Chronic portal vein thrombosis
ICD-10 I81 · ICD-11 DB98.3.2
Treatment of Chronic Portal Vein Thrombosis with Life-Threatening Symptoms: Bowel Ischemia, Bowel Necrosis, and Yerdel Grade 4 PVT
Clinical Scenario
This protocol applies to patients with chronic portal vein thrombosis presenting with life-threatening symptoms — specifically those with extensive involvement of the superior mesenteric vein (SMV), complicated by bowel ischemia or bowel necrosis. It also covers patients classified as Yerdel grade 4 portal vein thrombosis, representing the most anatomically severe extent of disease.
Treatment Approach
In this setting, a major combined transplant procedure involving multiple abdominal organs may be considered for carefully selected patients, contingent on local surgical expertise — full selection criteria and procedural details are in the complete protocol.
References
DOI: 10.1016/j.tvir.2025.101084
In patients with acute life-threatening symptoms related to PVT, particularly with extensive involvement of the SMV, surgical consultation should be obtained, especially in cases involving bowel ischemia or bowel necrosis.
Multivisceral transplant of liver and small bowel may be considered for patients with Yerdel grade 4 PVT depending on local surgical expertise.