anesthesia for patient with portal vein thrombosis

Whether anesthesia type is associated with the surgical outcome of Hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) remains to be determined. This study aims to investigate the impact of volatile inhalational anesthesia (INHA) versus total IV anesthesia (TIVA) on the survival outcomes in HCC patients with PVTT.

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How is perianal vein thrombosis (Pvt) treated?

May 27, 2019 · This large retrospective study confirms that anticoagulation improves survival and is safe for cirrhotic patients who develop portal vein thrombosis. Prior studies have shown that anticoagulation is indicated for noncirrhotic patients with portal vein thrombosis (PVT), but the efficacy and safety of anticoagulation for cirrhotic patients with ...

Which medications are used in the treatment of portal vein thrombosis?

Background: Whether anesthesia type is associated with the surgical outcome of Hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) remains to be determined. This study aims to investigate the impact of volatile inhalational anesthesia (INHA) versus total IV anesthesia (TIVA) on the survival outcomes in HCC patients with PVTT.

What is portal vein thrombosis (Pvt)?

Mar 07, 2021 · In an Italian single‐center study, nine cirrhotic patients with recent PVT received a continuous intravenous infusion of recombinant tissue plasminogen activator with a dose of 0.25 mg/kg‧d −1 in combination with LMWH for a maximum duration of 7 days, of whom four achieved complete portal vein recanalization, four achieved partial portal vein recanalization, and the …

When is anticoagulation indicated in the treatment of pulmonary venous thrombosis (Pvt)?

Portal vein thrombosis is common in cirrhotic patients and results in increased morbidity and mortality. Transjugular intrahepatic portosystemic shunt (TIPS) creation is a well-established therapy for refractory variceal bleeding and refractory ascites in patients who do not tolerate repeated large volume paracentesis.

What is the treatment for portal vein thrombosis?

TREATMENT OF PORTAL VEIN THROMBOSIS [1,4] This is most often performed through continuous intravenous heparin infusion, but some authors report using low-molecular-weight heparin. Chronic treatment options include warfarin or low-molecular-weight heparin.

Why is tips contraindicated in portal vein thrombosis?

The potential concerns in performing TIPS in a patient with acute portal vein thrombosis would be increased technical difficulty in performing the procedure as there blood cannot be freely aspirated from the portal vein after the puncture, a gradient across the stent cannot always be established, and the risk for ...Sep 22, 2014

Is portal vein thrombosis a DVT?

Portal vein thrombosis (PVT) is a vascular disease of the liver that occurs when a blood clot occurs in the hepatic portal vein, which can lead to increased pressure in the portal vein system and reduced blood supply to the liver. The mortality rate is approximately 1 in 10....Portal vein thrombosisSpecialtyAngiology2 more rows

What are the complications of portal vein thrombosis?

Frequent complications were splenomegaly, oesophageal- and gastric varices with or without bleeding, portal hypertensive gastropathy and ascites. Varices and bleeding were more frequent in patients with chronic PVT. Patients who received anticoagulant therapy more frequently achieved partial/complete recanalization.Aug 15, 2007

What is TIP procedure?

Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure that involves inserting a stent (tube) to connect the portal veins to adjacent blood vessels that have lower pressure. This relieves the pressure of blood flowing through the diseased liver and can help stop bleeding and fluid back up.

Who is a candidate for a TIPS procedure?

Accepted indications for TIPS include the following: Uncontrolled variceal hemorrhage from esophageal, gastric, and intestinal varices that do not respond to endoscopic and medical management. Refractory ascites. Hepatic pleural effusion (hydrothorax)Jan 27, 2022

Is portal vein thrombosis painful?

Portal vein thrombosis (PVT) is a rare cause of abdominal pain, typically associated with cirrhosis or thrombophilia. The following describes the presentation of PVT in a young male, the search for risk factors and underlying etiology, and the debate of anticoagulation therapy.

How long can you live with portal vein thrombosis?

In adults with portal vein thrombosis, the 10-year survival rate has been reported to be 38-60%, with most of the deaths occurring secondary to the underlying disease (eg, cirrhosis, malignancy).

Is portal vein thrombosis an emergency?

Portal vein thrombosis (PVT) is a blood clot of the portal vein, also known as the hepatic portal vein. This vein allows blood to flow from the intestines to the liver. A PVT blocks this blood flow. Although PVT is treatable, it can be life-threatening.Oct 24, 2017

Can you live without a portal vein?

When the portal vein is absent, toxic metabolites such as ammonia and bile acids collected from the gastrointestinal tract have to bypass the liver directly drainage into the systemic circulation, thus may initiate hepatic encephalopathy.

What is the commonest cause of portal vein thrombosis?

The underlying causes of portal vein thrombosis (PVT) are frequently multifactorial and include malignancies, progressive chronic liver diseases, processes localized to the epigastrium and hepatobiliary system, and acquired as well as inherited thrombophilia.Dec 5, 2014

How long can you live with portal hypertension?

These complications result from portal hypertension and/or from liver insufficiency. The survival of both stages is markedly different with compensated patients having a median survival time of over 12 years compared to decompensated patients who survive less than 2 years (1, 3).Jun 11, 2012

What is open access?

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author (s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

What is Kaplan Meier method?

The Kaplan–Meier method was used to calculate the overall survival and recurrence-free survival of patients from the date of surgery to the date of events. A univariable Cox regression analysis was applied, and for variables with P less than 0.1 were then included into the multivariable model to identify risk factors.

What did XYM and WFY do?

XYM helped conduct the study, analyze the data, and write the manuscript; XPZ helped conduct the study, analyze the data, ZS and HQW helped revise the manuscript; WFY helped design the study and revise the manuscript. The author (s) read and approved the final manuscript.

Is TIVA better than INHA?

This retrospective analysis identifies that TIVA is associated with better outcomes compared with INHA. Future prospective studies clinical and translational studies are required to verify this difference and investigate underlying pathophysiology.

Is HCC anesthesia associated with PVTT?

Whether anesthesia type is associated with the surgical outcome of Hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) remains to be determined. This study aims to investigate the impact of volatile inhalational anesthesia (INHA) versus total IV anesthesia (TIVA) on the survival outcomes in HCC patients with PVTT.

Is IV anesthesia worse than INHA?

Currently, several researches reported that INHA was associated with worse postoperative outcomes compare to INHA in certain types of cancers. Dr. Wigmore et al. [ 1] did a retrospective analysis which firstly compared long-term survival in more than 7000 patients undergoing elective cancer surgeries, and reported that mortality of patients accepted INHA is approximately 50% greater than those accepted TIVA. Since then, more studies reported similar results in different cancers [ 2 ]. Besides from these clinical evidences, animal researches also reported that administration of volatile inhalational agents was associated with up-regulation of tumorigenic growth factors including hypoxia-inducible factors (HIFs) and insulin-like growth factor (IGF) [ 3, 4 ], which are highly associated with progression angiogenesis and cell proliferation in tumor.

What causes portal hypertension?

The most common cause in the Western world, accounting for around 90% of cases, is liver cirrhosis.

What is hepatic venography?

Hepatic venography (using contrast or carbon dioxide), often ultrasound-assisted by a second operator, is used to delineate the vascular anatomy of the liver and a communication between a branch of the hepatic venous and portal venous circulation is created by the cutting tip of the catheter under fluoroscopic control.

How does TIPS help with ascites?

TIPS provides symptomatic benefit and improves survival in patients with diuretic-resistant ascites which requires frequent paracentesis. 3 It confers a survival advantage when used for the control of variceal bleeding, 4 in which it can be used to control haemorrhage from oesophageal and gastric varices, and to prevent recurrence once initial control has been established. There are other uses for TIPS, which have limited supportive evidence (Table 2 ). Clinical outcomes, including mortality, after TIPS can be predicted using liver disease severity scores such as the model for end-stage liver disease or Child–Pugh scores. 5

What is TIPS insertion?

TIPS insertion requires expertise in interventional radiology and is usually performed in the angiography suite. Internal jugular vein cannulation allows passage of a catheter into the hepatic vein where wedge pressure is measured and HVPG calculated.

How long does it take for pulmonary oedema to develop after a pulmonary shunt?

The application of continuous positive airway pressure may also be considered in treating pulmonary oedema. A haemolytic anaemia may develop between 7 and 14 days post-procedure, due to mechanical shear stress on blood cells as they pass through the shunt. Encephalopathy occurs in up to 20% of patients after TIPS.

What is Conscious Sedation?

Conscious sedation can be used, using combinations of short-acting sedative agents that include midazolam, propofol, and remifentanil. Although sedation may avoid the need for general anaesthesia, many patients experience significant discomfort in the supine position for a prolonged period of time.

Which organs carry oxygenated blood?

Portal hypertension. The liver receives ∼25% of the cardiac output, via a dual blood supply. The hepatic arteries carry oxygenated blood via the aorta and coeliac axis, while the portal vein carries nutrient-rich blood from the gastrointestinal tract to process within the hepatic parenchyma.

What is the procedure for a portal vein thrombus?

An effective approach in these cases is a thrombendovenectomy. This technique is similar to a thrombo-endarterectomy : The intima is removed together with the clot. 1

What is a TIPS shunt?

The objective of transjugular intrahepatic portosystemic shunt (TIPS) is to recanalize the portal vein and, subsequently, prevent rethrombosis by restoring portal flow through a low-resistance shunt. It clearly appears that the feasibility of TIPS varies according to the extent of thrombosis. Technical failure may be related to the absence of visibility of intrahepatic branches of the portal vein, transformation of the portal vein into a fibrous cord, and extension of the thrombus to the SMV. TIPS may be feasible in some patients with cavernoma. Ideally, TIPS insertion and recanalization might be associated with disrupture of the thrombus and mechanical thrombectomy.