Risk factors influencing the outcome of portal and mesenteric vein thrombosis

BACKGROUND/AIMS: This study analyzes risk factors that influence the course and outcome of portal and superior mesenteric vein thrombosis (PMVT). METHODOLOGY: We retrospectively reviewed 45 patients who were admitted to o ur institution over a 17-year period with a diagnosis of PMVT. Patients wer e classified according to three etiological groups, namely: cirrhosis (47%) , pancreatitis (22%), and other causes (33%), with 1 patient belonging to t wo different groups. RESULTS: Over the course of the disease, rupture of gastric or esophageal v arices was more frequent (p<0.005) in cirrhotics (75%) than non-cirrhotics (17%). Sclerotherapy was always the first treatment for variceal bleeding, with a success rate of 73% but a rate of recurrence of 56%. Surgical proced ures were performed on 22% of patients. Actuarial survival was 43% at 5 yea rs, but survival was significantly increased for idiopathic cases (p=0.005) and decreased in the presence of cirrhosis (p<0.001), malignancy (p<0.0001 ) or hematemesis (p<0.005). Gastrointestinal bleeding and terminal malignan cies were responsible for 50% of deaths. CONCLUSIONS: Cirrhotic patients experience a detrimental outcome with an in creased risk of gastrointestinal bleeding, which is the first cause of mort ality in PMVT. Non-cirrhotic patients, especially idiopathic cases, enjoy a longer survival rate and seldom bleed, which allows for the use of anticoa gulative therapy.