内脏或内脏静脉血栓形成(VVT)是非典型的血栓形成实体,包括门静脉血栓形成,肝静脉(布加综合征),肠系膜静脉,和脾静脉.所有VVT均具有高达20%的高30天死亡率,并且由于其稀有性和广泛的非特异性症状,因此似乎难以早期诊断VVT。VVT通常与骨髓增殖性肿瘤有关,血栓形成倾向,和肝硬化。VVT主要通过超声和/或计算机断层扫描来诊断。与静脉血栓栓塞相反,D-二聚体测试既没有建立也没有帮助。对于循环稳定且无器官并发症的患者,抗凝治疗是一线治疗。抗凝显著提高再通率并阻止血栓形成的进展。低分子量肝素,维生素K拮抗剂,以及直接作用的口服抗凝剂是可能的抗凝剂,但值得注意的是,所有支持标签外使用抗凝剂的建议都是基于不良证据,主要包括病例系列,观察性研究,或病例数很少的研究。当选择合适的抗凝药时,必须非常仔细地权衡出血和血栓形成的个体风险.在出血的情况下,肠梗塞,或其他并发症,最佳治疗应该由经验丰富的多学科团队根据具体情况确定,该团队由一名外科医生参与.除了抗凝,有治疗选择,包括血栓切除术,球囊血管成形术,支架,经颈静脉放置肝内门体分流术,肝移植,和缺血性肠切除术.本文概述了当前的诊断和治疗策略。
Splanchnic or visceral vein thromboses (VVTs) are atypical thrombotic entities and include thrombosis of the portal vein, hepatic veins (Budd-Chiari syndrome), mesenteric veins, and splenic vein. All VVTs have in common high 30-day mortality up to 20% and it seems to be difficult to diagnose VVT early because of their rarity and their wide spectrum of unspecific symptoms. VVTs are often associated with myeloproliferative neoplasia, thrombophilia, and liver cirrhosis. VVT is primarily diagnosed by sonography and/or computed tomography. In contrast to venous thromboembolism, D-dimer testing is neither established nor helpful. Anticoagulation is the first-line therapy in patients with stable circulation and no evidence of organ complications. Anticoagulation improves significantly recanalization rates and stops the progress of thrombosis. Low-molecular-weight heparin, vitamin K antagonists, as well as direct-acting oral anticoagulants are possible anticoagulants, but it is noteworthy to be aware that all recommendations supporting the off-label use of anticoagulants are based on poor evidence and consist predominantly of case series, observational studies, or studies with small case numbers. When choosing a suitable anticoagulation, the individual risk of bleeding and thrombosis must be weighted very carefully. In cases of bleeding, bowel infarction, or other complications, the optimal therapy should be determined on a case-by-case basis by an experienced multidisciplinary team involving a surgeon. Besides anticoagulation, there are therapeutic options including thrombectomy, balloon angioplasty, stenting, transjugular placement of an intrahepatic portosystemic shunt, liver transplantation, and ischemic bowel resection. This article gives an overview of current diagnostic and therapeutic strategies.