Being such a rare vascular entity its management should be reserved to high-volume tertiary hepato-biliary centres.Ĭopyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Aneurysmectomy and aneurysmorrhaphy are considered in patients with normal liver, while shunt procedures or liver transplantation are the treatment of choice in case of portal hypertension. Surgical indication is considered in case of rupture, thrombosis or symptomatic aneurysms. It can be congenital or acquired and portal hypertension represents the main cause of the acquired version. Portal vein aneurysm is defined as a portal vein diameter exceeding 1.9cm in cirrhotic patients and 1.5cm in normal livers. All articles published from 1956 to 2014 were examined for a total of 96 reports, including 190 patients.
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A systematic literature search of the Pubmed database was performed for all articles related to portal vein aneurysm. The aim of this article is to provide an overview of the international literature to better clarify various aspects of this rare nosological entity and provide clear evidence-based summary, when available, of the clinical and surgical management. Portal vein aneurysm is an unusual vascular dilatation of the portal vein, which was first described by Barzilai and Kleckner in 1956 and since then less than 200 cases have been reported. Portal vein aneurysms present a diagnostic challenge for any surgeon, and the goal for surgical therapy is based on repairing the portal vein aneurysm, and if portal hypertension is present decompressing via surgically constructed shunts. While asymptomatic aneurysms less than 3 cm can be clinically observed, surgical intervention may be necessary in large asymptomatic aneurysms (>3 cm) with or without thrombus, or small aneurysms with evidence of evolving mural thrombus formation on imaging. The rising prevalence of abdominal imaging in clinical practice has increased rates of portal vein aneurysm detection. We reviewed the existing literature as well as present a unique anecdotal case of a patient presenting with a very large portal vein aneurysm that was successfully managed conservatively and non-operatively without anticoagulation, with close follow-up and routine surveillance. Portal vein aneurysms are rare dilations in the portal venous system, for which the etiology and pathophysiological consequences are poorly understood. Portal pressure measurement is helpful for predicting the patient's clinical outcome. Portal pressure after PARTO was a significant risk factor for EV deterioration. Liver function was improved over the 6-month follow-up period. The artificial blockade of the portosystemic shunt evidently leads to an increase in HVPG.
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Post-PARTO portal pressure was a risk factor affecting EV deterioration (HVPG-post: odds ratio, 1.341 95% confidence interval, 1.017 to 1.767 p=0.037).
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No factor associated with portal pressure was affected by liver function improvement.
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Twenty-five patients with portal pressure measured before and after PARTO were evaluated for risk factors affecting liver function improvement and EV deterioration. Among these 54 patients, 25 patients were evaluated for their hepatic venous pressure gradient (HVPG) before and after PARTO (change from 12.52☓.83 to 14.68±5.03 mm Hg p<0.001). The analysis of 54 patients showed improvement in liver function during the 6-month follow-up period (Model for End-Stage Liver Disease score: change from 11.46±4.35 to 10.33☒.96, p=0.021). The parameters collected included liver function and episodes of cirrhotic complications before and at 1 and 6 months after PARTO. The aim of this study was to determine the changes in portal pressure and the associated changes in liver function, ascites, hepatic encephalopathy, and especially esophageal varix (EV) after PARTO.įrom March 2012 to February 2018, 54 patients who underwent PARTO were analyzed retrospectively. It is not clear whether portal pressure and the incidence of complications increase after PARTO. Plug-assisted retrograde transvenous obliteration (PARTO) is widely used to manage gastric varices with a portosystemic shunt.