Abstract
Background
Intra-abdominal surgery is a cause of portal vein thrombosis; however, postsurgical
portal vein thrombosis has not been extensively described.
Methods
This is a retrospective study of 107 patients with postsurgical portal vein thrombosis
followed for a median 25 months (interquartile range 11–51). Outcomes were complete
radiographic resolution of portal vein thrombosis and development of clinical portal
hypertension.
Results
Surgeries associated with portal vein thrombosis included colectomy (n = 42), bariatric surgery (n = 25), and splenectomy (n = 11). Presentations were nonspecific, typically characterized by abdominal pain.
Sixty-three patients (59%) achieved complete radiographic resolution. On univariable
analysis, provoking surgery, occlusivity of portal vein thrombosis, and anticoagulant
used were associated with complete radiographic resolution. Colectomy was associated
with a complete radiographic resolution rate of 30/42 (71%), bariatric 10/25 (40%),
splenectomy 2/11 (18%), and other 21/29 (72%), (log rank P = .0033). Nonocclusive thrombus was associated with a complete radiographic resolution
rate of 44/62 (71%), occlusive thrombus 19/45 (42%), (log rank P = .0101). Direct oral anticoagulants were associated with a complete radiographic
resolution rate of 27/35 (77%), enoxaparin 20/29 (69%), warfarin 14/31 (45%), and
no anticoagulant 2/12 (17%), (log rank P = .0002). On multivariable analysis, only anticoagulant choice was significantly
associated with complete radiographic resolution. Using direct oral anticoagulants
as reference, no anticoagulant yielded an adjusted hazard ratio of 0.10 for complete
radiographic resolution (95% confidence interval 0.023–0.44), warfarin 0.40 (95% confidence
interval 0.20–0.78), and enoxaparin 0.64 (95% confidence interval 0.49–1.60). Failure
to achieve complete radiographic resolution was associated with greater risk of future
clinical portal hypertension. Twenty-three patients (21%) went on to develop clinical
portal hypertension; 20 who failed to achieve complete radiographic resolution (45%),
and only 3 who achieved complete radiographic resolution (5%), (log rank P < .0001).
Conclusion
The natural history of postsurgical portal vein thrombosis is variable and influenced
by type of surgery, degree of occlusion, and, most notably, type of anticoagulant
used. Failure to recanalize the portal vein carries considerable risk of future clinical
portal hypertension.
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Article info
Publication history
Published online: December 24, 2020
Accepted:
November 8,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
