Department of Radiology, Loyola University Medical Center, Maywood, IL, USA.
Department of Imaging, Cleveland Clinic Florida, Weston, FL, USA.
Curr Gastroenterol Rep. 2021 Oct 15;23(12):24. doi: 10.1007/s11894-021-00826-1.
Portal vein thrombosis (PVT) is a frequent consequence of cirrhosis and its management is variable and controversial. Herein we highlight interventional treatment options and outcomes, together with mention of the physiology, presentation and imaging of PVT.
Utilization of transjugular intrahepatic portosystemic shunt (TIPS) for acute and chronic PVT is expanding. In acute PVT, TIPS improves hepatopetal flow which promotes thrombus resorption and prevents rethrombosis. The TIPS also functions as a conduit for thrombectomy devices and allows for embolization of variceal shunts. Chronic PVT is a relative contraindication to liver transplant. Portal vein recanalization (PVR) TIPS restores flow in a previously occluded portal vein, allowing for a conventional end-to-end portal vein anastomosis at transplant. PVR TIPS is technically demanding and often requires percutaneous splenic vein access for portal venous recanalization. Selection of endovascular PVT treatment varies with the age (acute or chronic) and the extent of thrombus, along with presenting symptoms and transplant candidacy.
门静脉血栓形成（PVT）是肝硬化的常见后果，其治疗方法多样且存在争议。本文重点介绍了介入治疗的选择和结果，并提及了 PVT 的生理学、表现和影像学。
经颈静脉肝内门体分流术（TIPS）在急性和慢性 PVT 中的应用正在扩大。在急性 PVT 中，TIPS 改善了向肝血流，促进血栓吸收并防止再血栓形成。TIPS 还可作为血栓切除术器械的通道，并允许栓塞静脉曲张分流。慢性 PVT 是肝移植的相对禁忌症。门静脉再通（PVR）TIPS 可恢复先前闭塞门静脉的血流，使移植时可进行常规端端门静脉吻合。PVR TIPS 技术要求较高，通常需要经皮脾静脉入路进行门静脉再通。血管内 PVT 治疗的选择取决于血栓的年龄（急性或慢性）和程度，以及临床表现和移植候选资格。
