Idiopathic Portal Vein Thrombosis: Endovascular Intervention Leads the Way to Recanalization

Background Data on treating idiopathic portal vein thrombosis (IPVT)—via anticoagulation (AC), systemic thrombolysis (ST), endovascular intervention (EVI), and surgery—are limited, despite the potentially severe clinical implications of this condition. This study aims to compare treatment outcomes a...

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Main Authors: Xiaolu Zhu MS, Zhize Peng MS, Yinjun Xu MS, Yuanqiang Lu PhD
Format: Article
Language:English
Published: SAGE Publishing 2025-08-01
Series:Clinical and Applied Thrombosis/Hemostasis
Online Access:https://doi.org/10.1177/10760296251368885
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Summary:Background Data on treating idiopathic portal vein thrombosis (IPVT)—via anticoagulation (AC), systemic thrombolysis (ST), endovascular intervention (EVI), and surgery—are limited, despite the potentially severe clinical implications of this condition. This study aims to compare treatment outcomes and evaluate the prognosis. Methods A retrospective analysis of 77 IPVT patients was conducted. Patients were categorized according to their treatment modalities, and their demographics, clinical features, prognoses, and risk factors were analyzed. The primary endpoint was the radiological complete recanalization (CR) rate; secondary endpoints were clinical portal hypertension (CPH) incidence and overall mortality. Results Among the 77 patients with IPVT included in this study, 26 received AC, 23 EVI, 17 ST, and 11 surgery. During follow-up, the overall CR rate was 23.4%, CPH incidence 14.3%, and mortality 7.8%. Patients treated with EVI had a significantly higher CR rate than AC patients (HR: 0.214, 95%CI: 0.058 - 0.795, P  = .011). Treatment modalities had no significant impact on long-term survival or CPH. Cox regression analysis identified elevated C-reactive protein (CRP) levels (HR 1.045, 95%CI: 1.016 - 1.075, P  = .002) and splenomegaly (HR 20.325, 95%CI: 1.952 - 212.213, P  = .012) at admission as mortality risk factors. Conclusions EVI therapy enhances the CR rate in IPVT patients compared to anticoagulation alone. Elevated CRP and splenomegaly at admission independently increase IPVT mortality.
ISSN:1938-2723