Treatment of Acute Portal Vein Thrombosis

[Dr. Benjamin May]
Anytime I think about thrombosis on the venous side, you think about inflow and outflow. Obviously most people are familiar, in the legs or the systemic venous system, portal system in some ways is no different. We have inflow from the intestines, inflow from the spleen, outflows to the liver. When that's occluded, especially acutely, you can have problems in those organs, in particular the bowels. The dreaded complication after portal vein, acute portal vein thrombosis is bowel ischemia and infarction and can lead to death. That's on the acute side.

If it's untreated and becomes chronic, then you have all the sequelae of chronic mesenteric hypertension. Varices, even if you get through that acute phase, if you don't open up the portal vein, those mesenteric vessels are going to be under pressure, they're going to be forming collaterals, varices within the small bowel, which are incredibly hard to treat, ascites, pain after eating, it's miserable. If they do become or are transplant candidates, keeping that portal vein open is obviously very important for transplant candidacy. We can avoid those chronic sequelae. It's a huge plus and prevent, of course, some of the more acute dreaded complications like bowel infarction.