7,340 results on '"portal vein thrombosis"'
Search Results
2. HAIC Combine With Lenvatinib and PD-1 Inhibitors for Advanced HCC With PVTT
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Xiaodong Wang, MD, Professor
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- 2024
3. Nadroparin Versus TIPS in Cirrhotic Patients With Refractory Asymptomatic PVT
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Shanghai 6th People's Hospital, ShuGuang Hospital, Tongji Hospital, and Renmin Hospital of Wuhan University
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- 2024
4. Global Coagulation Assessment in Portal Vein Thrombosis and Budd-Chiari Syndrome (Liv-Thrombus)
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Madhumita Premkumar, Associate Professor
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- 2024
5. Vienna Vascular Liver Disease Study (VALID)
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Thomas Reiberger, Assoc.-Prof. Priv.-Doz. Dr.
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- 2024
6. Transjugular intrahepatic portosystemic shunt in patients with splanchnic vein thrombosis: Prevalence and management of patent foramen ovale.
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Becchetti, Chiara, De Nicola, Stella, Gallo, Camilla, Perricone, Giovanni, Annoni, Giuseppe, Solcia, Marco, Musca, Francesco, Alfonsi, Angela, Morelli, Francesco, Barbosa, Fabiane, Brambillasca, Pietro M., Rampoldi, Antonio, Airoldi, Aldo, and Belli, Luca S.
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TRANSIENT ischemic attack , *PATENT foramen ovale , *PATIENT portals , *PARADOXICAL embolism , *PATIENT experience - Abstract
Background and Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is an established procedure for the treatment of several complications of portal hypertension (PH), including non‐neoplastic portal vein thrombosis (PVT). Selection criteria for TIPS in PVT are not yet well established. Despite anecdotal, cases of thromboembolic events from paradoxical embolism due to the presence of patent foramen ovale (PFO) after TIPS placement have been reported in the literature. Therefore, we aimed at describing our experience in patients with non‐neoplastic splanchnic vein thrombosis (SVT) who underwent TIPS following PFO screening. Methods: We conducted a single‐centre retrospective study, including consecutive patients who underwent TIPS for the complications of cirrhotic and non‐cirrhotic portal hypertension (NCPH) and having SVT. Results: Of 100 TIPS placed in patients with SVT, 85 patients were screened for PFO by bubble‐contrast transthoracic echocardiography (TTE) with PFO being detected in 22 (26%) cases. PFO was more frequently detected in patients with non‐cirrhotic portal hypertension (NCPH) (23% in the PFO group vs. 6% in those without PFO, p =.04) and cavernomatosis (46% in the PFO group vs. 19% in those without PFO, p =.008). Percutaneous closure was effectively performed in 11 (50%) after multidisciplinary evaluation of anatomical and clinical features. No major complications were observed following closure. Conclusions: PFO screening and treatment may be considered feasible for patients with SVT who undergo TIPS placement. [ABSTRACT FROM AUTHOR]
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- 2024
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7. Portal Vein Thrombosis in the Setting of Cirrhosis: Evaluation and Management Strategies.
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Hilscher, Moira B., Wysokinski, Waldemar E., Andrews, James C., Simonetto, Douglas A., Law, Ryan J., and Kamath, Patrick S.
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- 2024
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8. GSDMD-Dependent Neutrophil Extracellular Traps Mediate Portal Vein Thrombosis and Associated Fibrosis in Cirrhosis.
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Che, Ying, Chien, Youjung, Zhu, Yuli, Huang, Xiaoquan, Wu, Ling, Ai, Yingjie, Jiang, Siyu, Li, Feng, and Chen, Shiyao
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PORTAL vein , *CIRRHOSIS of the liver , *NEUTROPHILS , *DISULFIRAM , *THIOACETAMIDE - Abstract
Portal vein thrombosis (PVT) is a challenging and controversial complication of cirrhosis. Experimental models that reproduce cirrhotic PVT and effective pharmacological therapies are limited. We aimed to investigate the nature course and mechanisms of PVT in cirrhosis. A novel PVT model was developed via two-step total portal vein ligation in healthy and thioacetamide (TAA)-cirrhotic rats. Circulating and liver-infiltrating neutrophils were isolated from individuals with cirrhosis to examine neutrophil extracellular traps (NETs) and explore their unique characteristics and implications in PVT-associated fibrosis in cirrhosis. We further validated macrophage–myofibroblast transition (MMT) via multiplex immunofluorescence and single-cell sequencing. In the experimental model, cirrhosis promoted PVT development and portal vein intimal thickening. Interestingly, cirrhosis promoted spontaneous resolution of PVT due to instability of thrombus structure, along with pulmonary and intrahepatic clots. NETs-MMT mediate cirrhotic PVT and PVT-associated fibrosis, including fibrotic thrombus remodeling and increased hepatic collagen deposition. Mechanistically, caspase-4-dependent activation of neutrophils and GSDMD mediated the formation of NETs. The extracellular DNA of NETs promoted TGF-β1/Smad3-driven MMT. Inhibiting GSDMD with disulfiram suppressed cirrhotic PVT and prevented associated fibrosis. The cirrhotic PVT model reflected the following three main characteristics of cirrhotic PVT: spontaneous resolution, immunothrombosis, and intimal fibrosis. Targeting NETs with GSDMD inhibitors may serve as a new therapeutic concept to treat cirrhotic PVT. [ABSTRACT FROM AUTHOR]
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- 2024
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9. Post laparoscopic sleeve gastrectomy portal vein thrombosis with venous mesenteric ischemia: a case report with literature review.
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Wadaani, Hamid Abdulla Al, Omar, Sarah Al, AlRaihan, Jawaher, Alnajjar, Jawad S, Elserougi, Mohamed, and Jabran, Hussain Al
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SURGICAL smoke , *VENOUS thrombosis , *MESENTERIC veins , *PORTAL vein , *SLEEVE gastrectomy - Abstract
Saudi Arabia's obesity prevalence is 19.2% among men and 21.4% among women. Treatment includes lifestyle modifications, medication, and bariatric surgery. Procedures reach up to 1200 annually in our center. Porto-mesenteric venous thrombosis associated with venous mesenteric ischemia and bowel necrosis is a rare complication that necessitates an early workup and management. A 29-year-old Saudi male underwent laparoscopic sleeve gastrectomy. Post-surgery, he experienced abdominal pain, nausea, and vomiting, exacerbated by eating and smoking. Abdomen computed tomography scans revealed engorged portal veins, congested mesenteric veins, and small bowel thickening. He underwent exploratory laparoscopy shifted to laparotomy with resection of an infarcted omentum and 1 m of jejunal small bowel loop, and was discharged postoperatively after 7 days. Porto-mesenteric venous thrombosis is a rare complication after laparoscopic sleeve gastrectomy, requiring early diagnosis and appropriate treatment. Patients present with non-specific symptoms, necessitating high suspicion for computed tomography recommendations. [ABSTRACT FROM AUTHOR]
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- 2024
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10. Migrated toothpick causing a hepatic abscess with portal vein thrombosis: A case report and review of literature.
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Joueidi, Faisal, Alzahrani, Ali A., Altaweel, Abdulaziz A., Alwhaibi, Omar, Elgohary, Ahmed, and Bin Saad, Khalid O.
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LITERATURE reviews , *PORTAL vein , *ABDOMINAL pain , *ASYMPTOMATIC patients , *CHRONIC pain , *FOREIGN bodies - Abstract
Key Clinical Message: Accidental foreign body ingestion is the most common hidden cause of abdominal pain. A high index of suspicion should be implemented in patients with unresolved abdominal pain. Here we reported a 54‐year‐old patient with vague abdominal pain who had a successful laparoscopic removal of a toothpick. Toothpicks and fish bones are considered one of the most common accidentally ingested foreign bodies. Fortunately, most patients are asymptomatic. About 80%–90% of ingested foreign bodies pass through the gut spontaneously within a week. We present a case of a 54‐year‐old female with chronic epigastric pain and fever found to have a foreign body (toothpick) that penetrated the stomach and migrated to the liver causing liver abscess with portal vein thrombosis. The patient was managed with laparoscopic removal of the foreign body with an uneventful postoperative course. [ABSTRACT FROM AUTHOR]
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- 2024
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11. Analysis of factors related to recanalization of portal vein thrombosis in liver cirrhosis: a retrospective cohort study.
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Shi, Yali, Feng, Wanlin, Cai, Jiaman, Wang, Zhonglin, Pu, Ying, Mao, Weiting, Zhan, Ke, and Chen, Daorong
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PORTAL vein , *CIRRHOSIS of the liver , *FACTOR analysis , *ANTICOAGULANTS , *THROMBOSIS - Abstract
Background: Portal vein thrombosis (PVT) is a common complication of liver cirrhosis, yet there are fewer studies about predictors of PVT recanalization. We aimed to further explore the predictors of recanalization in cirrhotic PVT to facilitate accurate prediction of patients' clinical status and timely initiation of appropriate treatment and interventions. To further investigate the benefits and risks of anticoagulant therapy in cirrhotic PVT patients. Methods: A retrospective cohort study of patients with cirrhotic PVT in our hospital between January 2016 and December 2022, The primary endpoint was to analyze predictors of PVT recanalization by COX regression. Others included bleeding rate, liver function, and mortality. Results: This study included a total of 82 patients, with 30 in the recanalization group and 52 in the non-recanalization group. Anticoagulation therapy was the only independent protective factor for portal vein thrombosis recanalization and the independent risk factors included massive ascites, history of splenectomy, Child-Pugh B/C class, and main trunk width of the portal vein. Anticoagulation therapy was associated with a significantly higher rate of PVT recanalization (75.9% vs. 20%, log-rank P < 0.001) and a lower rate of PVT progression (6.9% vs. 54.7%, log-rank P = 0.002). There was no significant difference between different anticoagulation regimens for PVT recanalization. Anticoagulation therapy did not increase the incidence of bleeding complications(P = 0.407). At the end of the study follow-up, Child-Pugh classification, MELD score, and albumin level were better in the anticoagulation group than in the non-anticoagulation group. There was no significant difference in 2-year survival between the two groups. Conclusion: Anticoagulation, massive ascites, history of splenectomy, Child-Pugh B/C class, and main portal vein width were associated with portal vein thrombosis recanalization. Anticoagulation may increase the rate of PVT recanalization and decrease the rate of PVT progression without increasing the rate of bleeding. Anticoagulation may be beneficial in improving liver function in patients with PVT in cirrhosis. [ABSTRACT FROM AUTHOR]
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- 2024
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12. Association between Portal Vein Thrombosis after Umbilical Vein Catheterization and Neonatal Asphyxia.
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Colella, Marina, Zanin, Anna, Toumazi, Artemis, Bourmaud, Aurélie, Boizeau, Priscilla, Guilmin-Crepon, Sophie, Leick, Noémie, Khat, Sophea, Alison, Marianne, Baud, Olivier, and Biran, Valerie
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CEREBRAL anoxia-ischemia , *UMBILICAL veins , *PORTAL vein , *INTRAVENOUS catheterization , *GESTATIONAL age - Abstract
Introduction: Neonatal portal vein thrombosis (PVT) is frequently related to umbilical venous catheterization (UVC), but risk factors remain unclear. This study aims to analyze the variables associated to PVT in near- to full-term newborns with UVC, with a focus on newborns exposed to controlled therapeutic hypothermia (CTH) for hypoxic ischemic encephalopathy (HIE). Methods: This is retrospective cohort study of infants delivered at or after 36 weeks and with a birthweight over 1,500 g. All infants were assessed for UVC location and PVT using ultrasonography performed between day 5 and day 10 after catheterization. Results: Among 213 eligible patients, PVT was diagnosed in 57 (27%); among them, 54 (95%) were localized in the left portal vein branch. With all significant factors in univariate analysis considered, higher gestational age at birth (adjusted OR 1.35; 95% CI: 1.12–1.64, p = 0.002) and duration of UVC placement (adjusted OR 1.36; 95% CI: 1.11–1.67, p = 0.004) were the main risk factors of PVT. Among 87 infants who were cooled for HIE, 31 (36%) had PVT compared to 26 (21%) in infants without CTH. Using a multivariate model including variables linked to treatment procedures only, an increased PVT incidence was statistically associated with UVC duration (adjusted OR 1.33; 95% CI: 1.08; 1.63, p = 0.01) and CTH (adjusted OR 1.94; 95% CI: 1.04–3.65, p = 0.04). Conclusion: Left PVT was frequently observed in near- to full-term neonates with UVC. Among factors linked to treatment procedures, both duration of UVC and CTH exposure for HIE were found to be independent risk factors of PVT. [ABSTRACT FROM AUTHOR]
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- 2024
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13. Prevalence and Risk Factors for Portal Cavernoma in Adult Patients with Portal Vein Thrombosis.
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Cazacu, Sergiu Marian, Alexandru, Dragoș Ovidiu, Dumitrescu, Daniela, Vieru, Alexandru Marian, Urhuț, Marinela Cristiana, and Săndulescu, Larisa Daniela
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MESENTERIC veins , *PATIENT portals , *PORTAL vein , *THROMBOSIS , *CONTRAST-enhanced ultrasound - Abstract
Portal vein thrombosis (PVT) represents a restriction or occlusion of the portal vein by a blood clot, which can appear in liver cirrhosis, inherited or acquired thrombophilia, malignancies, abdominal infection, abdominal inflammation, and injury to the portal vein; it can evolve to local venous extension, recanalization, or portal cavernoma (PC). This research represents an observational study of patients admitted with a diagnosis of PVT between January 2018 and December 2022. We assessed the rate of and risk factors for PC. In total, 189 patients with PVT were included; the rate of PC was 14.8%. In univariate and multivariate analysis, the main risk factors for the presence of PC were etiology (thrombophilia, myeloproliferative disorders, local inflammatory diseases, and idiopathic causes), prior PVT, and complete versus incomplete or single-branch portal obstruction. In patients with superior mesenteric vein (SMV) thrombosis, distal obstruction was more prone to PC than proximal obstruction. The main predictive factors were etiology, prior PVT, complete PVT obstruction, and no prior non-selective beta-blocker (NSBB) use; in patients with SMV thrombosis, the distal extension was more significantly associated with the risk of PC. We propose a composite score for the prediction of PC which includes etiology, prior diagnosis of PVT, prior NSBB use, complete versus incomplete PVT, and distal versus proximal SMV thrombosis, with good accuracy (AUC 0.822) and an estimated sensitivity of 76.92% and specificity of 82.39% at a cut-off value of 4. [ABSTRACT FROM AUTHOR]
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- 2024
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14. Management of extensive portal vein thrombosis via thrombolysis and thrombectomy without underlying liver disease: A case report.
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Gul, Mohammadshah Isam, Umer, Waseem, Nawaz, Ahmed Daniyal, Elhissi, Mohammad J. H., and Zahid, Muhammad
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PORTAL vein , *THROMBECTOMY , *THROMBOLYTIC therapy , *LIVER diseases , *THROMBOSIS - Abstract
Key Clinical Message: Portal vein thrombosis (PVT) is a rare condition, particularly in non‐cirrhotic patients. Anticoagulation remains the mainstay of the treatment. Extensive PVT can lead to variceal bleeding, ascites, bowel ischemia, and hypersplenism. The role of thrombolysis and thrombectomy in these patients remains unclear. However, there is evidence that local thrombolysis and thrombectomy should be considered in those who remain symptomatic on anticoagulation and are at risk of complications with acute PVT. [ABSTRACT FROM AUTHOR]
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- 2024
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15. Concurrent Atezolizumab Plus Bevacizumab and High-Dose External Beam Radiotherapy for Highly Advanced Hepatocellular Carcinoma.
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Su, Chung-Wei, Teng, Wei, Shen, Eric Yi-Liang, Huang, Bing-Shen, Lin, Po-Ting, Hou, Ming-Mo, Wu, Tsung-Han, Tsan, Din-Li, Hsieh, Chia-Hsun, Wang, Ching-Ting, Chai, Pei-Mei, Lin, Chun-Yen, Lin, Shi-Ming, and Lin, Chen-Chun
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THERAPEUTIC use of antineoplastic agents ,THERAPEUTIC use of monoclonal antibodies ,PROTON therapy ,PORTAL vein ,DRUG toxicity ,BEVACIZUMAB ,DRUG therapy ,VENOUS thrombosis ,QUESTIONNAIRES ,CHEMORADIOTHERAPY ,SEVERITY of illness index ,TREATMENT effectiveness ,RADIOSURGERY ,RETROSPECTIVE studies ,DESCRIPTIVE statistics ,MULTIVARIATE analysis ,DOSE-effect relationship in pharmacology ,ODDS ratio ,MONOCLONAL antibodies ,STEREOTAXIC techniques ,MEDICAL records ,ACQUISITION of data ,DRUG efficacy ,SURVIVAL analysis (Biometry) ,COMPARATIVE studies ,CONFIDENCE intervals ,HEPATOCELLULAR carcinoma ,OVERALL survival - Abstract
Background Atezolizumab plus bevacizumab (atezo-bev) has been recommended for advanced hepatocellular carcinoma (HCC). High-dose external beam radiotherapy (RT) is recognized for its excellent local tumor control. The efficacy and safety of concurrent atezo-bev with RT for highly advanced HCC has been minimally explored. Methods In this preliminary retrospective study, we assessed patients with highly advanced HCC, characterized by Vp4 portal vein thrombosis or tumors exceeding 50% of liver volume, who received concurrent atezo-bev and RT (group A). Group A included 13 patients who received proton radiation at a dose of 72.6 GyE in 22 fractions, and one patient who received photon radiation at a dose of 54 Gy in 18 fractions. This group was compared with 34 similar patients treated atezo-bev alone as a control (group B). The primary objectives were to evaluate the objective response rate (ORR), overall survival (OS), and safety. Results Baseline characteristics were similar between groups, except for a higher incidence of Vp4 portal vein thrombosis in group A (78.6% vs. 21.4%, P = .05). Group A achieved a higher ORR (50.0% vs. 11.8%, P < .01) and a longer OS (not reached vs. 5.5 months, P = .01) after a median follow-up of 5.2 months. Multivariate analysis indicated that concurrent RT independently favored longer OS (hazard ratio: 0.18; 95% CI, 0.05-0.63, P < .01). Group A did not increase any grade adverse events (78.6% vs. 58.8%, P = .19) or severe adverse events of grade ≥ 3 (14.3% vs. 14.7%, P = .97) compared to group B. Conclusions The concurrent high-dose external beam radiotherapy appears to safely enhance the effectiveness of atezolizumab plus bevacizumab for highly advanced patients with HCC. Further studies are warranted to confirm these findings. [ABSTRACT FROM AUTHOR]
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- 2024
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16. Analysis of factors related to recanalization of portal vein thrombosis in liver cirrhosis: a retrospective cohort study
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Yali Shi, Wanlin Feng, Jiaman Cai, Zhonglin Wang, Ying Pu, Weiting Mao, Ke Zhan, and Daorong Chen
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Portal vein thrombosis ,Liver cirrhosis ,Recanalization ,Anticoagulation ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Abstract Background Portal vein thrombosis (PVT) is a common complication of liver cirrhosis, yet there are fewer studies about predictors of PVT recanalization. We aimed to further explore the predictors of recanalization in cirrhotic PVT to facilitate accurate prediction of patients’ clinical status and timely initiation of appropriate treatment and interventions. To further investigate the benefits and risks of anticoagulant therapy in cirrhotic PVT patients. Methods A retrospective cohort study of patients with cirrhotic PVT in our hospital between January 2016 and December 2022, The primary endpoint was to analyze predictors of PVT recanalization by COX regression. Others included bleeding rate, liver function, and mortality. Results This study included a total of 82 patients, with 30 in the recanalization group and 52 in the non-recanalization group. Anticoagulation therapy was the only independent protective factor for portal vein thrombosis recanalization and the independent risk factors included massive ascites, history of splenectomy, Child-Pugh B/C class, and main trunk width of the portal vein. Anticoagulation therapy was associated with a significantly higher rate of PVT recanalization (75.9% vs. 20%, log-rank P
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- 2024
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17. A Patient with a Liver Transplant and Abdominal Pain
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Stauber, Stacey, Jun-Ihn, Esther, Venick, Robert, Kamzan, Audrey, editor, Kulkarni, Deepa, editor, and Newcomer, Charles A., editor
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- 2024
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18. Portal Vein Thrombosis in Neonate With Umbilical Catheter
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esraa mostafa ahmed, MA Researcher
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- 2023
19. Prognostic Value Related to the Presence of Thrombosis or Portal Vein Invasion in Patients With Hepatocellular Carcinoma Submitted to Surgery (HSL2012-06)
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Frederico Perego Costa, Attending physician
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- 2023
20. Preemptive TIPS for Variceal Bleeding in Cirrhotic Patients With Occlusive Portal Vein Thrombosis
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The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Beijing YouAn Hospital, Beijing Friendship Hospital, Beijing 302 Hospital, and luo xuefeng, Professor
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- 2023
21. Risk Factors and Management Outcome of Chronic Portal Vein Thrombosis in Children
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Asmaa Aly Fathy Shehata, Principal Investigator
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- 2023
22. Portal vein thrombosis as extraintestinal complications of Crohn’s disease: a case report and review of literature
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Marouf Alhalabi, Duaa Nasri, and Widad Aji
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Crohn’s disease ,Ulcerative colitis ,Portal vein thrombosis ,Inflammatory bowel disease ,Extraintestinal manifestations ,Case report ,Medicine - Abstract
Abstract Introduction Thrombotic events are more than twice as common in inflammatory bowel disease patients as in the general population. We report an interesting and rare case of portal vein thrombosis as a venous thromboembolic event in the context of extraintestinal manifestations of Crohn’s disease. We also conducted a literature review on portal vein thrombosis associated with inflammatory bowel disease, with the following concepts: inflammatory bowel diseases, ulcerative colitis, Crohn’s disease, portal vein, and thrombosis. Case presentation A 24-year-old Syrian female with active chronic Crohn’s disease was diagnosed 11 years ago and classified as A1L3B1P according to the Montreal classification. She had no prior surgical history. Her previous medications included azathioprine and prednisolone. Her Crohn’s disease activity index was 390 points. Gastroduodenoscopy revealed grade I esophageal varices, a complication of portal hypertension. Meanwhile, a colonoscopy revealed several deep ulcers in the sigmoid, rectum, and descending colon. An investigation of portal vein hypertension revealed portal vein thrombosis. We used corticosteroids to induce remission, followed by tapering; additionally she received ustekinumab to induce and maintain remission. She began on low-molecular-weight heparin for 1 week, warfarin for 3 months, and then apixaban, a novel oral anticoagulant, after excluding antiphospholipid syndrome. Primary prophylaxis for esophageal varices was not required. After 1 year, she achieved clinical, biochemical, and endoscopic remission. Despite 1 year of treatment, a computed tomography scan revealed no improvement in portal vein recanalization. Conclusion Portal vein thrombosis is a rare and poorly defined complication of inflammatory bowel disease. It is usually exacerbated by inflammatory bowel disease. The symptoms are nonspecific and may mimic a flare-up of inflammatory bowel disease, making the diagnosis difficult. Portal vein Doppler ultrasound for hospital-admitted inflammatory bowel disease patients may contribute to the diagnosis and management of this complication.
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- 2024
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23. A new model of portal vein thrombosis in rats with cirrhosis induced by partial portal vein ligation plus carbon tetrachloride and intervened with rivaroxaban
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Yanan Guo, Sisi Dong, Meng Li, Yanyan Tao, Jing Lv, and Chenghai Liu
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Portal vein thrombosis ,Cirrhosis ,Partial portal vein ligation ,Carbon tetrachloride ,Model ,Rivaroxaban ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Abstract Background and aims Portal vein thrombosis (PVT) is a common complication of liver cirrhosis that can aggravate portal hypertension. However, there are features of both PVT and cirrhosis that are not recapitulated in most current animal models. In this study, we aimed to establish a stable animal model of PVT and cirrhosis, intervene with anticoagulant, and explore the related mechanism. Methods First, 49 male SD rats received partial portal vein ligation (PPVL), and 44 survival rats were divided into 6 groups: PPVL control group; 4-week, 6 -week, 8-week, and 10-week model group; and the rivaroxaban (RIVA)-treated group. The rats were intoxicated with or without carbon tetrachloride (CCl4) for 4–10 weeks. Seven normal rats were used as the normal controls. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels and parameters for blood coagulation were all assayed with kits. Liver inflammation, collagen deposition and hydroxyproline (Hyp) levels were also measured. The extrahepatic macro-PVT was observed via portal vein HE staining, etc. The intrahepatic microthrombi was stained via fibrin immunohistochemistry. The portal blood flow velocity (PBFV) and diameter were detected via color Doppler ultrasound. Vascular endothelial injury was evaluated by von Willebrand Factor (vWF) immunofluorescence. Fibrinolytic activity was estimated by western blot analysis of fibrin and plasminogen activator inhibitor-1 (PAI-1). Results After PPVL surgery and 10 weeks of CCl4 intoxication, a rat model that exhibited characteristics of both cirrhosis and extra and intrahepatic thrombi was established. In cirrhotic rats with PVT, the PBFV decreased, both factors of pro- and anti-coagulation decreased, but with relative hypercoagulable state, vascular endothelial injured, and fibrinolytic activity decreased. RIVA-treated rats had improved coagulation function, increased PBFV and attenuated thrombi. This effect was related to the improvements in endothelial injury and fibrinolytic activity. Conclusions A new rat model of PVT with cirrhosis was established through partial portal vein ligation plus CCl4 intoxication, with the characteristics of macrothrombi at portal veins and microthrombi in hepatic sinusoids, as well as liver cirrhosis. Rivaroxaban could attenuate PVT in cirrhosis in the model rats. The underlying mechanisms of PVT formation in the rat model and pharmacological action of rivaroxaban are related to the regulation of portal blood flow, coagulant factors, and vascular endothelial cell function.
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- 2024
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24. Effectiveness of edoxaban in portal vein thrombosis associated with liver cirrhosis
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Tomoko Tadokoro, Joji Tani, Takushi Manabe, Kei Takuma, Mai Nakahara, Kyoko Oura, Shima Mimura, Koji Fujita, Takako Nomura, Asahiro Morishita, Hideki Kobara, Takashi Himoto, Masafumi Ono, and Tsutomu Masaki
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Cirrhosis ,Direct-acting oral anticoagulants ,Portal vein thrombosis ,Warfarin ,Medicine ,Science - Abstract
Abstract Portal vein thrombosis (PVT) worsens the long-term prognosis of patients with cirrhosis; however, the optimal treatment remains to be determined. Reports on the efficacy of direct oral anticoagulants are increasing, and further evidence is needed. Therefore, we investigated the effectiveness of treatment with edoxaban in patients with PVT. We retrospectively reviewed the outcomes of edoxaban and warfarin as antithrombotic therapies for PVT. The median overall survival time was 4.2 years in patients with PVT, with a 1-year survival rate of 70.7% and a 5-year survival rate of 47.9%. The leading cause of death was hepatocellular carcinoma. The overall response rate for thrombolysis in the edoxaban group was 76.7% compared to 29.4% in the warfarin group, and edoxaban significantly improved PVT compared to warfarin. In addition, edoxaban provided long-term improvement of PVT. Warfarin, on the other hand, was temporarily effective but did not provide long-term benefits. The Child–Pugh and albumin-bilirubin scores did not change after edoxaban or warfarin use. No deaths occurred due to adverse events associated with edoxaban or warfarin. Edoxaban as a single agent can achieve long-term recanalization without compromising the hepatic reserves. Edoxaban is easy to initiate, even in an outpatient setting, and could become a major therapeutic agent for the treatment of PVT.
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- 2024
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25. Neutrophil extracellular traps formation may be involved in the association of propranolol with the development of portal vein thrombosis.
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Xu, Xiangbo, Xu, Shixue, Zhang, Yiyan, Wang, Le, Yan, Chenghui, Xu, Zihua, Zhao, Qingchun, and Qi, Xingshun
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PORTAL vein , *PROPRANOLOL , *TISSUE plasminogen activator , *HEPATIC fibrosis , *NEUTROPHILS - Abstract
Nonselective β blockers (NSBBs) facilitate the development of portal vein thrombosis (PVT) in liver cirrhosis. Considering the potential effect of NSBBs on neutrophils and neutrophil extracellular traps (NETs), we speculated that NSBBs might promote the development of PVT by stimulating neutrophils to release NETs. Serum NETs biomarkers were measured, use of NSBBs was recorded, and PVT was evaluated in cirrhotic patients. Carbon tetrachloride and ferric chloride (FeCl 3) were used to induce liver fibrosis and PVT in mice, respectively. After treatment with propranolol and DNase I, neutrophils in peripheral blood, colocalization and expression of NETs in PVT specimens, and NETs biomarkers in serum were measured. Ex vivo clots lysis analysis was performed and portal vein velocity and coagulation parameters were tested. Serum MPO-DNA level was significantly higher in cirrhotic patients treated with NSBBs, and serum H3Cit and MPO-DNA levels were significantly higher in those with PVT. In fibrotic mice, following treatment with propranolol, DNase I significantly shortened the time of FeCl 3 -induced PVT formation, lowered the peripheral blood neutrophils labelled by CD11b/Ly6G, inhibited the positive staining of H3Cit and the expression of H3Cit and MPO proteins in PVT tissues, and reduced serum nucleosome level. Furthermore, the addition of DNase I to tissue plasminogen activator (tPA) significantly accelerated clots lysis as compared with tPA alone. Propranolol reduced portal vein velocity in fibrotic mice, but did not influence coagulation parameters. Our study provides a clue to the potential impact of NETs formation on the association of NSBBs with the development of PVT. [Display omitted] • Nonselective β blockers (NSBBs) can increase the risk of portal vein thrombosis (PVT) in patients with liver cirrhosis. • NSBBs may influence neutrophil extracellular traps (NETs) formation, which can affect the development of thrombosis. • Clinical studies supported the association of serum NETs biomarkers with use of NSBBs and PVT in cirrhotic patients. • Experimental studies suggested that NETs formation may participate in the effect of NSBBs on the development of FeCl 3 -induced PVT model. [ABSTRACT FROM AUTHOR]
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- 2024
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26. A case of Crimean‐Congo haemorrhagic fever complicated with portal vein thrombosis and hemophagocytosis.
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Çaydaşı, Özge, Arslan, Eyüp, Adıyeke, Esra, Kuzan, Taha Yusuf, Karadağ, Fatma Yılmaz, and Engin, Derya Öztürk
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PORTAL vein , *HEMORRHAGIC fever , *THROMBOSIS , *SYMPTOMS , *HEMOPHAGOCYTIC lymphohistiocytosis , *DENGUE hemorrhagic fever , *MACROPHAGE activation syndrome - Abstract
Objectives: Crimean‐Congo haemorrhagic fever (CCHF) is a zoonotic viral infection which is an important public health problem in Turkey. CCHF causes fever and bleeding and can lead to severe health outcomes. The study aims to report a case of a male patient with severe CCHF, hemophagocytic lymphohistiocytosis (HLH) treated with steroids and portal vein thrombosis. Case Report: A 37‐year‐old man was admitted to the emergency department with complaints of high fever, headache, myalgia and diarrhoea. The patient travelled to the endemic region of Turkey. In laboratory findings, thrombocytopenia, abnormal liver function tests and elevated coagulation parameters were observed. Real‐time polymerase chain reaction assay was used for diagnosis of CCHF. Hypofibrinogenemia, hypertriglyceridemia, elevated ferritin and d‐dimer levels were observed in the clinical follow‐up. Prednisolone treatment was performed due to considered the diagnosis of HLH. Portal vein thrombosis was detected on abdominal computed tomography scan. He was successfully treated with ribavirin, corticosteroids, anticoagulant and supportive therapy. Conclusion: The clinical presentation of CCHF can range from self‐limiting flu‐like to severe symptoms possibly fatal. Acute portal vein embolism is a rare complication that has not been reported before to our knowledge. Corticosteroids may be a life‐saving treatment for CCHF patients presenting with HLH. [ABSTRACT FROM AUTHOR]
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- 2024
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27. Living donor liver transplantation for patients with portal vein thrombosis: high-volume single center experience.
- Author
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ELSARAWY, A., AKBULUT, S., AKTAS, S., KILERCIK, H., ALKARA, U., and SEVMIS, S.
- Abstract
OBJECTIVE: End-stage liver disease is commonly associated with portal vein thrombosis (PVT). Lastly, PVT is no longer an absolute contraindication for liver transplantation, and many centers adopt portal vein thrombectomy. PVT imposes special technical difficulties during living donor liver transplantation (LDLT). In this research, the experience with PVT cases during LDLT in a high-volume center is introduced. PATIENTS AND METHODS: Between January 2018 and July 2023, 312 patients underwent LDLT. After 88 cases were excluded, 224 cases were included, and their incidence of pre-transplant PVT was 16.5% (37/224). Demographic and clinical features, perioperative variables, and post-transplant outcomes of patients with PVT (PVT group, n=37) were compared to patients who had no PVT (non-PVT group, n=187). RESULTS: According to Yerdel classification, 16, 16, 2, and 3 patients had PVT grade I, II, III, and IV, respectively. Complete venous thrombectomy was accomplished in 34 patients, while for three patients, thrombectomy was not feasible, and graft inflow was established by interposition vascular graft. For portal flow modulation, splenectomy and splenic artery ligation were performed in 7 and 4 patients, respectively, while two patients underwent post-transplant splenic artery embolization. The PVT group had longer operation time (p<0.001), longer warm ischemia time (p=0.031), longer anhepatic phase (p<0.001), and intraoperatively required more than 3 packed RBCs units (p=0.029) and ≥1 platelet unit transfusion (p=0.021) than the nonPVT group. No statistically significant difference was found between groups in terms of re-exploration (p=0.954), post-transplant PVT (p=0.375), biliary (p=0.253) and arterial complications (p=0.593), ICU stay (p=0.633), hospital stay (p=896), and 30-day mortality (p=1.000). Survival analysis showed no statistically significant difference regarding 1-year survival (p=0.176) between both groups. CONCLUSIONS: This study showed that patients with different stages of PVT can successfully undergo LDLT in experienced centers and that they do not differ from patients without PVT in terms of post-transplant complications. [ABSTRACT FROM AUTHOR]
- Published
- 2024
28. Diagnosis and medical treatment of portal vein thrombosis in a pet rabbit (Oryctolagus cuniculus).
- Author
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Berry, Alexandra, Lau, Michelle, and Cowan, Melinda Lee
- Subjects
PORTAL vein ,EUROPEAN rabbit ,HEPATIC portal system ,RABBITS ,DIAGNOSIS ,THERAPEUTICS ,THROMBOSIS - Abstract
Portal vein thrombosis is the partial or total obstruction of blood flow due to a thrombus in the hepatic portal system. This case report outlines the diagnosis and treatment of portal vein thrombosis in a rabbit. The animal presented for inappetence and lack of faecal production, and was found to have markedly elevated alanine transaminase on biochemistry. Abdominal ultrasound revealed a focal hyperechoic structure within the right intrahepatic portal venous branches, with no flow on colour Doppler interrogation. The rabbit was subsequently diagnosed with portal vein thrombosis and treated with clopidogrel and rivaroxaban. Thirty‐two days after presentation, the previously noted intrahepatic portal venous thrombus had resolved, with normal flow visualised in the portal venous branches on colour Doppler interrogation. The rabbit has remained stable for 1 year 5 months after cessation of treatment. [ABSTRACT FROM AUTHOR]
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- 2024
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29. Portal vein thrombosis as extraintestinal complications of Crohn's disease: a case report and review of literature.
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Alhalabi, Marouf, Nasri, Duaa, and Aji, Widad
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CROHN'S disease , *PORTAL vein , *LITERATURE reviews , *INFLAMMATORY bowel diseases , *PORTAL hypertension , *ANTIPHOSPHOLIPID syndrome ,PORTAL vein diseases - Abstract
Introduction: Thrombotic events are more than twice as common in inflammatory bowel disease patients as in the general population. We report an interesting and rare case of portal vein thrombosis as a venous thromboembolic event in the context of extraintestinal manifestations of Crohn's disease. We also conducted a literature review on portal vein thrombosis associated with inflammatory bowel disease, with the following concepts: inflammatory bowel diseases, ulcerative colitis, Crohn's disease, portal vein, and thrombosis. Case presentation: A 24-year-old Syrian female with active chronic Crohn's disease was diagnosed 11 years ago and classified as A1L3B1P according to the Montreal classification. She had no prior surgical history. Her previous medications included azathioprine and prednisolone. Her Crohn's disease activity index was 390 points. Gastroduodenoscopy revealed grade I esophageal varices, a complication of portal hypertension. Meanwhile, a colonoscopy revealed several deep ulcers in the sigmoid, rectum, and descending colon. An investigation of portal vein hypertension revealed portal vein thrombosis. We used corticosteroids to induce remission, followed by tapering; additionally she received ustekinumab to induce and maintain remission. She began on low-molecular-weight heparin for 1 week, warfarin for 3 months, and then apixaban, a novel oral anticoagulant, after excluding antiphospholipid syndrome. Primary prophylaxis for esophageal varices was not required. After 1 year, she achieved clinical, biochemical, and endoscopic remission. Despite 1 year of treatment, a computed tomography scan revealed no improvement in portal vein recanalization. Conclusion: Portal vein thrombosis is a rare and poorly defined complication of inflammatory bowel disease. It is usually exacerbated by inflammatory bowel disease. The symptoms are nonspecific and may mimic a flare-up of inflammatory bowel disease, making the diagnosis difficult. Portal vein Doppler ultrasound for hospital-admitted inflammatory bowel disease patients may contribute to the diagnosis and management of this complication. [ABSTRACT FROM AUTHOR]
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- 2024
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30. A new model of portal vein thrombosis in rats with cirrhosis induced by partial portal vein ligation plus carbon tetrachloride and intervened with rivaroxaban.
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Guo, Yanan, Dong, Sisi, Li, Meng, Tao, Yanyan, Lv, Jing, and Liu, Chenghai
- Subjects
- *
PORTAL vein surgery , *PORTAL vein , *CARBON tetrachloride , *VASCULAR endothelial cells , *CIRRHOSIS of the liver , *RIVAROXABAN - Abstract
Background and aims: Portal vein thrombosis (PVT) is a common complication of liver cirrhosis that can aggravate portal hypertension. However, there are features of both PVT and cirrhosis that are not recapitulated in most current animal models. In this study, we aimed to establish a stable animal model of PVT and cirrhosis, intervene with anticoagulant, and explore the related mechanism. Methods: First, 49 male SD rats received partial portal vein ligation (PPVL), and 44 survival rats were divided into 6 groups: PPVL control group; 4-week, 6 -week, 8-week, and 10-week model group; and the rivaroxaban (RIVA)-treated group. The rats were intoxicated with or without carbon tetrachloride (CCl4) for 4–10 weeks. Seven normal rats were used as the normal controls. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels and parameters for blood coagulation were all assayed with kits. Liver inflammation, collagen deposition and hydroxyproline (Hyp) levels were also measured. The extrahepatic macro-PVT was observed via portal vein HE staining, etc. The intrahepatic microthrombi was stained via fibrin immunohistochemistry. The portal blood flow velocity (PBFV) and diameter were detected via color Doppler ultrasound. Vascular endothelial injury was evaluated by von Willebrand Factor (vWF) immunofluorescence. Fibrinolytic activity was estimated by western blot analysis of fibrin and plasminogen activator inhibitor-1 (PAI-1). Results: After PPVL surgery and 10 weeks of CCl4 intoxication, a rat model that exhibited characteristics of both cirrhosis and extra and intrahepatic thrombi was established. In cirrhotic rats with PVT, the PBFV decreased, both factors of pro- and anti-coagulation decreased, but with relative hypercoagulable state, vascular endothelial injured, and fibrinolytic activity decreased. RIVA-treated rats had improved coagulation function, increased PBFV and attenuated thrombi. This effect was related to the improvements in endothelial injury and fibrinolytic activity. Conclusions: A new rat model of PVT with cirrhosis was established through partial portal vein ligation plus CCl4 intoxication, with the characteristics of macrothrombi at portal veins and microthrombi in hepatic sinusoids, as well as liver cirrhosis. Rivaroxaban could attenuate PVT in cirrhosis in the model rats. The underlying mechanisms of PVT formation in the rat model and pharmacological action of rivaroxaban are related to the regulation of portal blood flow, coagulant factors, and vascular endothelial cell function. [ABSTRACT FROM AUTHOR]
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- 2024
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31. Effectiveness of edoxaban in portal vein thrombosis associated with liver cirrhosis.
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Tadokoro, Tomoko, Tani, Joji, Manabe, Takushi, Takuma, Kei, Nakahara, Mai, Oura, Kyoko, Mimura, Shima, Fujita, Koji, Nomura, Takako, Morishita, Asahiro, Kobara, Hideki, Himoto, Takashi, Ono, Masafumi, and Masaki, Tsutomu
- Subjects
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PORTAL vein , *EDOXABAN , *CIRRHOSIS of the liver , *ORAL medication , *THROMBOSIS - Abstract
Portal vein thrombosis (PVT) worsens the long-term prognosis of patients with cirrhosis; however, the optimal treatment remains to be determined. Reports on the efficacy of direct oral anticoagulants are increasing, and further evidence is needed. Therefore, we investigated the effectiveness of treatment with edoxaban in patients with PVT. We retrospectively reviewed the outcomes of edoxaban and warfarin as antithrombotic therapies for PVT. The median overall survival time was 4.2 years in patients with PVT, with a 1-year survival rate of 70.7% and a 5-year survival rate of 47.9%. The leading cause of death was hepatocellular carcinoma. The overall response rate for thrombolysis in the edoxaban group was 76.7% compared to 29.4% in the warfarin group, and edoxaban significantly improved PVT compared to warfarin. In addition, edoxaban provided long-term improvement of PVT. Warfarin, on the other hand, was temporarily effective but did not provide long-term benefits. The Child–Pugh and albumin-bilirubin scores did not change after edoxaban or warfarin use. No deaths occurred due to adverse events associated with edoxaban or warfarin. Edoxaban as a single agent can achieve long-term recanalization without compromising the hepatic reserves. Edoxaban is easy to initiate, even in an outpatient setting, and could become a major therapeutic agent for the treatment of PVT. [ABSTRACT FROM AUTHOR]
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- 2024
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32. Statin use in cirrhosis and its association with incidence of portal vein thrombosis.
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Amjad, Waseem, Jiang, Zhenghui, and Lai, Michelle
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STATINS (Cardiovascular agents) , *PORTAL vein , *BUDD-Chiari syndrome , *CIRRHOSIS of the liver , *PORTAL hypertension , *THROMBOSIS - Abstract
Background and Aim: Statin use has shown a reduction in hepatic decompensation and portal hypertension. Its association with portal vein thrombosis (PVT) incidence is unknown. We aim to compare the incidence of PVT in patients with and without statin use. Methods: We excluded patients with a history of hepatocellular cancer, liver transplants, Budd–Chiari syndrome, and intra‐abdominal malignancies. Patients with cirrhosis were followed from their first hepatologist clinical encounter (January 1, 2016, to January 31, 2021) for 180 days to determine PVT incidence. We tested the association of statin use with PVT using 1:1 propensity score (PS) matching and Cox proportional hazard regression. Results: We analyzed 2785 patients with cirrhosis (mean age:61.0 ± 12.3 years, 44.3% female, 63.8% White, mean MELD‐Na score:11.7 ± 6.1, and statin use:23.1%). A total of 89 patients developed PVT during the follow‐up, which was lower in patients with statin use as compared to no statin use (1.3% vs 3.8%, P = 0.001, unadjusted HR:0.28, 95% CI: 0.13–0.62, P = 0.001). After matching for demographics, comorbidities, and hepatic decompensation events, patients with statin use had a lower risk of developing PVT in 180‐day follow‐up as compared to those without statin use (HR:0.24, 95% CI: 0.10–0.55, P = 0.001). Subgroup analysis showed that statin use was associated with lower PVT incidence in non‐NASH (HR: 0.20, 95% CI: 0.07–0.54, P = 0.002) and decompensated cirrhosis (HR: 0.12, 95% CI:0.03–0.53, P = 0.005) than no statin use. Conclusion: PVT incidence was lower in decompensated cirrhosis patients with statin use than in those with no statin use. However, this finding needs to be further tested in randomized control trials. [ABSTRACT FROM AUTHOR]
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- 2024
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33. Objective Tumor Response of Hepatocellular Carcinoma Obtained by Transarterial Radioembolization with Iodine-131-Lipiodol Versus Transarterial Chemoembolization for Patients with and without Portal Venous Thrombosis: A Controlled Interventional Trial.
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Oliveira Ribeiro, Michele Costa de, Moda, Kerolyn Adorne, Alvarez, Matheus, Koga, Katia Hiromoto, Moriguchi, Sônia Marta, Carvalho, Fábio Cardoso, Pinheiro, Rafael Soares Nunes, Qi, Xingshun, and Romeiro, Fernando Gomes
- Abstract
Hepatocellular carcinoma (HCC) treatment often requires transarterial chemoembolization (TACE). However, TACE efficacy is controversial in the presence of portal vein thrombosis (PVT). Although transarterial radioembolization (TARE) benefit was previously documented in PVT, neither the objective tumor response (OTR) after TARE with Iodine-131-lipiodol (
131 I-lipiodol) nor the PVT effect on the results of locoregional therapies was accurately measured in prospective clinical trials. The aim of this study was to compare OTR and survival obtained by TARE with131 I-lipiodol versus TACE in patients with cirrhosis and HCC, as well as between those with and without PVT. 33 patients were included, from whom 38 tumors were assessed. OTR was quantified by a special algorithm to measure hypervascular HCC tissue. 19 tumors received each therapy. Nine subjects (27%) had PVT, most of them in the TARE group (p = 0.026). Mean OTR according to the tumor volumes was 24.2% ± 56% after TARE and 32.8% ± 48.9% after TACE, with no difference between the treatments (p = 0.616). Similar values were also observed between those with and without PVT (p = 0.704). Mean survival was 340 days and did not differ between the two treatments (p = 0.596), but was 194 days in PVT cases (p = 0.007). This is the first study in which OTR obtained by TARE with131 I-lipiodol is accurately measured. Additionally, PVT impact on survival after TARE and TACE was precisely documented. Although the TARE group had more PVT subjects (who had shorter survival), TARE and TACE achieved similar OTR and OS rates. [ABSTRACT FROM AUTHOR]- Published
- 2024
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34. Fatal pulmonary embolism after surgery for small intestinal necrosis caused by idiopathic portal vein thrombosis: a case report.
- Author
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Iwasaki, Hitoshi, Uehara, Hideo, Fujimoto, Yugo, Hasuda, Hirofumi, Kusumoto, Eiji, Hisamatsu, Yuichi, Yoshida, Rintaro, Sakaguchi, Yoshihisa, and Kusumoto, Tetsuya
- Subjects
PORTAL vein ,THROMBOSIS ,THROMBOEMBOLISM ,NECROSIS ,CARDIOPULMONARY resuscitation ,EXTRACORPOREAL membrane oxygenation - Abstract
Background: Portal vein thrombosis (PVT) and venous thromboembolism (VTE) both result from partial or complete occlusion of a blood vessel by a blood clot. The prognosis of PVT is generally good; however, PVT with VTE, including pulmonary embolism (PE), has a high mortality rate. We report here a case of PE after surgery for small intestinal necrosis caused by idiopathic PVT. Case presentation: A 69-year-old female attended our hospital with a chief complaint of upper abdominal discomfort, and was diagnosed with necrosis of the small intestine as a result of unexplained PVT. She underwent partial resection of the small intestine. On the second postoperative day, she suffered from respiratory distress and went into cardiopulmonary arrest. The patient recovered following cardiopulmonary resuscitation, but PE was detected. Extracorporeal veno-arterial cardiopulmonary resuscitation and anticoagulation therapy were initiated immediately and the thrombus was aspirated as much as possible. Two days later, extracorporeal veno-arterial cardiopulmonary resuscitation was withdrawn and anticoagulation therapy was continued. The patient subsequently recovered with no neurological damage and was discharged on day 26 after the above procedure. Conclusions: Idiopathic PVT is often associated with VTE, and a prompt diagnosis and intervention may result in a good prognosis. [ABSTRACT FROM AUTHOR]
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- 2024
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35. Migrated toothpick causing a hepatic abscess with portal vein thrombosis: A case report and review of literature
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Faisal Joueidi, Ali A. Alzahrani, Abdulaziz A. Altaweel, Omar Alwhaibi, Ahmed Elgohary, and Khalid O. Bin Saad
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case report ,foreign body ,hepatic ,liver abscess ,portal vein thrombosis ,toothpick ,Medicine ,Medicine (General) ,R5-920 - Abstract
Key Clinical Message Accidental foreign body ingestion is the most common hidden cause of abdominal pain. A high index of suspicion should be implemented in patients with unresolved abdominal pain. Here we reported a 54‐year‐old patient with vague abdominal pain who had a successful laparoscopic removal of a toothpick. Abstract Toothpicks and fish bones are considered one of the most common accidentally ingested foreign bodies. Fortunately, most patients are asymptomatic. About 80%–90% of ingested foreign bodies pass through the gut spontaneously within a week. We present a case of a 54‐year‐old female with chronic epigastric pain and fever found to have a foreign body (toothpick) that penetrated the stomach and migrated to the liver causing liver abscess with portal vein thrombosis. The patient was managed with laparoscopic removal of the foreign body with an uneventful postoperative course.
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- 2024
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36. Management of extensive portal vein thrombosis via thrombolysis and thrombectomy without underlying liver disease: A case report
- Author
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Mohammadshah Isam Gul, Waseem Umer, Ahmed Daniyal Nawaz, Mohammad J. H. Elhissi, and Muhammad Zahid
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anticoagulation ,case report ,liver cirrhosis ,portal vein thrombosis ,thrombectomy ,thrombolysis ,Medicine ,Medicine (General) ,R5-920 - Abstract
Key Clinical Message Portal vein thrombosis (PVT) is a rare condition, particularly in non‐cirrhotic patients. Anticoagulation remains the mainstay of the treatment. Extensive PVT can lead to variceal bleeding, ascites, bowel ischemia, and hypersplenism. The role of thrombolysis and thrombectomy in these patients remains unclear. However, there is evidence that local thrombolysis and thrombectomy should be considered in those who remain symptomatic on anticoagulation and are at risk of complications with acute PVT.
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- 2024
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37. Do heavy metals have a role in extrahepatic portal vein obstruction in children: A pilot case-control study
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Neha Sonker, Shalini Verma, Chandrakanta Kumar, Kausar Mahmood Ansari, and Sanjeev Kumar Verma
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Pediatric extrahepatic portal venous obstruction ,Heavy metals ,Portal vein thrombosis ,India ,Public aspects of medicine ,RA1-1270 - Abstract
Objective: Extrahepatic portal venous obstruction (EHPVO) is a common cause of portal hypertension in Southeast Asia as compared to the western world, where chronic liver disease is the most common cause. Pollution and inadvertent exposure to heavy metals in poor socio-economic status in this part of the world are quite common. Therefore, this study was proposed to determine the association between heavy metal levels and oxidative stress in children with EHPVO. Methods: This pilot case-control study was conducted in the department of Pediatrics, of a tertiary health care centre from January 2020 to October 2021. Children between 1 and 14 years, diagnosed with EHPVO were included. Controls were the healthy volunteers from OPD and near discharge indoor pediatrics patients. Metal analysis for Copper, Lead, Zinc, and Manganese, & Antioxidant activity for superoxide dismutase (SOD), Glutathione reductase (GR) and Lipid peroxidase (LPO) in form of malondialdehyde (MDA) was measured in both the groups. Results: A total of 80 subjects were enrolled (40 EHPVO cases and 40 controls) mean age for cases was 8.15 ± 3.53, and for control, was 7.69 ± 3.55 years (p = 0.560). Lead values were found to be significantly higher (p = 0.003) in EHPVO cases (5.39 ± 3.13) in comparison to controls (3.30 ± 2.91). Mean superoxide dismutase (SOD) and Glutathione reductase (GR) values were decreased (p = 0.035- GR) and the malondialdehyde (MDA) value was increased in the EHPVO cases as compared to controls. Conclusion: Children with high blood levels of lead might be at risk of portal vein thrombosis resulting in EHPVO, and lead-induced oxidative stress.
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- 2024
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38. Surgical Outcome of HCC With Portal Vein Tumor Thrombosis on the Basis of Risk Scoring
- Published
- 2023
39. Percutaneous recanalization of non-cirrhotic extrahepatic portal vein obstruction in children: technical considerations in a preliminary cohort
- Author
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Marra, Paolo, Franchi-Abella, Stephanie, Hernandez, José A., Ronot, Maxime, Muglia, Riccardo, D’Antiga, Lorenzo, and Sironi, Sandro
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- 2024
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40. Remarkable alpha-fetoprotein elevation and pseudo-infarction of cirrhotic liver: case report
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Maged Tharwat Elghannam, Moataz Hassan Hassanien, Yosry Abdelrahman Ameen, Gamal Mohammed ELattar, Ahmed Aly ELRay, and Mohammed Darwish ELTalkawy
- Subjects
remarkable alpha-fetoprotein elevation ,portal vein thrombosis ,liver cirrhosis ,liver pseudo-infarction ,case report ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
This is a case of remarkable alpha-fetoprotein in a female patient with known cryptogenic liver cirrhosis. Both ultrasound and triphasic computed tomography (CT) abdomen cannot diagnose or exclude hepatocellular carcinoma (HCC). It turns out to be a case of portal vein thrombosis and hepatic pseudo-infarction. It is better to postpone the therapeutic intervention, whether surgical or chemotherapeutic, in cases not confirmed to be HCC for at least 3 months to avoid misdiagnosis of hepatic pseudo-infarction.
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- 2024
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41. Study of Factors Associated with Concomitant Gastrointestinal Bleeding in Patients with Portal Vein Thrombosis in Liver Cirrhosis
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DONG Wendi, YANG Jiani, ZHU Jie, QUAN Yujie, ZHANG Jinjing, LIU Yan, ZHANG Hairong
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liver cirrhosis ,portal vein thrombosis ,gastrointestinal bleeding ,risk factors ,Medicine - Abstract
Background Both portal vein thrombosis (PVT) and gastrointestinal bleeding are complications in patients with liver cirrhosis, and PVT can aggravate the risk of gastrointestinal bleeding, but the conflicting treatment of both is another challenge in clinical work. Objective To investigate the clinical characteristics and risk factors of concomitant gastrointestinal bleeding in patients with PVT in liver cirrhosis. Methods A total of 279 patients diagnosed with PVT in liver cirrhosis at the First Affiliated Hospital of Kunming Medical University from 2016-10-01 to 2021-09-30 were retrospectively collected and divided into the bleeding group (n=127) and non-bleeding group (n=152) according to the presence of gastrointestinal bleeding symptoms of hematemesis and melena in this admission. The differences in general information, complications, laboratory and imaging tests, surgical history and other relevant information between the two groups were compared. Multivariate Logistic regression analysis was used to explore the influencing factors of the complications of gastrointestinal bleeding in cirrhotic patients with PVT. Results A total of 5 807 patients were retrospectively investigated in the study, including 350 patients combined with PVT with a incidence of 6.0%. PVT was most common in 279 cirrhotic patients with PVT complicated by liver function Child B grade[146 (52.3%) ]. There were significant differences in etiology, vascular involvement, jaundice, internal diameter of main portal vein, gastroesophageal varices, white blood cell (WBC), blood urea nitrogen (BUN), hemoglobin (Hb), hematocrit (HCT), total bilirubin (TBiL), fibrinogen (FIB), and history of laparotomy between the bleeding group and non-bleeding group (P
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- 2024
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42. Shear Wave Elastography in Children with Portal Vein Thrombosis is not a Sensitive Predictor of Upper Gastrointestinal Bleeding: a Pilot Study
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Magd Ahmed Kotb, Marwa Mohamed Onsy, Bothainah M. Abdulwahab Abduljalil, Mona Ahmed Kamel, and Rania Hamdy Hashem
- Subjects
shear wave elastography ,upper gastrointestinal bleeding ,portal vein thrombosis ,Pediatrics ,RJ1-570 - Abstract
Background: Extrahepatic portal vein thrombosis (EHPVT) is a cause of portal hypertension in children. It is complicated by upper gastrointestinal variceal bleeding. Aim of the work: to study shear wave elastography (SWE) assessed liver and spleen stiffness among children with EHPVT as a predictor of esophageal varices, its grade and/or upper gastrointestinal (GIT) bleeding. Methods: This case-control study included 18 children with EHPVT who were not secondary to liver disease and 18 healthy children as a control group who underwent ultrasonography and SWE of the liver and spleen. The patient group underwent upper GIT endoscopy as well. Results: The mean ± SD age of the children with EPVT was 9.11 ± 5.26 years, and 5 (27.7%) were females. Three (16.7%) had thrombophilia, 11 (61.1%) had undergone neonatal placement of umbilical catheter, both neonatal intensive care unit admission and thrombophilia in 2 (11.1%) and omphalitis in one (5.5%). All had clinically evident splenomegaly and sonographic evidence of portal vein cavernoma, 2 had recanalized portal vein. SWE stiffness of the right lobe was 7.39 ± 0.86 kPa, the left lobe was 7.64± 0.99 kPa and splenic stiffness was (mean± SD was 68.1 ± 22.8 kPa and range 28-121 kPa) among those with EHPVT, compared to the control group which was 6.83 ± 0.37 kPa, 7.39 ± 0.85 kPa, and (mean± SD was 19.61 ± 2.7 kPa and range 17.2-24.2 kPa), (p = 0.018), (p=0.036) and (p=0.00001) respectively. Esophageal varices bleeding and grade did not correlate with the modified caudate to right lobe diameter ratio (p=0.621), and (p= 0.53), stiffness of the right lobe (p=0.64) and (p= 0.684), left lobe (p=0.297) and (p= 0.223), or spleen stiffness (p=0.499) and (p= 0.196) respectively. Eleven (61.1%) had patent lienorenal collaterals, they were older (mean age 10± 5.3years) compared to those who did not develop (6.7 ± 3.6 years) lienorenal collaterals (p=0.06). The development of spontaneous lienorenal shunts was associated with a decreased risk of variceal bleeding (p= 0.013). Conclusion: EHPVT in children was associated with hepatic and splenic stiffness compared to the control group. The stiffness did not correlate with the upper GIT variceal grade or bleeding. The development of spontaneous lienorenal shunts seems to deflate portosystemic shunt pressure and reduce the risk of variceal bleeding.
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- 2024
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43. Hypoalbuminemia and Risk of Portal Vein Thrombosis in Cirrhosis
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Roberto Cangemi, Valeria Raparelli, Giovanni Talerico, Stefania Basili, Francesco Violi, Palasciano Giuseppe, D’Alitto Felicia, Palmieri Vincenzo Ostilio, Santovito Daniela, Di Michele Dario, Croce Giuseppe, Sacerdoti David, Brocco Silvia, Fasolato Silvano, Cecchetto Lara, Bombonato Giancarlo, Bertoni Michele, Restuccia Tea, Andreozzi Paola, Liguori Maria Livia, Perticone Francesco, Caroleo Benedetto, Perticone Maria, Staltari Orietta, Manfredini Roberto, De Giorgi Alfredo, Averna Maurizio, Giammanco Antonina, Granito Alessandro, Pettinari Irene, Marinelli Sara, Bolondi Luigi, Falsetti Lorenzo, Salvi Aldo, Durante-Mangoni Emanuele, Cesaro Flavio, Farinaro Vincenza, Ragone Enrico, Morana Ignazio, Andriulli Angelo, Ippolito Antonio, Iacobellis Angelo, Niro Grazia, Merla Antonio, Raimondo Giovanni, Maimone Sergio, Cacciola Irene, Varvara Doriana, Drenaggi Davide, Staffolani Silvia, Picardi Antonio, Vespasiani-Gentilucci Umberto, Galati Giovanni, Gallo Paolo, Davì Giovanni, Schiavone Cosima, Santilli Francesca, Tana Claudio, Licata Anna, Soresi Maurizio, Bianchi Giovanni Battista, Carderi Isabella, Pinto Antonio, Tuttolomondo Antonino, Ferrari Giovanni, Gresele Paolo, Fierro Tiziana, Morelli Olivia, Laffi Giacomo, Romanelli Roberto Giulio, Arena Umberto, Stasi Cristina, Gasbarrini Antonio, Gargovich Matteo, Zocco Maria Assunta, Riccardi Laura, Ainora Maria Elena, Capeci William, Martino Giuseppe Pio, Nobili Lorenzo, Cavallo Maurizio, Frugiuele Pierluigi, Greco Antonio, Pietrangelo Antonello, Ventura Paolo, Cuoghi Chiara, Marcacci Matteo, Serviddio Gaetano, Vendemiale Gianluigi, Villani Rosanna, Gargano Ruggiero, Vidili Gianpaolo, Di Cesare Valentina, Masala Maristella, Delitala Giuseppe, Invernizzi Pietro, Di Minno Giovanni, Tufano Antonella, Purrello Francesco, Privitera Graziella, Forgione Alessandra, Curigliano Valentina, Senzolo Marco, Rodríguez-Castro Kryssia Isabel, Giannelli Gianluigi, Serra Carla, Neri Sergio, Pignataro Pietro, Rizzetto Mario, Debernardi Venon Wilma, Svegliati Baroni Gianluca, Bergamaschi Gaetano, Masotti Michela, Costanzo Filippo, Corazza Gino Roberto, Caldwell Stephen Hugh, Angelico Francesco, Del Ben Maria, Napoleone Laura, Polimeni Licia, Proietti Marco, Raparelli Valeria, Romiti Giulio Francesco, Ruscio Eleonora, Severoni Andrea, Talerico Giovanni, Toriello Filippo, and Vestri Annarita
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Albumin ,Cirrhosis ,Portal Vein Thrombosis ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and Aims: Hypoalbuminemia, as defined by serum albumin (SA) levels ≤35 g/L, is associated to venous and arterial thrombosis in general population and in patients at risk of cardiovascular disease. It is unknown if SA ≤35 g/L is also associated to portal vein thrombosis (PVT) in cirrhosis. Methods: Cirrhotic patients enrolled in the Portal vein thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry (PRO-LIVER) study (n = 753), were followed-up for 2 years to assess the risk of PVT, that was diagnosed by Doppler ultrasonography. Child-Pugh classes, Model for End-Stage Liver Disease score, presence of hepatocellular carcinoma and laboratory variables including SA, D-dimer, and high-sensitivity C-reactive protein (hs-CRP) were measured at baseline. Results: SA ≤35 g/L was detected in 52% of patients. A logistic multivariate regression analysis showed that higher Child-Pugh class, hepatocellular carcinoma and thrombocytopenia were significantly associated to SA ≤35 g/L. In a subgroup of patients where data regarding hs-CRP and D-dimer were available, SA ≤35 g/L was inversely associated with hs-CRP and D-dimer. During the follow-up, a total of 61 patients experienced PVT. A Kaplan Meier survival analysis showed SA ≤35 g/L was associated to increased risk of PVT compared to SA >35 g/L (P = .005). A multivariate Cox proportional hazards regression analysis showed that male sex, lower platelet count, and SA ≤35 g/L remained associated to PVT after adjusting for confounding factors. Conclusion: Cirrhotic patients with SA ≤35 g/L are at higher risk of experiencing PVT compared to those with SA >35 g/L and could be considered as potential candidates to anticoagulant prophylaxis for PVT prevention.
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- 2024
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44. H101 Combined With TACE for Primary Hepatocellular Carcinoma With Portal Vein Thrombosis
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- 2023
45. Safety and efficacy of transjugular intrahepatic portosystemic shunts vs endoscopic band ligation plus propranolol in patients with cirrhosis with portal vein thrombosis: a systematic review and meta-analysis.
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Berengy, Mahmoud Saad, Abd El-Hamid Hassan, Elsayed Mohamed, Ibrahim, Amal H., and Mohamed, Eman F.
- Abstract
This systematic review and meta-analysis aimed to assess the efficacy and safety of transjugular intrahepatic portosystemic shunts (TIPS) against the combined treatment of endoscopic band ligation (EBL) and propranolol in managing patients with cirrhosis diagnosed with portal vein thrombosis (PVT). A literature search from inception to September 2023 was performed using MEDLINE, the Cochrane Library, Web of Science, and Scopus. Independent screening, data extraction, and quality assessment were performed. The main measured outcomes were the incidence and recurrence of variceal bleeding (VB), hepatic encephalopathy, and overall survival. A total of 5 studies were included. For variceal eradication, there was initially no significant difference between the groups; however, after sensitivity analysis, a significant effect emerged (risk ratio [RR], 1.55; P <.0001). TIPS was associated with a significant decrease in the incidence of VB (RR, 0.34; P <.0001) and a higher probability of remaining free of VB in the first 2 years after the procedure (first year: RR, 1.41; P <.0001; second year: RR, 1.58; P <.0001). TIPS significantly reduced the incidence of death due to acute GI bleeding compared with EBL + propranolol (RR, 0.37; P =.05). TIPS offers a comprehensive therapeutic advantage over the combined EBL and propranolol regimen, especially for patients with cirrhosis with PVT. Its efficacy in variceal eradication, reducing rebleeding, and mitigating death risks due to acute GI bleeding is evident. [ABSTRACT FROM AUTHOR]
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- 2024
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46. Ten‐year follow‐up of cavoportal hemitransposition in pediatric liver transplantation for complete portomesenteric venous thrombosis: A case report and literature review.
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Barron, John O., Radhakrishnan, Kadakkal, Coppa, Christopher, Goldman, Deborah, Hupertz, Vera, Leonis, Mike, Eghtesad, Bijan, and Hashimoto, Koji
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LIVER transplantation , *VENOUS thrombosis , *LITERATURE reviews , *MESENTERIC veins , *VENA cava inferior , *BILIARY atresia ,PORTAL vein diseases - Abstract
Background: Portal vein thrombosis is a potentially devastating complication following pediatric liver transplantation. In rare instances of complete portomesenteric thrombosis, cavoportal hemitransposition may provide graft inflow. Here we describe long‐term results following a case of pediatric cavoportal hemitransposition during liver transplantation and review the current pediatric literature. Methods: A 9‐month‐old female with a history of biliary atresia and failed Kasai portoenterostomy underwent living donor liver transplantation, which was complicated by portomesenteric venous thrombosis. The patient underwent retransplantation with cavoportal hemitransposition on postoperative day 12. Outcome: The patient recovered without further complication, and 10 years later, she continues to do well, with normal graft function and no clinical sequelae of portal hypertension. CT scan with 3‐D vascular reconstruction demonstrated recanalization of the splanchnic system, with systemic drainage to the inferior vena cava via an inferior mesenteric vein shunt. The cavoportal anastomosis remains patent with hepatopetal flow. Of the 12 previously reported cases of pediatric cavoportal hemitransposition as portal inflow in liver transplantation, this is the longest‐known follow‐up with a viable allograft. Notably, sequelae of portal hypertension were also rare in the 12 previously reported cases, with no cases of long‐term renal dysfunction, lower extremity edema, or ascites. Conclusions: Long‐term survival beyond 10 years with normal graft function is feasible following pediatric cavoportal hemitransposition. Complications related to portal hypertension were generally short‐lived, likely due to the development of robust collateral circulation. Additional reports of long‐term outcomes are necessary to facilitate informed decision making when considering pediatric cavoportal hemitransposition for liver graft inflow. [ABSTRACT FROM AUTHOR]
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- 2024
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47. ADAMTS-13: A Prognostic Biomarker for Portal Vein Thrombosis in Japanese Patients with Liver Cirrhosis.
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Suzuki, Junya, Namisaki, Tadashi, Takya, Hiroaki, Kaji, Kosuke, Nishimura, Norihisa, Shibamoto, Akihiko, Asada, Shohei, Kubo, Takahiro, Iwai, Satoshi, Tomooka, Fumimasa, Takeda, Soichi, Koizumi, Aritoshi, Tanaka, Misako, Matsuda, Takuya, Inoue, Takashi, Fujimoto, Yuki, Tsuji, Yuki, Fujinaga, Yukihisa, Sato, Shinya, and Kitagawa, Koh
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PORTAL vein , *JAPANESE people , *SPIRAL computed tomography , *CIRRHOSIS of the liver , *FIBRIN fibrinogen degradation products , *FIBRIN - Abstract
Portal vein thrombosis (PVT), one of the most prevalent hepatic vascular conditions in patients with liver cirrhosis (LC), is associated with high mortality rates. An imbalance between a disintegrin-like metalloproteinase with thrombospondin type-1 motifs 13 (ADAMTS-13) enzyme and von Willebrand factor (VWF) is responsible for hypercoagulability, including spontaneous thrombus formation in blood vessels. Herein, we aimed to identify potential prognostic and diagnostic biomarkers in Japanese patients with LC and PVT. In total, 345 patients were divided into two groups: 40 patients who developed PVT (PVT group) and 305 who did not develop PVT (NPVT group). Among the 345 patients with LC, 81% (279/345) were deemed ineligible due to the presence of preventive comorbidities, active or recent malignancies, and organ dysfunction. The remaining 66 patients were divided into two groups: the PVT group (n = 33) and the NPVT group (n = 33). Plasma ADAMTS-13 activity (ADAMTS-13:AC) and the vWF antigen (VWF:Ag) were measured using enzyme-linked immunosorbent assays. Contrast-enhanced, three-dimensional helical computed tomography (CT) was used to detect and characterize PVT. ADAMTS-13:AC was significantly lower in the PVT group than in the NPVT group. No significant differences in plasma vWF:Ag or liver stiffness were observed between the two groups. ADAMTS-13:AC of <18.8 was an independent risk factor for PVT on multivariate analyses (odds ratio: 1.67, 95% confidence interval: 1.21–3.00, p < 0.002). The receiver operating characteristic analysis of ADAMTS-13:AC revealed an area under the curve of 0.913 in PVT detection. Patients with PVT having ADAMTS-13:AC ≥18.8 (n = 17) had higher albumin levels and better prognoses than those with ADAMTS-13:AC <18.8 (n = 16). No significant correlations of ADAMTS-13:AC levels with either fibrin degradation product or D-dimer levels were observed. ADAMTS-13:AC levels could be potential diagnostic and prognostic biomarkers for PVT in Japanese patients with LC. [ABSTRACT FROM AUTHOR]
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- 2024
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48. Analysis of Related Influencing Factors of Portal Vein Thrombosis After Hepatectomy.
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Qi, ShiGuai, Tao, Jie, Wu, Xinhua, Feng, Xu, Feng, Guoying, and Shi, Zhengrong
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Purpose: To analyze the related factors of portal vein thrombosis (PVT) after hepatectomy. Methods: A retrospective analysis was made on 1029 patients who underwent partial hepatectomy in the first affiliated Hospital of Chongqing Medical University from March 2018 to March 2023, including PVT group (n = 24) and non-PVT group (n = 1005). The general and clinical data of the two groups were collected. Univariate and multivariate logistic regression analysis was used to analyze the clinical information of the two groups. Result: The proportion of preoperative hepatitis B, liver cirrhosis, ascites, intraoperative blood transfusion, postoperative hemostatic drugs, preoperative prothrombin time, intraoperative portal occlusion time, operation time, international standardized ratio of prothrombin time on the first day after operation, D-dimer on the first day after operation, fibrin degradation products on the first day after operation and postoperative hospital stay in the PVT group were all higher than those in the control group (P < .05). The preoperative platelet and albumin in the PVT group were lower than those in the control group. Intraoperative blood transfusion, liver cirrhosis, ascites, international standardized ratio of postoperative prothrombin time, postoperative fibrin degradation products, hilar occlusion time and albumin were independent risk factors for PVT. Conclusion: There are many influencing factors of PVT after hepatectomy. Clinical intervention should be taken to reduce PVT. Clinical Registration Number: K2023-348. [ABSTRACT FROM AUTHOR]
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- 2024
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49. Disasters that develop in the liver due to hydatid cyst: a case report.
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Karahan, Furkan, Atay, Arif, Dilek, Fatma H., Karasu, Şebnem, and Dilek, Osman N.
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ECHINOCOCCOSIS ,PORTAL vein diseases ,THROMBOSIS ,ETIOLOGY of diseases ,ABDOMINAL pain - Abstract
Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2024
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50. Portal Vein Thrombosis in Patients with Cirrhosis.
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Wang, Peter L., Ramalingam, Vijay, and Yang, Lauren M.
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Purpose of Review: Portal vein thromboses occur in patients with cirrhosis, including those awaiting liver transplant, and uncertainty exists regarding its prognosis, workup, and optimal management. Recent Findings: The prevalence of PVT is higher in those with more severe liver disease (24% vs 14% for Child-Pugh B/C vs A, respectively). PVT, especially those with complete occlusion, is associated with mortality and graft loss in liver transplant recipients. Increasing data on direct oral anticoagulant (DOAC) use in cirrhosis and specifically for use in patients with PVT provides physicians and patients with more appealing anticoagulation options. In addition to observation and anticoagulation, there is an emerging role of transjugular intrahepatic porto-systemic (TIPS) shunt for recanalization of the portal vein in certain patients, with prospective single-center study demonstrating 98–100% efficacy in those with complete occlusion compared to a lower rate of patency with medical therapy alone (13%). Summary: Due to the complexities involved in assessing and managing PVTs in cirrhosis based on individual patient factors, a multidisciplinary approach with hepatologists, hematologists, interventional radiologists, and transplant surgeons is strongly recommended for patients who are transplant candidates, have recurrent thromboses or complex anatomy, and may be considered in any patient with cirrhosis. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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