Portal Vein Thrombosis in Cirrhosis with Variceal Hemorrhage

Marshall J. Orloff, Mark S. Orloff, Susan Orloff, Barbara Girard

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Organized thrombus in the main trunk of the portal vein was encountered in 85 (6.5%) of 1300 patients with cirrhosis and variceal hemorrhage who underwent direct portacaval shunt (PCS). The thrombus was successfully removed with restoration of portal blood flow in all patients by phlebothrombectomy and balloon catheter extraction. Of the 85 patients, 65 were among 400 unselected patients who underwent emergency PCS (16%), and 20 were among 900 selected patients who underwent elective PCS (2%). All patients were closely followed for at least 5 years. Patients with portal vein thrombosis (PVT) had more advanced liver disease than those without PVT, reflected preoperatively in significantly higher (P 3 (92%), and placement in Child's class C (52%). Side-to-side PCS reduced the portal vein-inferior vena cava pressure gradient to a mean of 23 mm saline solution in patients with PVT, similar to the marked pressure reduction obtained in patients without PVT. PCS promptly stopped variceal bleeding in all patients in the emergency PCS group. Permanent prevention of recurrent variceal bleeding was successful in 95% of patients with PVT and more than 99% of patients without PVT. Survival rates were similar in patients with and without PVT. In patients with PVT, survival rates at 30 days and 1, 5, 10, and 15 years following emergency PCS were 69%, 66%, 65%, 55%, and 51%, respectively, and following elective PCS were 95%, 90%, 70%, 65%, and 60%, respectively. Quality of life was similar in patients with and without PVT. Long-term PCS patency was demonstrated yearly in 93% of patients in the group with PVT and in 99.7% of patients without PVT. Other similarities after 5 years between patients with and without PVT, respectively, were the incidences of recurrent encephalopathy (9% vs. 8%), alcohol abstinence (61% vs. 64%), improved liver function (68% vs. 62% to 75%), and return to work (52% vs. 56% to 64%). It was concluded that in patients with cirrhosis and variceal hemorrhage it is almost always possible to remove portal vein thrombus by means of phlebothrombectomy and then perform a direct PCS with results similar to those achieved in the absence of PVT.

Original languageEnglish (US)
Pages (from-to)123-131
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume1
Issue number2
StatePublished - Mar 1997

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Portal Vein
Thrombosis
Fibrosis
Surgical Portacaval Shunt
Hemorrhage
Emergencies
Survival Rate
Alcohol Abstinence
Pressure
Return to Work
Inferior Vena Cava
Brain Diseases

ASJC Scopus subject areas

  • Surgery

Cite this

Portal Vein Thrombosis in Cirrhosis with Variceal Hemorrhage. / Orloff, Marshall J.; Orloff, Mark S.; Orloff, Susan; Girard, Barbara.

In: Journal of Gastrointestinal Surgery, Vol. 1, No. 2, 03.1997, p. 123-131.

Research output: Contribution to journalArticle

Orloff, MJ, Orloff, MS, Orloff, S & Girard, B 1997, 'Portal Vein Thrombosis in Cirrhosis with Variceal Hemorrhage', Journal of Gastrointestinal Surgery, vol. 1, no. 2, pp. 123-131.
Orloff, Marshall J. ; Orloff, Mark S. ; Orloff, Susan ; Girard, Barbara. / Portal Vein Thrombosis in Cirrhosis with Variceal Hemorrhage. In: Journal of Gastrointestinal Surgery. 1997 ; Vol. 1, No. 2. pp. 123-131.
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title = "Portal Vein Thrombosis in Cirrhosis with Variceal Hemorrhage",
abstract = "Organized thrombus in the main trunk of the portal vein was encountered in 85 (6.5{\%}) of 1300 patients with cirrhosis and variceal hemorrhage who underwent direct portacaval shunt (PCS). The thrombus was successfully removed with restoration of portal blood flow in all patients by phlebothrombectomy and balloon catheter extraction. Of the 85 patients, 65 were among 400 unselected patients who underwent emergency PCS (16{\%}), and 20 were among 900 selected patients who underwent elective PCS (2{\%}). All patients were closely followed for at least 5 years. Patients with portal vein thrombosis (PVT) had more advanced liver disease than those without PVT, reflected preoperatively in significantly higher (P 3 (92{\%}), and placement in Child's class C (52{\%}). Side-to-side PCS reduced the portal vein-inferior vena cava pressure gradient to a mean of 23 mm saline solution in patients with PVT, similar to the marked pressure reduction obtained in patients without PVT. PCS promptly stopped variceal bleeding in all patients in the emergency PCS group. Permanent prevention of recurrent variceal bleeding was successful in 95{\%} of patients with PVT and more than 99{\%} of patients without PVT. Survival rates were similar in patients with and without PVT. In patients with PVT, survival rates at 30 days and 1, 5, 10, and 15 years following emergency PCS were 69{\%}, 66{\%}, 65{\%}, 55{\%}, and 51{\%}, respectively, and following elective PCS were 95{\%}, 90{\%}, 70{\%}, 65{\%}, and 60{\%}, respectively. Quality of life was similar in patients with and without PVT. Long-term PCS patency was demonstrated yearly in 93{\%} of patients in the group with PVT and in 99.7{\%} of patients without PVT. Other similarities after 5 years between patients with and without PVT, respectively, were the incidences of recurrent encephalopathy (9{\%} vs. 8{\%}), alcohol abstinence (61{\%} vs. 64{\%}), improved liver function (68{\%} vs. 62{\%} to 75{\%}), and return to work (52{\%} vs. 56{\%} to 64{\%}). It was concluded that in patients with cirrhosis and variceal hemorrhage it is almost always possible to remove portal vein thrombus by means of phlebothrombectomy and then perform a direct PCS with results similar to those achieved in the absence of PVT.",
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N2 - Organized thrombus in the main trunk of the portal vein was encountered in 85 (6.5%) of 1300 patients with cirrhosis and variceal hemorrhage who underwent direct portacaval shunt (PCS). The thrombus was successfully removed with restoration of portal blood flow in all patients by phlebothrombectomy and balloon catheter extraction. Of the 85 patients, 65 were among 400 unselected patients who underwent emergency PCS (16%), and 20 were among 900 selected patients who underwent elective PCS (2%). All patients were closely followed for at least 5 years. Patients with portal vein thrombosis (PVT) had more advanced liver disease than those without PVT, reflected preoperatively in significantly higher (P 3 (92%), and placement in Child's class C (52%). Side-to-side PCS reduced the portal vein-inferior vena cava pressure gradient to a mean of 23 mm saline solution in patients with PVT, similar to the marked pressure reduction obtained in patients without PVT. PCS promptly stopped variceal bleeding in all patients in the emergency PCS group. Permanent prevention of recurrent variceal bleeding was successful in 95% of patients with PVT and more than 99% of patients without PVT. Survival rates were similar in patients with and without PVT. In patients with PVT, survival rates at 30 days and 1, 5, 10, and 15 years following emergency PCS were 69%, 66%, 65%, 55%, and 51%, respectively, and following elective PCS were 95%, 90%, 70%, 65%, and 60%, respectively. Quality of life was similar in patients with and without PVT. Long-term PCS patency was demonstrated yearly in 93% of patients in the group with PVT and in 99.7% of patients without PVT. Other similarities after 5 years between patients with and without PVT, respectively, were the incidences of recurrent encephalopathy (9% vs. 8%), alcohol abstinence (61% vs. 64%), improved liver function (68% vs. 62% to 75%), and return to work (52% vs. 56% to 64%). It was concluded that in patients with cirrhosis and variceal hemorrhage it is almost always possible to remove portal vein thrombus by means of phlebothrombectomy and then perform a direct PCS with results similar to those achieved in the absence of PVT.

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