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Patterns of portal vein occlusion and their aetiological significance
M D Stringer1, N D Heaton, J Karani
1Department of Surgery, King's College Hospital, London, UK.
Insights
Portal vein occlusion patterns were classified in 53 patients, revealing distinct etiological links. Congenital factors were common in main portal vein occlusion, while sepsis correlated with specific patterns sparing the splenic vein.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Radiology
Background:
- Portal vein occlusion is a significant vascular condition with diverse causes.
- Understanding the patterns of occlusion is crucial for diagnosis and management.
Purpose of the Study:
- To investigate the relationship between the pattern of portal vein occlusion and its underlying etiology.
- To classify different patterns of portal vein occlusion based on clinical and angiographic findings.
Main Methods:
- Retrospective review of clinical and angiographic data from 53 patients with portal vein occlusion.
- Classification of patients into five distinct patterns of venous occlusion.
Main Results:
- Five patterns of portal vein occlusion were identified.
- Idiopathic intrahepatic portal vein occlusion (hepatoportal sclerosis) was observed in three children.
- Main portal vein occlusion, often congenital, affected 25 patients.
- Occlusion of the main portal and superior mesenteric veins, with splenic vein sparing, was linked to intra-abdominal sepsis in ten patients.
- Widespread portal venous thrombosis occurred in 15 patients, associated with hypercoagulable states and other thromboses.
Conclusions:
- The pattern of portal vein occlusion is strongly associated with its etiology.
- Distinct patterns correlate with congenital factors, sepsis, and hypercoagulable states.
- Classification aids in understanding the pathogenesis and clinical implications of portal vein occlusion.
Abstract:
Clinical and angiographic findings in 53 patients with portal vein occlusion were reviewed to determine the relationship between the pattern of venous occlusion and its aetiology. Five major patterns were identified. Group 1 comprised three children with idiopathic intrahepatic portal vein occlusion alone (hepatoportal sclerosis). Those in group 2 (25 patients), with occlusion of the main portal vein, accounted for almost half the total number and for most of those with a probable congenital aetiology. The ten patients in group 3 had angiographic occlusion and collateralization of the main portal and superior mesenteric veins. Intra-abdominal sepsis, other than that from pancreatic disease, was associated with this pattern of venous occlusion in which the splenic vein is spared. No patients with isolated portal and splenic vein occlusion (group 4) were recorded. Widespread thrombosis throughout the portal venous system (group 5; 15 patients) had a multifactorial aetiology but was typically observed in hypercoagulable states that were also associated with hepatic vein occlusion or other deep vein thromboses.