Chronic portal vein thrombosis: transcapsular hepatic collateral vessels and communicating ectopic varices.

Marcus Seeger, Rainer Günther, Holger Hinrichsen, Marcus Both, Ulf Helwig, Alexander Arlt, Birte Stelck, Jan H Bräsen, Bence Sipos, Clemens Schafmayer, Felix Braun, Dieter C Bröring, Stefan Schreiber, Jochen Hampe
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Radiology : an index of 35 journals ; diagnost. radiology, nuclear medicine, ultrasound, magnetic resonance imaging and radiation therapy
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Transcapsular collaterals frequently occur in patients with chronic PVT due to hepatobilary surgery or necrotizing pancreatitis. They are associated with ectopic varices; therefore, awareness of transcapsular collaterals in this patient subgroup will help to localize ectopic varices as potential bleeding source.To assess patients with chronic portal vein thrombosis (PVT) with respect to transcapsular collateral veins, the communication between these veins and ectopic varices, and the cause of PVT.This study was approved by the institutional review committees, and written informed consent was obtained. From November 2003 to March 2008, 145 consecutive patients with chronic PVT due to a variety of causes were assessed for transcapsular collaterals and ectopic varices with ultrasonography (US). Analysis of contingency tables was performed with the Fisher exact test.Transcapsular collaterals were detected in 15 (10.3%) of 145 patients with chronic PVT. They were restricted to patients with a history of hepatobilary surgery, severe pancreatitis, or abdominal surgery (n = 21) and were not detected in patients with liver cirrhosis, systemic coagulopathy, extrahepatic malignancy, idiopathic PVT, chronic pancreatitis, or infectious or inflammatory diseases (n = 124) (P < .001). Ectopic varices were infrequent in 70 patients with liver cirrhosis (n = 2, 3%) but were common in 14 patients with PVT after hepatobiliary surgery (n = 9, 64%) (P < .001, odds ratio = 21.4). Direct communication between transcapsular collaterals and ectopic varices was visible in all nine patients in this cohort. In eight of these patients, ectopic varices were found to be the bleeding source in gastrointestinal hemorrhage.