Diagnosis and Management of Acute and Chronic Portomesenteric Venous Thrombosis

Abstract

AbstractThrombosis of the portal and mesenteric veins is relatively uncommon. Thrombosis can be acute or chronic. Management is dictated by symptoms on clinical presentation. Acute symptomatic mesenteric vein thrombosis may require aggressive endovascular intervention with mechanical thrombectomy, thromboaspiration, infusion of thrombolytic drugs, TIPS creation or surgery. Chronic, symptomatic portal and mesenteric vein thrombosis usually requires recanalization of occluded segments and stent placement. The three main catheterization techniques for access into the portal venous system are: transhepatic, transjugular and trans-splenic. Evidence-based therapeutic strategies for acute and chronic portal and mesenteric vein thrombosis have not been established. There are no prospective comparative studies to support superiority of any given technique in the management of these conditions. The purpose of this review is to present an overview of the etiology, physiopathology, clinical presentation, and management of acute and chronic portal and mesenteric vein thrombosis.