Portal venous system thrombosis: helical CT angiography before transjugular intrahepatic portosystemic shunt creation.

Abstract:

PURPOSE:To evaluate the utility of helical computed tomographic (CT) angiography for depiction of thrombi in the portal venous system in patients under consideration for transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS:Contrast material-enhanced helical CT was performed before TIPS creation in 25 patients. Axial, multiplanar, and three-dimensional images were evaluated to determine whether thrombus was present in the portal system and whether TIPS creation was contraindicated. CT findings were confirmed at visceral angiography (n = 3), direct portography (n = 20), or duplex ultrasonography (n = 2). RESULTS:Ten (40%) of 25 patients, including 10 (56%) of 18 patients with refractory variceal hemorrhage, had thrombus in the portal venous system. Helical CT scans depicted thrombus in nine (90%) of 10 patients (95% confidence interval = 0.71, 1.00) and in 16 (94%) of 17 vessels (95% confidence interval = 0.83, 1.00), including the portal vein (eight of eight patients), splenic vein (three of four patients), and superior mesenteric vein (five of five patients). TIPS creation was canceled in four (16%) patients on the basis of CT findings. CONCLUSION:Thrombi in the portal venous system are common in patients with refractory variceal hemorrhage. Helical CT angiography is sensitive and specific for portal venous system thrombosis and can provide information that alters treatment in these patients.

journal_name

Radiology

journal_title

Radiology

authors

Kuszyk BS,Osterman FA Jr,Venbrux AC,Heath DG,Urban BA,Smith PA,Fishman EK

doi

10.1148/radiology.206.1.9423670

subject

Has Abstract

pub_date

1998-01-01 00:00:00

pages

179-86

issue

1

eissn

0033-8419

issn

1527-1315

journal_volume

206

pub_type

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