Portal Vein Tumor Thrombosis Treatment

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Treatment of portal vein thrombosis: an updated narrative review

Different treatment options (unfractionated or low molecular weight heparin, vitamin K antagonists and direct oral anticoagulants [DOACs]) can be considered. In this narrative review we will discuss the treatment of PVT in the three most common scenarios (cirrhosis-associated, cancer-associated and non-malignant non-cirrhotic PVT).(1)

Treatment of hepatocellular carcinoma with portal vein tumor thrombus …

RFA, radiofrequency ablation; PVTT, portal vein tumor thrombosis; TACE, transarterial chemoembolization; TAC, transarterial chemotherapy.(2)

Portal Vein Thrombosis Treatment: Clinical Considerations

Apr 23, 2021C. Andrew Kistler, MD, PharmD. Prevalence of PVT in patients with cirrhosis is as high as 50%, with an increased risk as the liver decompensates further. Portal vein thrombosis (PVT) is being increasingly diagnosed in patients both with and without cirrhosis, as contrast enhanced imaging has continued to evolve and improve. The portal vein represents the confluence of the splenic (drains the spleen) and superior mesenteric veins (drains the small bowel).(3)

The Treatment of Hepatocellular Carcinoma With Portal Vein Tumor Thrombosis

Current staging systems designate MVI as advanced disease. Recent advances in multimodal approaches, including systemic therapies, radiation therapy, liver-directed therapies, and surgical approaches, in the treatment of HCC with MVI have rendered this disease process more treatable with improved outcomes and are discussed here.(4)

Update on Management of Portal Vein Thrombosis and the Role of Novel …

The range of treatment for PVT includes close monitoring without intervention, anticoagulation, thrombolysis, thrombectomy, and transjugular intrahepatic portosystemic shunt (TIPS). A clinician’s role is, therefore, to understand the range of options and to recommend the most appropriate treatment based on these considerations.(5)

Treatment of portal vein tumor thrombosis of hepatoma patients with …

Transcatheter arterial chemoembolization (TACE) is one of the limited alternative treatments that can prolong these patients’ survival. However, the presence of portal vein tumor thrombosis (PVTT) is a contraindication for TACE and, therefore, HCC patients with PVTT would be depleted of the advantage of TACE.(6)

Management of hepatocellular carcinoma with portal vein tumor …

One of the treatment modalities is surgical resection, the two common modes of which are tumor thrombectomy and en bloc resection of the thrombus and the portal vein followed by portal vein reconstruction. Tumor thrombectomy is technically less demanding but might result in a residual tumor.(7)

Management of hepatocellular carcinoma patients with portal vein tumor …

Systemic chemotherapy, hepatic arterial infusion chemotherapy, radiofrequency ablation, portal stenting, and traditional Chinese medicine are also beneficial in Vp3-4 PVTT. The accurate diagnosis of PVTT can be made by radiomics, and prognostic classification models can be used to design personalized treatments.(8)

Portal Vein Tumor Thrombosis and Hepatocellular Carcinoma – The …

Sep 7, 2021HCC, hepatocellular carcinoma; PVTT, portal vein tumor thrombosis; TACE, transarterial chemoembolization; RT, radiotherapy; 3D CRT, three-dimensional conformational radiotherapy; SBRT, stereotactic body radiation therapy; EBRT, external beam radiotherapy; SIRT, selective internal radiotherapy; RE, radioembolization; TARE, transarterial radioembolization; IMRT, intermittent radiotherapy; HAIC, hepatic artery infusion chemotherapy; Y90, yttrium 90; LR, liver resection; LT, liver …(9)

Hepatocellular Carcinoma with Portal Vein Tumor Involvement: Best …

First-line lenvatinib, which was shown to be noninferior to sorafenib, excluded patients with main portal trunk invasion. Regorafenib and nivolumab, an immune-based therapy, were recently approved in the United States for second-line therapy after sorafenib.(10)

Treatments of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus …

Aug 10, 2021High-level evidence has recently suggested the value of proton beam radiotherapy 60 and stereotactic radiotherapy 61 in the treatment of small HCC, and positive results of these two methods in PVTT are expected. Treatments via hepatic artery(11)

Treatment of hepatocellular carcinoma in patients with portal vein …

In 1990s, Kumada et al reported a surgical resection of a tumor thrombus extended in the main portal trunk, describing five possible surgical approaches: (1) Hepatolobectomy, consisting in the en-bloc resection of both HCC (located either in the left or the right lobe) and PVTT (confined to the first portal branch); (2) Thrombectomy with a balloon catheter that is introduced in the clamped portal vein by an incision and used to extract the thrombus by suction or curettage; (3) Portal vein(12)

Portal Vein Thrombosis (PVT): Symptoms, Causes, and Treatment

Treatment greatly depends on the initial cause of the blood clot. For portal vein thrombosis, treatment recommendations will focus on dissolving the blood clot or preventing growth over a long…(13)

Portal vein thrombosis: What you need to know | Vinmec

Currently, there are treatment methods for portal vein thrombosis, which are: Surgical removal of thrombus: This method is indicated for patients in the acute stage, where the blood clot is located in first extrahepatic branch; and is not indicated for patients with chronic stage or blood clots that have spread to other venous branches such as hepatic veins, spleen, superior mesentery …(14)

The Treatment of Hepatocellular Carcinoma With Portal Vein Tumor Thrombosis

Hepatocellular carcinoma (HCC) is the sixth most common cancer and third leading cause of cancer-related death worldwide. HCC is also is a tumor with a distinct ability to invade and grow within the hepatic vasculature. Approximately 20% of patients with HCC have macrovascular invasion (MVI) at the time of diagnosis. MVI is associated with dismal prognosis, with median survival ranging from 2 …(15)

Portal Vein Tumor Thrombus: No Longer a Death Sentence

Jan 21, 2021Treatment options for HCC include liver transplantation, surgical resection, transarterial chemoembolization (TACE), … Life expectancy with portal vein tumor thrombosis is two to four months with only supportive care . Tumor cells can proliferate within the vessel lumen. They can either serve as a nidus for thrombus formation or become coated …(16)

HCC with portal vein tumor thrombosis: how to manage?

Sep 19, 2020The molecular targeting agents, sorafenib, lenvatinib, and regorafenib, are the only proposed treatment options for the HCC with portal invasion or PVTT patients. The MST of patients with advanced HCC treated with sorafenib is reported as short as 10.7 months.(17)

Portal vein thrombosis | Radiology Reference Article | Radiopaedia.org

Apr 21, 2022Ideally, the presence of thrombosis is identified early and thrombolysis/thrombectomy performed to re-establish flow. This may avoid a possible long-term complication of portal hypertension, although portal vein thrombus often develops in a pre-existing setting of portal hypertension. The principles of management include 3,15:(18)

Portal Vein Tumor Thrombosis and Hepatocellular Carcinoma | JHC

Treatment Options for HCC with PVTT Treatment modalities for PVTT can be largely classified as local, locoregional and systemic therapies. A) Local therapies include surgery (liver resection and liver transplantation) and radiotherapy (3D-CRT, EBRT). B) Locoregional therapies include TACE, TARE (SIRT), and HAIC.(19)

Portal vein tumor thrombus is a bottleneck in the treatment of …

The effect of portal vein tumor thrombus (PVTT) on the prognosis of patients with hepatocellular carcinoma has become clear over the past several decades. However, identifying the mechanisms and performing the diagnosis and treatment of PVTT remain challenging. Therefore, this study aimed to summarize the progress in these areas. A computerized literature search in Medline and EMBASE was …(20)

Excerpt Links

(1). Treatment of portal vein thrombosis: an updated narrative review
(2). Treatment of hepatocellular carcinoma with portal vein tumor thrombus …
(3). Portal Vein Thrombosis Treatment: Clinical Considerations
(4). The Treatment of Hepatocellular Carcinoma With Portal Vein Tumor Thrombosis
(5). Update on Management of Portal Vein Thrombosis and the Role of Novel …
(6). Treatment of portal vein tumor thrombosis of hepatoma patients with …
(7). Management of hepatocellular carcinoma with portal vein tumor …
(8). Management of hepatocellular carcinoma patients with portal vein tumor …
(9). Portal Vein Tumor Thrombosis and Hepatocellular Carcinoma – The …
(10). Hepatocellular Carcinoma with Portal Vein Tumor Involvement: Best …
(11). Treatments of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus …
(12). Treatment of hepatocellular carcinoma in patients with portal vein …
(13). Portal Vein Thrombosis (PVT): Symptoms, Causes, and Treatment
(14). Portal vein thrombosis: What you need to know | Vinmec
(15). The Treatment of Hepatocellular Carcinoma With Portal Vein Tumor Thrombosis
(16). Portal Vein Tumor Thrombus: No Longer a Death Sentence
(17). HCC with portal vein tumor thrombosis: how to manage?
(18). Portal vein thrombosis | Radiology Reference Article | Radiopaedia.org
(19). Portal Vein Tumor Thrombosis and Hepatocellular Carcinoma | JHC
(20). Portal vein tumor thrombus is a bottleneck in the treatment of …

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