ABSTRACT
BACKGROUND & AIMS: The natural history of chronic portomesenteric (PM) and portosplenomesenteric (PSM) venous thrombosis is defined poorly. Therapeutic options are limited, and are directed at the prevention of variceal bleeding and the control of abdominal pain related to gastrointestinal hyperemia. METHODS: Patients with extensive PM and PSM thrombosis were reviewed retrospectively to evaluate the efficacy of medical therapy and to determine which clinical variables had prognostic significance regarding long-term survival. RESULTS: Sixty patients, with a median age at diagnosis of 44 years (range, 18-68 y), were assessed. The median follow-up period was 3.5 years (range, 0.2-32.0 y). The overall survival rate was 73.3%, with 1- and 5-year survival rates of 81.6%, and 78.3%, respectively. One- and 5-year survival rates, excluding patients who died from malignancy-related causes, were 85.7% and 82.1%, respectively. Factors associated with improved survival included treatment with beta-blockers (P = .02; odds ratio [OR], .09; 95% confidence interval [CI], 0.01-0.70) and anticoagulation (P = .005; OR, 0.01; 95% CI, <0.01 to 0.26). Eighteen patients in total were anticoagulated, including 8 patients who had variceal bleeding, all of whom underwent endoscopic band ligation of esophageal varices before anticoagulation. By using Cox regression analysis, variables associated with reduced survival were the presence of ascites (P = .001; OR, 42.6; 95% CI, 5.03-360), and hyperbilirubinemia (P = .01; OR, 13.8; 95% CI, 1.9-100) at presentation. Six patients died of variceal hemorrhage. CONCLUSIONS: Patients with chronic PM and PSM venous thrombosis without underlying malignancy have an acceptable long-term survival. Treatment with beta-blockers and anticoagulation appears to improve outcome.
Subject(s)
Mesenteric Vascular Occlusion/mortality , Mesenteric Veins , Survival Rate , Venous Thrombosis/mortality , Adolescent , Adrenergic beta-Antagonists/therapeutic use , Adult , Aged , Anticoagulants/therapeutic use , Ascites/complications , Chronic Disease , Esophageal and Gastric Varices/mortality , Esophageal and Gastric Varices/therapy , Female , Follow-Up Studies , Gastrointestinal Hemorrhage/mortality , Gastrointestinal Hemorrhage/therapy , Humans , Hyperbilirubinemia/complications , Ligation , London/epidemiology , Male , Mesenteric Vascular Occlusion/drug therapy , Mesenteric Vascular Occlusion/etiology , Middle Aged , Multivariate Analysis , Serum Albumin/analysis , Venous Thrombosis/drug therapy , Venous Thrombosis/etiology , Warfarin/therapeutic useSubject(s)
Heart Neoplasms/diagnosis , Magnetic Resonance Imaging , Pericardium/pathology , Teratoma/diagnosis , Adult , Blood Pressure , Chest Pain/etiology , Dyspnea/etiology , Heart Neoplasms/physiopathology , Humans , Jugular Veins , Male , Pericardial Effusion/etiology , Pulmonary Artery/physiopathology , Teratoma/physiopathologyABSTRACT
Radiology is a key specialty within a liver transplant program. Interventional techniques not only contribute to graft and recipient survival but also allow appropriate patient selection and ensure that recipients with severe liver decompensation, hepatocellular carcinoma or portal hypertension are transplanted with the best chance of prolonged survival. Equally inappropriate selection for these techniques may adversely affect survival. Liver transplantation is a dynamic field of innovative surgical techniques with a requirement for interventional radiology to parallel these developments. This paper reviews the current practice within a major European center for adult and pediatric transplantation.
