Incidence and Management of Splanchnic Vein Thrombosis in Pancreatic Diseases

Abstract

Splanchnic vein thrombosis (SVT) in pancreatic disease has a 20%-30% incidence rate, leading to increased mortality and complication rates. Therefore, the aim of this review is to summarize recent evidence about the incidence, risk factors, and management of pancreatic cancer, pancreatic cystic neoplasm-, and pancreatitis-related SVT. Doppler ultrasound should be the first imaging choice, followed by contrast-enhanced computed tomography or magnetic resonance imaging. Data regarding SVT treatment in acute pancreatitis and pancreatic cancer are scarce; however, for venous thromboembolism treatment, direct oral anticoagulants and low molecular weight heparin have been effective. Further trials must investigate the length of anticoagulant treatment and the need for interventional radiological procedures.

Keywords: cancer; cystic; pancreas; pancreatitis; thrombosis.

FIGURE 1

Pancreatic cancer‐related risk factors of splanchnic vein thrombosis.

FIGURE 2

The pancreatic head tumor led to almost total obstruction of the extrahepatic portal vein. On the axial (left) and coronal (right) CT images, the red arrow points to the filling defect in the extrahepatic portal vein. The head of the pancreas is marked with an asterisk.

FIGURE 3

Management of splanchnic vein thrombosis based on the International Society on Thrombosis and Haemostasis Scientific and Standardization Committee 2020 recommendations. DOAC—direct‐acting oral anticoagulant, LMWH—low‐molecular‐weight heparin, SVT—splanchnic vein thrombosis, VKA—vitamin K antagonist.

FIGURE 4

Acute pancreatitis‐related risk factors of splanchnic vein thrombosis.

FIGURE 5

After acute pancreatitis, a hypoechoic structure was found in the main portal vein (red arrow) with B‐mode ultrasound (left). Doppler ultrasound flow could be detected distal to the thrombus (blue arrow), suggesting only partial thrombosis.

FIGURE 6

Acute necrotizing pancreatitis led to partial thrombosis in the superior mesenteric vein. On the axial (left) and coronal (right) CT images, the red arrow points to a partial filling defect in the superior mesenteric vein. The uncinate process is marked with an asterisk, and the blue arrow indicates the necrosis in the head of the pancreas.