Lima da Rocha Renan Danilo, Diniz Paulo Inácio Alves Ramos, Leão Alessandra Góes, Rodriguez Juan Eduardo Rios, Campelo Priscilla Ribeiro Dos Santos, Souza José Emerson Dos Santos, Bernardes Marcos Velludo, Cavalcante Leonardo Pessoa
Federal University of Amazonas, Getúlio Vargas University Hospital, Vascular Surgery Division, Manaus, AM, Brazil.
Heart Hospital Foundation Francisca Mendes, Vascular and Endovascular Surgery Division, Manaus, AM, Brazil.
Ann Med Surg (Lond). 2022 Sep 2;81:104527. doi: 10.1016/j.amsu.2022.104527. eCollection 2022 Sep.
Chronic extrahepatic non-tumoral thrombotic portal vein occlusion in non-cirrhotic patients is a rare condition, affecting 5-10% of patients with portal hypertension
The present study reports the case of a young patient without previous comorbidities who presented with portal hypertension secondary to chronic extrahepatic non-tumoral thrombotic occlusion of the portal vein. He underwent portal recanalization with a 12 × 80 mm nitinol self-expandable stent and embolization of esophagogastric varices with fibrous springs and cyanoacrylate via transparieto-hepatic access. Immediate resolution of the -lesion pressure gradient was obtained transoperatively, while complete remission of esophagogastric varices was verified by endoscopic control during outpatient follow-up.
Chronic portal vein occlusion is associated or not with liver cirrhosis. The chronic phase is characterized by cavernomatous transformation of the portal vein, which consists of the formation of multiple collaterals that bypass the lesion. This phase usually courses with portal hypertension and consequent variceal gastrointestinal bleeding. Decompression of the portal system through direct recanalization (angioplasty with stenting) is one therapeutic options.
We conclude that, in the present case, resolving portal hypertension by direct portal recanalization was a good therapeutic option, as it decompressed the portal system while maintaining the hepatopetal flow.
非肝硬化患者的慢性肝外非肿瘤性血栓形成门静脉闭塞是一种罕见疾病，影响5% - 10%的门静脉高压患者。
本研究报告了一例无既往合并症的年轻患者，该患者因慢性肝外非肿瘤性门静脉血栓形成闭塞继发门静脉高压。他接受了门静脉再通术，使用12×80毫米镍钛诺自膨式支架，并通过经皮肝穿刺途径用纤维弹簧和氰基丙烯酸酯栓塞食管胃静脉曲张。术中病变压力梯度立即得到缓解，门诊随访期间通过内镜检查证实食管胃静脉曲张完全缓解。
慢性门静脉闭塞与肝硬化有关或无关。慢性期的特征是门静脉海绵样变性，由绕过病变形成的多个侧支组成。此阶段通常伴有门静脉高压及随之而来的胃肠道静脉曲张出血。通过直接再通（血管成形术加支架置入）对门静脉系统进行减压是一种治疗选择。
我们得出结论，在本病例中，通过直接门静脉再通解决门静脉高压是一种良好的治疗选择，因为它在维持向肝血流的同时减压了门静脉系统。
