This protocol addresses chronic portal vein thrombosis (PVT) that has progressed to cavernous transformation in patients without underlying cirrhosis — a clinically distinct subgroup whose management differs from cirrhotic PVT due to the absence of hepatic fibrosis and elevated outflow resistance.
Chronic portal vein thrombosis with cavernous transformation, in the absence of cirrhosis. The noncirrhotic liver preserves relatively normal hepatic sinusoidal architecture, which has direct implications for how recanalization strategies are selected.
The interventional strategy centres on portal vein recanalization — with evidence supporting a stenting-based approach in this specific population. The full structured regimen, including procedural sequencing and decision points, is available in the complete protocol.
In noncirrhotic patients, the lack of high outflow resistance from the absence of fibrotic hepatic sinusoids may obviate the need for a TIPS.
The largest comparison study to date in noncirrhotic patients with chronic PVT and cavernous transformation reported higher long-term patency rates with PVR and stenting than with PVR-TIPS, a finding that the authors speculated was a result of the short stent lengths used in portal venous stenting.
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