Extrahepatic portal vein thrombosis: aetiology and determinants of survival

Abstract

Background: Malignancy, hypercoagulability, and conditions leading to decreased portal flow have been reported to contribute to the aetiology of extrahepatic portal vein thrombosis (EPVT). Mortality of patients with EPVT may be associated with these concurrent medical conditions or with manifestations of portal hypertension, such as variceal haemorrhage.

Patients and methods: To determine which variables have prognostic significance with respect to survival, we performed a retrospective study of 172 adult EPVT patients who were followed over the period 1984-1997 in eight university hospitals.

Results: Mean follow up was 3.9 years (range 0.1-13.1). Overall survival was 70% (95% confidence interval (CI) 62-76%) at one year, 61% (95% CI, 52-67%) at five years, and 54% (95% CI, 45-62%) at 10 years. The one, five, and 10 year survival rates in the absence of cancer, cirrhosis, and mesenteric vein thrombosis were 95% (95% CI 87-98%), 89% (95% CI 78-94%), and 81% (95% CI 67-89%), respectively (n=83). Variables at diagnosis associated with reduced survival according to multivariate analysis were advanced age, malignancy, cirrhosis, mesenteric vein thrombosis, absence of abdominal inflammation, and serum levels of aminotransferase and albumin. The presence of variceal haemorrhage and myeloproliferative disorders did not influence survival. Only four patients died due to variceal haemorrhage and one due to complications of a portosystemic shunt procedure.

Conclusion: We conclude that mortality among patients with EPVT is related primarily to concurrent disorders leading to EPVT and not to complications of portal hypertension.

Figure 1

Actuarial survival of 172 patients with extrahepatic portal vein thrombosis. Number of patients at risk during follow up are shown along the x axis.

Figure 2

Actuarial survival rates for patients with extrahepatic vein thrombosis without cirrhosis and cancer (patients at risk n=98, n=47, and n=17 after 0, 5, and 10 years of follow up, respectively), for patients with cirrhosis but no cancer (patients at risk n=33, n=9, and n=3 after 0, 5 and 10 years of follow up, respectively), and for patients with cancer (patients at risk n=41 and n=3 after 0 and 5 years of follow up, respectively).