中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 42 Issue 4
Apr.  2026
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2026  >  42(4): 748-754

Diagnosis and treatment of portal vein thrombosis

DOI: 10.12449/JCH260402

  • Department of Gastroenterology，Chongqing Key Laboratory of Digestive Malignancies，Daping Hospital，Army Medical University （Third Military Medical University），Chongqing 400042，China

Research funding:

National Natural Science Foundation of China (82273484);

National Natural Science Foundation of China (82473105);

Chongqing Young and Middle-aged Medical Talents Project 

More Information
  • Corresponding author: WEN Liangzhi， wenliangzhi@tmmu.edu.cn （ORCID： 0000-0001-9999-2422）
  • Received Date: 2026-01-22
  • Accepted Date: 2026-03-18
  • Published Date: 2026-04-25
    Abstract
  • Portal vein thrombosis （PVT） involves the main portal vein and its tributaries， and acute PVT can cause intestinal ischemia and necrosis， while chronic PVT can cause cavernous transformation of the portal vein and portal hypertension-related complications （such as ascites and gastroesophageal variceal bleeding）. Liver cirrhosis is the main risk factor for PVT. the Classification of PVT provides a basis for clinical diagnosis. Ultrasound is the preferred method for screening， and contrast-enhanced computed tomography is the gold standard for diagnosis， while magnetic resonance imaging/magnetic resonance venography can help to identify acute or chronic thrombosis. Treatment emphasizes individualized strategies： anticoagulant therapy is the first-line therapy for acute PVT， and direct oral anticoagulants have shown great potential in clinical practice； thrombolytic therapy is appropriate for severe acute PVT， and it is needed to strictly control the risk of bleeding； transjugular intrahepatic portosystemic shunt is an important method for the diagnosis and treatment of PVT-related ascites and gastroesophageal variceal bleeding； surgical operation can be used for the treatment of patients with no response to pharmacotherapy or those with serious complications such as intestinal necrosis. Future diagnosis and treatment of PVT should be based on multidisciplinary collaboration， focusing on the optimization of individualized regimens， balancing efficacy and safety， and continuously leveraging technological advances to improve clinical practice.

     

    • FullText(HTML)
  • loading
    • References(45)
  • [1]
    CAIANO LM, RIVA N, CARRIER M, et al. Treatment of portal vein thrombosis: An updated narrative review[J]. Minerva Med, 2021, 112( 6): 713- 725. DOI: 10.23736/S0026-4806.21.07526-1.
    [2]
    CUSTO S, TABONE E, AQUILINA A, et al. Splanchnic vein thrombosis: The state-of-the-art on anticoagulant treatment[J]. Hamostaseologie, 2024, 44( 4): 242- 254. DOI: 10.1055/a-2232-5480.
    [3]
    TONG WL, GADANI S. Chronic portal vein thrombosis: Diagnosis, management, and review of the literature[J]. Tech Vasc Interv Radiol, 2025, 28( 4): 101084. DOI: 10.1016/j.tvir.2025.101084.
    [4]
    CHEN HS, TRILOK G, WANG F, et al. A single hospital study on portal vein thrombosis in cirrhotic patients- clinical characteristics& risk factors[J]. Indian J Med Res, 2014, 139( 2): 260- 266.
    [5]
    ODRIOZOLA A, PUENTE Á, CUADRADO A, et al. Portal vein thrombosis in the setting of cirrhosis: A comprehensive review[J]. J Clin Med, 2022, 11( 21): 6435. DOI: 10.3390/jcm11216435.
    [6]
    HUANG XY, ZHANG YH, YI SY, et al. Potential contribution of the gut microbiota to the development of portal vein thrombosis in liver cirrhosis[J]. Front Microbiol, 2023, 14: 1217338. DOI: 10.3389/fmicb.2023.1217338.
    [7]
    SENZOLO M, GARCIA-TSAO G, GARCÍA-PAGÁN JC. Current knowledge and management of portal vein thrombosis in cirrhosis[J]. J Hepatol, 2021, 75( 2): 442- 453. DOI: 10.1016/j.jhep.2021.04.029.
    [8]
    ANTON A, CAMPRECIÓS G, PÉREZ-CAMPUZANO V, et al. The pathophysiology of portal vein thrombosis in cirrhosis: Getting deeper into Virchow's triad[J]. J Clin Med, 2022, 11( 3): 800. DOI: 10.3390/jcm11030800.
    [9]
    WU JL, DENG XY, LUO JY, et al. Update in the treatment of cirrhotic patients with portal vein thrombosis[J]. Clin Mol Hepatol, 2025, 31( 4): 1139- 1166. DOI: 10.3350/cmh.2025.0411.
    [10]
    LIN YK, CAI XR, HONG HJ, et al. Risk factors of portal vein system thrombosis after splenectomy: A meta-analysis[J]. ANZ J Surg, 2023, 93( 12): 2806- 2819. DOI: 10.1111/ans.18633.
    [11]
    MANTAKA A, GATSELIS N, TRIANTOS CK, et al. Treatment of portal vein thrombosis in cirrhosis: A multicenter real life cohort study[J]. Minerva Gastroenterol, 2023, 69( 1): 107- 113. DOI: 10.23736/s2724-5985.21.02861-8.
    [12]
    de VLOO C, MATTON T, MEERSSEMAN W, et al. Thrombosis of a portal vein aneurysm: A case report with literature review[J]. Acta Clin Belg, 2019, 74( 2): 115- 120. DOI: 10.1080/17843286.2018.1511298.
    [13]
    GERA DN, PATEL J, PATEL K, et al. Portal vein thrombosis: A rare complication of nephrotic syndrome[J]. Indian J Nephrol, 2018, 28( 3): 236- 239. DOI: 10.4103/ijn.IJN_25_17.
    [14]
    CAO L, WEI K, HAI J, et al. Efficacy and safety of different antithrombotic regimens including direct oral anticoagulants for the prevention of portal vein system thrombosis after splenectomy in patients with liver cirrhosis and portal hypertension: A systematic review and network meta-analysis[J]. Int J Surg, 2025, 111( 12): 9706- 9725. DOI: 10.1097/JS9.0000000000003220.
    [15]
    TURON F, DRIEVER EG, BAIGES A, et al. Predicting portal thrombosis in cirrhosis: A prospective study of clinical, ultrasonographic and hemostatic factors[J]. J Hepatol, 2021, 75( 6): 1367- 1376. DOI: 10.1016/j.jhep.2021.07.020.
    [16]
    PONZIANI FR, ZOCCO MA, CAMPANALE C, et al. Portal vein thrombosis: Insight into physiopathology, diagnosis, and treatment[J]. World J Gastroenterol, 2010, 16( 2): 143- 155. DOI: 10.3748/wjg.v16.i2.143.
    [17]
    UEDA T, SAITO H, SHIRAI S, et al. Endovascular treatment for acute portal vein thrombosis[J]. Interv Radiol, 2024, 10: e20230027. DOI: 10.22575/interventionalradiology.2023-0027.
    [18]
    YERDEL MA, GUNSON B, MIRZA D, et al. Portal vein thrombosis in adults undergoing liver transplantation: Risk factors, screening, management, and outcome[J]. Transplantation, 2000, 69( 9): 1873- 1881. DOI: 10.1097/00007890-200005150-00023.
    [19]
    de FRANCHIS R, BOSCH J, GARCIA-TSAO G, et al. Baveno VII-Renewing consensus in portal hypertension[J]. J Hepatol, 2022, 76( 4): 959- 974. DOI: 10.1016/j.jhep.2021.12.022.
    [20]
    Hepatobiliary Disease Study Group, Chinese Society of Gastroenterology, Chinese Medical Association. Consensus for management of portal vein thrombosis in liver cirrhosis(2020,Shanghai)[J]. J Clin Hepatol, 2020, 36( 12): 2667- 2674. DOI: 10.3969/j.issn.1001-5256.2020.12.007.

    中华医学会消化病学分会肝胆疾病学组. 肝硬化门静脉血栓管理专家共识(2020年,上海)[J]. 临床肝胆病杂志, 2020, 36( 12): 2667- 2674. DOI: 10.3969/j.issn.1001-5256.2020.12.007.
    [21]
    MOLVAR C, AMIN P. Portal vein thrombosis in cirrhosis: Interventional treatment options[J]. Curr Gastroenterol Rep, 2021, 23( 12): 24. DOI: 10.1007/s11894-021-00826-1.
    [22]
    GIRARDI L, ZARKA F, PRADIER M, et al. Diagnostic performance of ultrasound, computed tomography and magnetic resonance imaging in portal vein thrombosis: A systematic review with meta-analysis[J]. Thromb Res, 2026, 257: 109560. DOI: 10.1016/j.thromres.2025.109560.
    [23]
    JU C, LI X, GADANI S, et al. Portal vein thrombosis: Diagnosis and endovascular management[J]. Rofo, 2022, 194( 2): 169- 180. DOI: 10.1055/a-1642-0990.
    [24]
    ZHOU L, HUANG ZC, LIN XH, et al. Case report: CT manifestations of acute portal vein thrombosis: Cases report and literature review[J]. Front Radiol, 2025, 5: 1662089. DOI: 10.3389/fradi.2025.1662089.
    [25]
    COPIN P, RONOT M, NUZZO A, et al. Inter-reader agreement of CT features of acute mesenteric ischemia[J]. Eur J Radiol, 2018, 105: 87- 95. DOI: 10.1016/j.ejrad.2018.05.027.
    [26]
    PLESSIER A, DARWISH-MURAD S, HERNANDEZ-GUERRA M, et al. Acute portal vein thrombosis unrelated to cirrhosis: A prospective multicenter follow-up study[J]. Hepatology, 2010, 51( 1): 210- 218. DOI: 10.1002/hep.23259.
    [27]
    van DAM LF, KLOK FA, TUSHUIZEN ME, et al. Magnetic resonance thrombus imaging to differentiate acute from chronic portal vein thrombosis[J]. TH Open, 2020, 4( 3): e224- e230. DOI: 10.1055/s-0040-1716716.
    [28]
    LI CM, HU A, HAACKE M, et al. Direct portal vein thrombosis visualization with t2*-weighted magnetic resonance imaging[J]. Int J Med Sci, 2013, 10( 11): 1570- 1574. DOI: 10.7150/ijms.6681.
    [29]
    JOSHI A, KULKARNI S, SHAH A. Role of MRI in evaluation of spectrum of liver lesions in cirrhotic patients[J]. J Assoc Physicians India, 2020, 68( 4): 32- 38.
    [30]
    WANG SK, CHENG YF, LIM WX, et al. Applying intraoperative portal venography in liver transplantation vascular surgery[J]. Diagnostics, 2025, 15( 18): 2321. DOI: 10.3390/diagnostics15182321.
    [31]
    DEBERNARDI-VENON W, BANDI JC, GARCÍA-PAGÁN JC, et al. CO2 wedged hepatic venography in the evaluation of portal hypertension[J]. Gut, 2000, 46( 6): 856- 860. DOI: 10.1136/gut.46.6.856.
    [32]
    YANG L, BETTMANN MA. Identification of the portal vein: Wedge hepatic venography with CO2 or iodinated contrast medium[J]. Acad Radiol, 1999, 6( 2): 89- 93. DOI: 10.1016/S1076-6332(99)80487-5.
    [33]
    CAPOROSSI JM, VIDAL V, JACQUIER A, et al. Balloon occlusion versus wedged hepatic venography using iodinated contrast for targeting the portal vein during TIPS[J]. Diagn Interv Imaging, 2015, 96( 4): 357- 363. DOI: 10.1016/j.diii.2014.11.011.
    [34]
    de FRANCHIS R. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension[J]. J Hepatol, 2015, 63( 3): 743- 752. DOI: 10.1016/j.jhep.2015.05.022.
    [35]
    DELGADO MG, SEIJO S, YEPES I, et al. Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis[J]. Clin Gastroenterol Hepatol, 2012, 10( 7): 776- 783. DOI: 10.1016/j.cgh.2012.01.012.
    [36]
    European Association for the Study of the Liver. EASL clinical practice guidelines on vascular diseases of the liver[J]. J Hepatol, 2026, 84( 2): 399- 456. DOI: 10.1016/j.jhep.2025.08.001.
    [37]
    TSOCHATZIS EA, SENZOLO M, GERMANI G, et al. Systematic review: Portal vein thrombosis in cirrhosis[J]. Aliment Pharmacol Ther, 2010, 31( 3): 366- 374. DOI: 10.1111/j.1365-2036.2009.04182.x.
    [38]
    XIAO XL, ZHU WG, DAI QX. Direct oral anticoagulants versus traditional anticoagulation in cirrhotic patients with portal vein thrombosis: Updated systematic review[J]. Clin Appl Thromb Hemost, 2024, 30: 10760296241303758. DOI: 10.1177/10760296241303758.
    [39]
    ELKRIEF L, HERNANDEZ-GEA V, SENZOLO M, et al. Portal vein thrombosis: Diagnosis, management, and endpoints for future clinical studies[J]. Lancet Gastroenterol Hepatol, 2024, 9( 9): 859- 883. DOI: 10.1016/S2468-1253(24)00155-9.
    [40]
    KUMARI D. Acute mesenteric and portal vein thrombosis: Etiology, diagnosis, and interventional management[J]. Tech Vasc Interv Radiol, 2025, 28( 3): 101058. DOI: 10.1016/j.tvir.2025.101058.
    [41]
    PRIMIGNANI M, TOSETTI G, IERARDI AM. Approach to different thrombolysis techniques and timing of thrombolysis in the management of portal vein thrombosis in cirrhotic patients[J]. J Transl Int Med, 2023, 11( 3): 198- 202. DOI: 10.2478/jtim-2023-0113.
    [42]
    HOLLINGSHEAD M, BURKE CT, MAURO MA, et al. Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis[J]. J Vasc Interv Radiol, 2005, 16( 5): 651- 661. DOI: 10.1097/01.RVI.0000156265.79960.86.
    [43]
    LIU FY, WANG MQ, DUAN F, et al. Interventional therapy for symptomatic-benign portal vein occlusion[J]. Hepatogastroenterology, 2010, 57( 104): 1367- 1374.
    [44]
    ALANI M, ROWLEY M, KANG P, et al. Utility of transjugular intrahepatic portosystemic shunt placement for maintaining portal vein patency in candidates on wait lists who develop thrombus[J]. Exp Clin Transplant, 2020, 18( 7): 808- 813. DOI: 10.6002/ect.2019.0153.
    [45]
    RAVAIOLI M, ZANELLO M, GRAZI GL, et al. Portal vein thrombosis and liver transplantation: Evolution during 10 years of experience at the University of Bologna[J]. Ann Surg, 2011, 253( 2): 378- 384. DOI: 10.1097/SLA.0b013e318206818b.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Tables(5)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (65) PDF downloads(25) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return