00560.x |url=}}</ref> | |||
*'''1. Shunt surgery''' | |||
**The preferred surgical shunt is usually distal splenorenal shunt. [[Splenectomy]] and other shunt procedures have been performed for patients with [[splenic vein thrombosis]] and whom surgery is undertaken.<ref name="pmid291109902">{{cite journal |vauthors=Lahat E, Lim C, Bhangui P, Fuentes L, Osseis M, Moussallem T, Salloum C, Azoulay D |title=Transjugular intrahepatic portosystemic shunt as a bridge to non-hepatic surgery in cirrhotic patients with severe portal hypertension: a systematic review |journal=HPB (Oxford) |volume= |issue= |pages= |year=2017 |pmid=29110990 |doi=10.1016/j.hpb.2017.09.006 |url=}}</ref> | |||
**In pateinets with portal vein thrombosis indications for shunt surgery include: | |||
***Failed endotherapy | |||
***Symptomatic [[Portal hypertension|portal hypertensive]] biliopathy | |||
***Symptomatic [[hypersplenism]] | |||
***Ectopic [[variceal bleed]] | |||
***Severe [[growth retardation]] | |||
***Poor chances of follow up and on demand one time treatment | |||
**Shunts may be selective or non-selective. The different types of shunt surgery include: | |||
***'''Selective shunts''' | |||
****Distal [[Lienorenal ligament|lienorenal]] shunt | |||
****[[Mesenteric]]-[[left portal vein]] bypass (Rex shunt) | |||
****Warren Zeppa distal splenorenal shunts | |||
****Mesocaval shunts | |||
***'''Non-selective shunts''' | |||
****[[Portocaval anastomoses|Portocaval shunts]] | |||
****Proximal [[lienorenal]] shunts | |||
****End to side mesocaval and large diameter interposition [[Portocaval anastomoses|portocaval shunts]] | |||
****Mesocaval shunts | |||
{{#ev:youtube|O2u4_hF3234|500}} | |||
* | :*'''2. Thrombectomy''' | ||
:**Mechanical [[thrombectomy]] by [[percutaneous]] [[transhepatic]] route remove [[thrombus]] in a recently developed portal vein thrombosis than occurred less than 30 days. | |||
* | :**Performing [[percutaneous]] [[transhepatic]] thromboaspiration is successful within 72 hours in some patients. | ||
{{#ev:youtube|v=JUM92PWlpQY}} | |||
:*'''3. Liver transplanation''' | |||
:**[[Liver transplantation]] is indicated in case of [[liver failure]]. | |||
:**[[Liver failure]] may be happened due to any diseases, such as [[cirrhosis]] or portal vein thrombosis. | |||
:**'''"[[Model for end stage liver disease|Model for end-stage liver disease]]” ([[MELD]])''' score is used to govern priority for [[liver transplantation]]. | |||
:**The score range between 6 and 40 and is calculated using a logarithmic assessment of three objective and reproducibe variables including: | |||
:***Total serum [[bilirubin]] | |||
:***[[Creatinine]] concentrations | |||
:***[[International normalized ratio]] | |||
{{#ev:youtube|v=hquWw4rRHh8}} | |||
==References== | ==References== | ||
Latest revision as of 14:44, 29 December 2017
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Risk calculators and risk factors for Portal vein thrombosis surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]
Overview
Surgery is not the first-line treatment option for patients with portal vein thrombosis. Surgery is usually reserved for patients with either medical failed therapy, liver failure, and cirrhosis.
Indications
- Surgery is not the first-line treatment option for patients with portal vein thrombosis. Surgery is usually reserved for patients with either:[1]
- Failed medical therapy
- Liver failure
- Cirrhosis
Surgery
Surgery procedures of portal vein thrombosis include:[2][3][4][5][6]
- 1. Shunt surgery
- The preferred surgical shunt is usually distal splenorenal shunt. Splenectomy and other shunt procedures have been performed for patients with splenic vein thrombosis and whom surgery is undertaken.[7]
- In pateinets with portal vein thrombosis indications for shunt surgery include:
- Failed endotherapy
- Symptomatic portal hypertensive biliopathy
- Symptomatic hypersplenism
- Ectopic variceal bleed
- Severe growth retardation
- Poor chances of follow up and on demand one time treatment
- Shunts may be selective or non-selective. The different types of shunt surgery include:
- Selective shunts
- Distal lienorenal shunt
- Mesenteric-left portal vein bypass (Rex shunt)
- Warren Zeppa distal splenorenal shunts
- Mesocaval shunts
- Non-selective shunts
- Portocaval shunts
- Proximal lienorenal shunts
- End to side mesocaval and large diameter interposition portocaval shunts
- Mesocaval shunts
- Selective shunts
{{#ev:youtube|O2u4_hF3234|500}}
- 2. Thrombectomy
- Mechanical thrombectomy by percutaneous transhepatic route remove thrombus in a recently developed portal vein thrombosis than occurred less than 30 days.
- Performing percutaneous transhepatic thromboaspiration is successful within 72 hours in some patients.
- 2. Thrombectomy
{{#ev:youtube|v=JUM92PWlpQY}}
- 3. Liver transplanation
- Liver transplantation is indicated in case of liver failure.
- Liver failure may be happened due to any diseases, such as cirrhosis or portal vein thrombosis.
- "Model for end-stage liver disease” (MELD) score is used to govern priority for liver transplantation.
- The score range between 6 and 40 and is calculated using a logarithmic assessment of three objective and reproducibe variables including:
- Total serum bilirubin
- Creatinine concentrations
- International normalized ratio
- 3. Liver transplanation
{{#ev:youtube|v=hquWw4rRHh8}}
References
- ↑ Chawla YK, Bodh V (2015). "Portal vein thrombosis". J Clin Exp Hepatol. 5 (1): 22–40. doi:10.1016/j.jceh.2014.12.008. PMC 4415192. PMID 25941431.
- ↑ Ponziani FR, Zocco MA, Campanale C, Rinninella E, Tortora A, Di Maurizio L, Bombardieri G, De Cristofaro R, De Gaetano AM, Landolfi R, Gasbarrini A (2010). "Portal vein thrombosis: insight into physiopathology, diagnosis, and treatment". World J. Gastroenterol. 16 (2): 143–55. PMC 2806552. PMID 20066733.
- ↑ Parikh, Sameer; Shah, Riddhi; Kapoor, Prashant (2010). "Portal Vein Thrombosis". The American Journal of Medicine. 123 (2): 111–119. doi:10.1016/j.amjmed.2009.05.023. ISSN 0002-9343.
- ↑ Parikh S, Shah R, Kapoor P (2010). "Portal vein thrombosis". Am. J. Med. 123 (2): 111–9. doi:10.1016/j.amjmed.2009.05.023. PMID 20103016.
- ↑ Lendoire J, Raffin G, Cejas N, Duek F, Barros Schelotto P, Trigo P, Quarin C, Garay V, Imventarza O (2007). "Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome". HPB (Oxford). 9 (5): 352–6. doi:10.1080/13651820701599033. PMC 2225512. PMID 18345318.
- ↑ Paskonis M, Jurgaitis J, Mehrabi A, Kashfi A, Fonouni H, Strupas K, Büchler MW, Kraus TW (2006). "Surgical strategies for liver transplantation in the case of portal vein thrombosis--current role of cavoportal hemitransposition and renoportal anastomosis". Clin Transplant. 20 (5): 551–62. doi:10.1111/j.1399-0012.2006.00560.x. PMID 16968480.
- ↑ Lahat E, Lim C, Bhangui P, Fuentes L, Osseis M, Moussallem T, Salloum C, Azoulay D (2017). "Transjugular intrahepatic portosystemic shunt as a bridge to non-hepatic surgery in cirrhotic patients with severe portal hypertension: a systematic review". HPB (Oxford). doi:10.1016/j.hpb.2017.09.006. PMID 29110990.