Chronic Mesenteric Venous Thrombosis: Evaluation and Determinants of Survival During Long-Term Follow-up

• Published in: Clinical gastroenterology and hepatology Vol. 5; no. 1; pp. 80 - 86
• Main Authors: Orr, David W, Harrison, Phillip M, Devlin, John, Karani, John B, Kane, Pauline A, Heaton, Nigel D, O’Grady, John G, Heneghan, Michael A
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2007
• Subjects: 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; Gastroenterology and Hepatology; Gastrointestinal Hemorrhage - mortality; Gastrointestinal Hemorrhage - therapy; Humans; Hyperbilirubinemia - complications; Ligation; London - epidemiology; Male; Mesenteric Vascular Occlusion - drug therapy; Mesenteric Vascular Occlusion - etiology; Mesenteric Vascular Occlusion - mortality; Mesenteric Veins; Middle Aged; Multivariate Analysis; Serum Albumin - analysis; Survival Rate; Venous Thrombosis - drug therapy; Venous Thrombosis - etiology; Venous Thrombosis - mortality; Warfarin - therapeutic use; London; MPD; portal vein; extrahepatic portal vein thrombosis; esophageal varices; OR; EHPVT; CI; PV; odds ratio; PSM; MRV; CT; EV; magnetic resonance venography; portomesenteric; myeloproliferative; superior mesenteric vein; confidence interval; computerized tomography; EVBL; portosplenomesenteric; PM; SMV; endoscopic variceal band ligation
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2006.09.030

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 β-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 β-blockers and anticoagulation appears to improve outcome.