Portal Vein Thrombosis

Portal vein thrombosis (PVT) is often associated with thrombophilic disorder(s), warranting an extensive thrombophilic work-up.

Anticoagulation should be initiated promptly to address PVT.  Radiological interventions are recommended for those with portal hypertension complications or persistent symptoms. These interventions, while safe and successful in expert hands, are not yet widely standardized.

Portal vein recanalization, combined with transjugular intrahepatic portosystemic shunt (TIPS), improves outcomes in controlling refractory bleeding compared to recanalization without TIPS.

It is advisable to avoid portal vein stent placement in patients undergoing TIPS if they are considered transplant candidates.

Portal vein recanalization may be considered in acute symptomatic PVT with persistent symptoms despite adequate anticoagulation. It is also an option in acute symptomatic PVT with persistent thrombus if the main portal vein is thrombosed despite adequate anticoagulation, but the primary and secondary branches of the portal vein are patent, even in the presence of mild symptoms.

Prompt therapy is associated with good outcomes in PVT cases.