The Experts below are selected from a list of 318 Experts worldwide ranked by ideXlab platform
Andrew K Burroughs - One of the best experts on this subject based on the ideXlab platform.
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systematic review Portal Vein thrombosis in cirrhosis
Alimentary Pharmacology & Therapeutics, 2010Co-Authors: Emmanuel Tsochatzis, Marco Senzolo, Giacomo Germani, Alex Gatt, Andrew K BurroughsAbstract:Aliment Pharmacol Ther 31, 366-374 Summary Background As current imaging techniques in cirrhosis allow detection of asymptomatic Portal Vein thrombosis during routine ultrasonography, more patients with cirrhosis are diagnosed with Portal Vein thrombosis. Although a consensus on noncirrhotic extra-hepatic Portal Vein thrombosis has been published, no such consensus exists for Portal Vein thrombosis with cirrhosis. Aim To perform a systematic review of nonmalignant Portal Vein thrombosis in cirrhosis in terms of prevalence, pathogenesis, diagnosis, clinical course and management. Methods Studies were identified by a search strategy using MEDLINE and EMBASE. Results Portal Vein thrombosis is encountered in 10–25% of cirrhotics. In terms of pathophysiology, cirrhosis is no longer considered a hypocoagulable state; rather than a bleeding risk in cirrhosis, various clinical studies support a thrombotic potential. Clinical findings of Portal Vein thrombosis in cirrhosis vary from asymptomatic disease to a life-threatening condition at first presentation. Optimal management of Portal Vein thrombosis in cirrhosis is currently not addressed in any consensus publication. Treatment strategies most often include the use of anticoagulation, while thrombectomy and transjugular intrahepatic portosystemic shunts are considered second-line options. Conclusions Portal Vein thrombosis in cirrhosis has many unresolved issues, which are often the critical problems clinicians encounter in their everyday practice. We propose a possible research agenda to address these unresolved issues.
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systematic review Portal Vein thrombosis in cirrhosis
Alimentary Pharmacology & Therapeutics, 2010Co-Authors: Emmanuel Tsochatzis, Marco Senzolo, Giacomo Germani, Alex Gatt, Andrew K BurroughsAbstract:Aliment Pharmacol Ther 31, 366-374 Summary Background As current imaging techniques in cirrhosis allow detection of asymptomatic Portal Vein thrombosis during routine ultrasonography, more patients with cirrhosis are diagnosed with Portal Vein thrombosis. Although a consensus on noncirrhotic extra-hepatic Portal Vein thrombosis has been published, no such consensus exists for Portal Vein thrombosis with cirrhosis. Aim To perform a systematic review of nonmalignant Portal Vein thrombosis in cirrhosis in terms of prevalence, pathogenesis, diagnosis, clinical course and management. Methods Studies were identified by a search strategy using MEDLINE and EMBASE. Results Portal Vein thrombosis is encountered in 10–25% of cirrhotics. In terms of pathophysiology, cirrhosis is no longer considered a hypocoagulable state; rather than a bleeding risk in cirrhosis, various clinical studies support a thrombotic potential. Clinical findings of Portal Vein thrombosis in cirrhosis vary from asymptomatic disease to a life-threatening condition at first presentation. Optimal management of Portal Vein thrombosis in cirrhosis is currently not addressed in any consensus publication. Treatment strategies most often include the use of anticoagulation, while thrombectomy and transjugular intrahepatic portosystemic shunts are considered second-line options. Conclusions Portal Vein thrombosis in cirrhosis has many unresolved issues, which are often the critical problems clinicians encounter in their everyday practice. We propose a possible research agenda to address these unresolved issues.
Mickael Lesurtel - One of the best experts on this subject based on the ideXlab platform.
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Temporary Portal Vein embolization is as efficient as permanent Portal Vein embolization in mice.
Surgery, 2017Co-Authors: Andrea Wirsching, Ksenia Lezhnina, Anton Buzdin, Omolara O. Ogunshola, Pieter Borger, Emmanuel Melloul, Pierre-alain Clavien, Mickael LesurtelAbstract:Background Temporary Portal Vein embolization may be a safe alternative to permanent Portal Vein embolization. Such a new approach could be applied in living-related liver transplantation to increase graft volume before procurement. The impact of temporary Portal Vein embolization on occluded liver after recanalization, however, has never been assessed. Using a mouse model of temporary Portal Vein embolization, we investigated (1) the efficiency of temporary Portal Vein embolization in inducing nonoccluded liver hypertrophy and (2) the regeneration potential and functional recovery of embolized liver after recanalization. Methods Selected Portal Vein branches were occluded using gelfoam powder (temporary Portal Vein embolization) or embospheres (permanent Portal Vein embolization), n = 5/group. Magnetic resonance volumetry and angiography were used to determine volumes of the liver lobe and Portal Vein branch recanalization. In order to assess the functional and regenerative capacity of occluded liver lobes, nonoccluded lobes were resected 14 days (timespan of complete Portal Vein recanalization) after temporary Portal Vein embolization or permanent Portal Vein embolization. Subsequently, RNA sequencing was performed to compare the signaling pathways of early liver regeneration among the groups. Results Hypertrophy of nonoccluded lobes 30 days after temporary Portal Vein embolization and permanent Portal Vein embolization was similar (103 ± 26% and 129 ± 13%, P = .11). Temporary occluded lobes increased their volumes after nonoccluded lobes resection, reaching similar liver-to-body-weight ratios and similar functional capacity after 7 days compared with partial hepatectomy controls (4 ± 1% vs 4 ± 1%, P = .22). Partial hepatectomy activated similar signaling pathways in temporary occluded and native liver. Conclusion Temporary Portal Vein embolization induces hypertrophy of contralateral liver lobes similarly to permanent Portal Vein embolization in mice. This experimental work suggests that temporary Portal Vein embolization may be considered as a possibility in living liver donation, because regenerative and functional capacities are preserved in the embolized liver after recanalization in mice.
Masaru Miyazaki - One of the best experts on this subject based on the ideXlab platform.
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Portal Vein stent placement for the treatment of postoperative Portal Vein stenosis: long-term success and factor associated with stent failure
BMC surgery, 2017Co-Authors: Atsushi Kato, Hiroaki Shimizu, Katsunori Furukawa, Masayuki Ohtsuka, Hideyuki Yoshitomi, Masaru MiyazakiAbstract:Background Portal Vein stenosis develops due to different causes including postoperative inflammation and oncological processes. However, limited effective therapy is available for Portal Vein stenosis. The objectives of this study were to evaluate the efficacy of a Portal Vein stent for Portal Vein stenosis after hepatobiliary pancreatic surgery and to determine the factors associated with stent patency.
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Portal Vein stent placement for the treatment of postoperative Portal Vein stenosis: long-term success and factor associated with stent failure
BMC Surgery, 2017Co-Authors: Atsushi Kato, Hiroaki Shimizu, Katsunori Furukawa, Masayuki Ohtsuka, Hideyuki Yoshitomi, Masaru MiyazakiAbstract:Background Portal Vein stenosis develops due to different causes including postoperative inflammation and oncological processes. However, limited effective therapy is available for Portal Vein stenosis. The objectives of this study were to evaluate the efficacy of a Portal Vein stent for Portal Vein stenosis after hepatobiliary pancreatic surgery and to determine the factors associated with stent patency. Methods From December 2003 to December 2015, Portal Vein stents were implanted in 29 patients who had Portal Vein stenosis after hepatobiliary pancreatic surgery. We conducted a retrospective analysis to evaluate the efficacy and safety of Portal Vein stent placement. Twelve clinical variables were analyzed for their role in stent patency. Results The symptoms before Portal Vein stent placements included nine patients with hepatic encephalopathy, six patients with gastrointestinal bleeding, four patients with ascites, and four patients with hyperbilirubinemia. Portal Vein thrombosis due to postoperative Portal stenosis was found in four patients. Portal Vein stent were successfully implanted without any major complications. Of the 21 patients with symptoms, 17 showed improvement, and stent patency was maintained in 22 (76%) patients. The presence of a collateral Vein is the only variable related to the development of an occlusion after Portal stenting. Conclusion Portal Vein stent were implanted safely and had good long-term patency. This procedure is useful to relieve Portal hypertension-related symptoms and to improve the quality of life. Our data strongly suggest that embolization to block blood flow in a collateral Vein during Portal Vein stent placement will improve the patency of the stent.
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Portal Vein thrombosis after reconstruction in 270 consecutive patients with Portal Vein resections in hepatopancreatobiliary (HPB) surgery.
American journal of surgery, 2016Co-Authors: Masaru Miyazaki, Hiroaki Shimizu, Masayuki Ohtuka, Atsushi Kato, Hiroyuki Yoshitomi, Katsunori Furukawa, Tsukasa Takayashiki, Satoshi Kuboki, Shigetsugu Takano, Daisuke SuzukiAbstract:Abstract Backgrounds This study was aimed to evaluate the occurrence of Portal Vein thrombosis after Portal Vein reconstruction. Methods The Portal Veins were repaired with venorrhaphy, end-to-end, patch graft, and segmental graft in consecutive 270 patients undergoing hepato-pancreto-biliary (HPB) surgery. Results Portal Vein thrombosis was encountered in 20 of 163 of end-to-end, 2 of 56 of venorrhaphy, and 2 of 5 of patch graft groups, as compared with 0 of 46 of segmental graft group ( p 0.05, N.S., p 0001 , respectively). Portal Vein thrombosis occurred more frequently after hepatectomy than after pancreatectomy ( p 0.0001 ). The restoration of Portal Vein blood flow was more sufficiently achieved in the early re-operation within 3 days after surgery than in the late re-operation over 5 days after surgery ( p 0.05 ). Conclusions The segmental graft might have to be more preferred in the Portal Vein reconstruction. The revision surgery for Portal Vein thrombosis should be performed within 3 days after surgery.
Emmanuel Tsochatzis - One of the best experts on this subject based on the ideXlab platform.
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systematic review Portal Vein thrombosis in cirrhosis
Alimentary Pharmacology & Therapeutics, 2010Co-Authors: Emmanuel Tsochatzis, Marco Senzolo, Giacomo Germani, Alex Gatt, Andrew K BurroughsAbstract:Aliment Pharmacol Ther 31, 366-374 Summary Background As current imaging techniques in cirrhosis allow detection of asymptomatic Portal Vein thrombosis during routine ultrasonography, more patients with cirrhosis are diagnosed with Portal Vein thrombosis. Although a consensus on noncirrhotic extra-hepatic Portal Vein thrombosis has been published, no such consensus exists for Portal Vein thrombosis with cirrhosis. Aim To perform a systematic review of nonmalignant Portal Vein thrombosis in cirrhosis in terms of prevalence, pathogenesis, diagnosis, clinical course and management. Methods Studies were identified by a search strategy using MEDLINE and EMBASE. Results Portal Vein thrombosis is encountered in 10–25% of cirrhotics. In terms of pathophysiology, cirrhosis is no longer considered a hypocoagulable state; rather than a bleeding risk in cirrhosis, various clinical studies support a thrombotic potential. Clinical findings of Portal Vein thrombosis in cirrhosis vary from asymptomatic disease to a life-threatening condition at first presentation. Optimal management of Portal Vein thrombosis in cirrhosis is currently not addressed in any consensus publication. Treatment strategies most often include the use of anticoagulation, while thrombectomy and transjugular intrahepatic portosystemic shunts are considered second-line options. Conclusions Portal Vein thrombosis in cirrhosis has many unresolved issues, which are often the critical problems clinicians encounter in their everyday practice. We propose a possible research agenda to address these unresolved issues.
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systematic review Portal Vein thrombosis in cirrhosis
Alimentary Pharmacology & Therapeutics, 2010Co-Authors: Emmanuel Tsochatzis, Marco Senzolo, Giacomo Germani, Alex Gatt, Andrew K BurroughsAbstract:Aliment Pharmacol Ther 31, 366-374 Summary Background As current imaging techniques in cirrhosis allow detection of asymptomatic Portal Vein thrombosis during routine ultrasonography, more patients with cirrhosis are diagnosed with Portal Vein thrombosis. Although a consensus on noncirrhotic extra-hepatic Portal Vein thrombosis has been published, no such consensus exists for Portal Vein thrombosis with cirrhosis. Aim To perform a systematic review of nonmalignant Portal Vein thrombosis in cirrhosis in terms of prevalence, pathogenesis, diagnosis, clinical course and management. Methods Studies were identified by a search strategy using MEDLINE and EMBASE. Results Portal Vein thrombosis is encountered in 10–25% of cirrhotics. In terms of pathophysiology, cirrhosis is no longer considered a hypocoagulable state; rather than a bleeding risk in cirrhosis, various clinical studies support a thrombotic potential. Clinical findings of Portal Vein thrombosis in cirrhosis vary from asymptomatic disease to a life-threatening condition at first presentation. Optimal management of Portal Vein thrombosis in cirrhosis is currently not addressed in any consensus publication. Treatment strategies most often include the use of anticoagulation, while thrombectomy and transjugular intrahepatic portosystemic shunts are considered second-line options. Conclusions Portal Vein thrombosis in cirrhosis has many unresolved issues, which are often the critical problems clinicians encounter in their everyday practice. We propose a possible research agenda to address these unresolved issues.
Annalisa Berzigotti - One of the best experts on this subject based on the ideXlab platform.
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systematic review with meta analysis Portal Vein recanalisation and transjugular intrahepatic portosystemic shunt for Portal Vein thrombosis
Alimentary Pharmacology & Therapeutics, 2019Co-Authors: S Rodrigues, Sebastian Sixt, Juan G Abraldes, Andrea De Gottardi, Christoph Klinger, Jaime Bosch, Iris Baumgartner, Annalisa BerzigottiAbstract:BACKGROUND Transjugular intrahepatic portosystemic shunt has been increasingly used in patients with Portal Vein thrombosis to obtain patency, but evidenced-based decisions are challenging. AIM To evaluate published data on efficacy and safety of endovascular therapy in Portal Vein thrombosis. METHODS Systematic search of PubMed, ISI, Scopus, and Embase for studies (in English, until October 2017) reporting feasibility, safety, 12-month Portal Vein recanalisation, transjugular intrahepatic portosystemic shunt patency, and survival in patients with benign Portal Vein thrombosis undergoing endovascular treatment. An independent extraction of articles using predefined data fields and quality indicators was used; pooled analyses based on random-effects models; heterogeneity assessment by Cochran's Q, I statistic, subgroup analyses, and meta-regression. RESULTS Thirteen studies including 399 patients (92% cirrhosis; Portal Vein thrombosis: complete 46%, chronic 87%, cavernous transformation 17%, superior mesenteric Vein involvement 55%) were included. Transjugular intrahepatic portosystemic shunt was technically feasible in 95% (95% CI: 89%-98%) with heterogeneity (I = 57%, P < 0.001) explained by cavernous transformation. Major complications occurred in 10% (95% CI: 6.0%-18.0%; I = 52%, P = 0.55). Additional catheter-directed thrombolysis was associated with more complications compared to transjugular intrahepatic portosystemic shunt alone or plus thrombectomy (17.6% vs 3.3%). Twelve-month Portal Vein recanalisation was 79% (95% CI: 67%-88%; I = 78%, P < 0.01). Shunt patency at 12 months was 84% (95% CI: 76%-90%; I = 62%, P < 0.01). Overall 12-month survival rate was 89%, with no heterogeneity. CONCLUSIONS Transjugular intrahepatic portosystemic shunt for Portal Vein thrombosis recanalisation was highly feasible, effective, and safe. Cavernous transformation was the main determinant of technical failure. Additional catheter-directed thrombolysis was associated with higher risk of severe complications.
