Extrahepatic portal vein thrombosis: aetiology and determinants of survival

Background-Malignancy, hypercoagulability, and conditions leading to decrea sed portal flow have been reported to contribute to the aetiology of extrah epatic portal vein thrombosis (EPVT). Mortality of patients with, EPVT may be associated with these concurrent medical conditions or with manifestatio ns of portal hypertension, such as. variceal haemorrhage. Patients and methods-To determine which variables have prognostic significa nce with respect to survival, we performed a retrospective study of 172 adu lt EPVT patients who were followed over the period 1984-1997 in eight unive rsity hospitals. Results-Mean follow up was 3.9 years (range 0.1-13.1). Overall survival was 70% (95% confidence interval (CI) 62-76%) at one year, 61% (95% CI, 52-67% ) at five years, and 54% (95% CI, 45-62%) at 10 years. The one, five, and 1 0 year survival rates in the absence of cancer, cirrhosis, and mesenteric v ein thrombosis were 95% (95% CI 87-98%), 89% (95% CI 78-94%), and 81% (95% GI 67-89%), respectively (n=83). Variables at diagnosis associated with red uced survival according to multivariate analysis were advanced age, maligna ncy, cirrhosis, mesenteric vein thrombosis, absence of abdominal inflammati on, and serum levels of aminotransferase and albumin. The presence of varic eal haemorrhage and myeloproliferative disorders did not influence survival . Only four patients died due to variceal haemorrhage and one due to compli cations of a portosystemic shunt procedure. Conclusion-We conclude that mortality among patients with EPVT is related p rimarily to concurrent disorders leading to EPVT and not to complications o f portal hypertension.