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2014 ; 30
(6
): 394-400
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Clinical Management of Acute Portal/Mesenteric Vein Thrombosis
#MMPMID26285602
Lang SA
; Loss M
; Wohlgemuth WA
; Schlitt HJ
Viszeralmedizin
2014[Dec]; 30
(6
): 394-400
PMID26285602
show ga
BACKGROUND: Acute thrombosis of the portal vein (PV) and/or the mesenteric vein
(MV) is a rare but potentially life-threatening disease. A multitude of risk
factors for acute portal vein thrombosis (PVT)/mesenteric vein thrombosis (MVT)
have been identified, including liver cirrhosis, malignancy, coagulation
disorders, intra-abdominal infection/inflammation, and postoperative condition.
METHODS: This article analyses the treatment options for acute PVT/MVT. RESULTS:
Initially, the clinical management should identify patients with an
intra-abdominal focus requiring immediate surgical intervention (e.g. bowel
ischaemia). Subsequently, emphasis is placed on the recanalization of the PV/MV
or at least the prevention of thrombus extension to avoid long-term complications
of portal hypertension. Several therapeutic options are currently available,
including anticoagulation therapy, local/systemic thrombolysis, interventional or
surgical thrombectomy, and a combination of these procedures. Due to the lack of
prospective randomized studies, a comparison between these therapeutic approaches
regarding the efficacy of PV/MV recanalization is difficult, if not impossible.
CONCLUSION: In patients with acute PVT/MVT, an individualized treatment based on
the clinical presentation, the underlying disease, the extent of the thrombosis,
and the patients' comorbidities is mandatory. Therefore, these patients should be
considered for an interdisciplinary therapy in specialized centres with the
option to utilise all therapeutic approaches currently available.