Ann Surg Treat Res.  2019 May;96(5):230-236. 10.4174/astr.2019.96.5.230.

Analysis of risk factors for portal vein thrombosis after liver resection

• Han JH
• Kim DS
• Yu YD
• Jung SW
• Yoon YI
• Jo HS

• KMID: 2443586
• DOI: http://doi.org/10.4174/astr.2019.96.5.230

Abstract

PURPOSE
We evaluated the risk factors for posthepatectomy thrombosis including portal vein thrombosis (PVT) and clinical outcomes.
METHODS
We retrospectively analyzed 563 patients who had undergone hepatectomy from February 2009 to December 2014. Twenty-nine patients with preoperatively confirmed thrombosis and tumor recurrence-related thrombosis were excluded. We identified the location of the thrombosis as main portal vein (MPV), peripheral portal vein (PPV) and other site such as hepatic vein or inferior vena cava. Patients with MPV thrombosis and PPV thrombosis with main portal flow disturbance were treated with anticoagulation therapy. We performed operative thrombectomy before anticoagulation therapy who did combined portal vein (PV) segmental resection.
RESULTS
Of the 534 patients, 22 (4.1%) developed posthepatectomy thrombosis after hepatectomy. Among them, 19 (86.4%) had PVT. The mean duration of Pringle's maneuver was significant longer in the PVT group than the no-thrombosis group (P = 0.020). Patients who underwent combined PV segmental resection during hepatectomy were more likely to develop posthepatectomy PVT (P = 0.001). Thirteen patients who had MPV thrombosis and PPV thrombosis with main portal flow disturbance received anticoagulation therapy immediately after diagnosis and all of them were improved. Among them, 2 patients who developed PVT at the PV anastomosis site after PV segmental resection, underwent operative thrombectomy before anticoagulation therapy and both were improved. There were no patients who developed complications related to anticoagulation therapy.
CONCLUSION
Long duration of Pringle's maneuver and PV segmental resection were risk factors. Anticoagulation therapy or operative thrombectomy should be considered for PVT without contraindications.

Keyword

Hepatectomy; Portal vein; Thrombosis; Risk factors; Treatment outcome

MeSH Terms

Diagnosis
Hepatectomy
Hepatic Veins
Humans
Liver*
Portal Vein*
Retrospective Studies
Risk Factors*
Thrombectomy
Thrombosis
Treatment Outcome
Vena Cava, Inferior
Venous Thrombosis*

Figure

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  Fig. 1 (A) Main portal vein thrombosis was discovered on the third day after hepatectomy and (B) it was disappeared after 8 months of anticoagulation therapy.

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  Fig. 2 (A) Peripheral portal vein thrombosis was discovered on the first week after hepatectomy and (B) it was disappeared after 3 months of anticoagulation therapy.

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