A MULTIDISCIPLINARY APPROACH FOR THE MANAGEMENT OF PORTAL VENOUS THROMBOSIS

Saturday, February 11, 2023

3:00pm – 4:00pm East Coast USA Time

Principal Contact(s)

MM

Maryann Mbaka, MD

Assistant Professor - Department of Surgery
University of South Alabama Medical Center, United States

Presenter(s)

Kyle Sheppard, MD

PGY 1 Surgery Resident
University of South Alabama Medical Center, United States

Objectives: Portal Venous Thrombosis (PVT) can be characterized as either acute or chronic depending on the presence of collateral venous circulation that bypasses the thrombus. Typically, PVT is seen in patients with a history of cirrhosis, hypercoagulable states such as malignancy, or prothrombotic states. Mainstay of treatment is early initiation of anticoagulation. Role and timing of thrombectomy and thrombolysis is not well-established. These cases give insight into the impact of endovascular treatment in patients with PVT not responsive to anticoagulation.

Methods: Case 1: The first patient is a 49 y/o female with a past medical history of hypertension who initially presented to an outside hospital with generalized weakness and intermittent abdominal pain. She was diagnosed with PVT on imaging. She required anticoagulation, and interventional radiology involvement when clot failed to resolve.

Case 2: The second patient is a 65 y/o woman with a past medical history of cerebral artery aneurysm, hypertension, IBS, GERD, and diverticulosis who presented to the emergency room with severe abdominal pain associated with nausea and decreased appetite. She was initially started on a heparin infusion. In addition to abdominal exploration, she underwent a thrombectomy by Interventional Radiology (IR).

Results: PVT is a relatively uncommon disease that occurs most frequently in patients with cirrhosis. It can also occur in patients with prothrombotic states such as myeloproliferative disorders. Malignancy is another common cause of PVT responsible for 21-24% of overall cases of PVT. Although the use of anticoagulation in the treatment of PVT is well established, the role and timing of thrombectomy and thrombolysis is more controversial.

Conclusion: Both patients developed bowel ischemia at the time of presentation that increased their morbidity. These patients required a combination of endovascular and surgical interventions to manage their thrombosis.