Thrombosis of the hepatic artery. Hepatic vein thrombosis

Hepatic veins are a violation of blood flow under the influence of blood clots in the lumen of the vessels that drain blood from the liver. As a result, they may overlap completely or partially. As a result similar disease not only activities are seriously disrupted cardiovascular system, and also the liver.

Features of the disease

More often similar illness manifests itself in older adults, but in lately Many doctors sounded the alarm. The disease is getting significantly younger.

Signs of hepatic vein thrombosis are observed in some young people, and this cannot but alarm doctors. Most often, the disease develops in women aged between forty and fifty years; in men, the disease is much less common.

What does incomplete thrombosis look like? portal vein liver, will tell the following video:

Forms

Hepatic vein thrombosis is often classified as Budd-Chiari syndrome. The disease occurs in two forms:

spicy. With this disease, the veins become blocked due to the appearance of a blood clot in them. The patient suddenly experiences severe abdominal pain, vomiting, and jaundice. Then the disease quickly gains momentum: in abdominal cavity accumulates free liquid, the legs swell, the veins on the front wall of the abdomen swell and become visible, and bloody vomiting may begin. Lymphostasis appears. If doctors do not intervene urgently, death will occur within a few days;
chronic. It occurs due to inflammation of the hepatic veins and the growth of fibrosis into their cavity. In most patients (about 85%) it occurs chronic form. It may not manifest itself for many years. But over time, all the symptoms that occur during the acute form suddenly appear. Typically accompanied by others chronic diseases, against the background of which it develops.

Causes

There may be several reasons for the appearance of the disease. Let's highlight the most important ones:

blood clotting disorder;
myeloproliferative lesions;
severe abdominal injuries;
tumors of the adrenal glands and kidneys;
pancreas;
paroxysmal nocturnal hemoglobinuria;
lupus erythematosus;
taking medications that increase blood clotting;
pregnancy;
bad heredity.

Read more about the symptoms of thrombosis of the hepatic veins and arteries.

Symptoms of Budd-Chiari syndrome (disease)

Let's make a reservation right away, some general clinical picture there is no such thing as Budd-Chiari syndrome; each patient's illness progresses individually. But doctors, watching large number patients, nevertheless, several of them were allocated to the general group:

severe pain in the abdominal area. This symptom is noted by almost all patients. Portability pain threshold Each person is different, but the pain is so severe that it deprives a person of rest and sleep;
enlarged liver and spleen. These factors are clearly evidenced by an enlarged belly. The patient experiences feelings of bloating and heaviness;
jaundice. A symptom that does not always appear;
ascites. Characterized by the accumulation of fluid in the abdomen, increasing its volume;
hepatic encephalopathy. This symptom observed in a small number of patients;
bleeding from . Occurs in a small number of patients;

If you notice one or more signs in yourself, contact your doctor immediately. He will more accurately determine the symptoms and send you for additional diagnostics.

Diagnostics

Since it is extremely difficult to visually detect the disease, and the symptoms may directly indicate a whole series diseases, then the most effective method of diagnosing Budd-Chiari syndrome is ultrasound with Doppler sonography. It allows you to determine whether there is a disease with a high degree of probability. During examination, blood clots may be detected in the veins of the liver. Moreover, it will be clear what their character is. That is, whether they are connected to the wall of the vein or not, and if they are connected, then the connective tissue is young or old.
Another effective method for detecting thrombosis is angiography. A catheter with a special substance is inserted into the liver veins and a series of x-rays. Very often, along with a special solution, drugs are administered that can not only detect, but also destroy a blood clot.
MRI of the abdominal cavity, radionuclide studies and laboratory tests and the tests will also help doctors make the most accurate diagnosis.

Read more about treatment methods for hepatic artery thrombosis.

Treatment

When treating liver thrombosis, complex treatment should be used, since medication alone is sometimes not enough. Additional surgery and physical therapy are often required.

Therapeutic and medicinal methods

In the drug treatment of hepatic vein thrombosis, diuretics, anticoagulants, and thrombolytics are used.

However, treatment only medicines does not help for long and leads to progression of the disease.

Operation

Surgical intervention is performed in three in different ways, it all depends on the stage at which the disease is detected:

angioplasty. A special substance is injected into the liver veins to destroy the blood clot. Fulfill this procedure should only be done by a trained specialist, as there is a possibility that blood clot will come off and continue moving through the vein. As a complication, progression of thromboembolism is possible;
bypass of liver vessels. Artificial vessels are applied to ensure blood flow from the liver. After similar procedure the patient becomes much easier and general condition the body improves;
liver transplantation. Necessary for patients with acute illness. Showing on late stages syndrome and complications developed in connection with it.

Prevention of disease

As such, there is no prevention of hepatic vein thrombosis. Regular use of blood thinning medications is necessary to prevent relapses. At least once every six months, see a doctor and have an ultrasound, preferably with Doppler ultrasound.

With blood flowing through the portal vein system, the liver also receives oxygen and nutrients.

Portal vein thrombosis or pilethrombosis is characterized by the formation of a parietal thrombus that completely or partially blocks the lumen of the vessel. Blood flow in the liver is impaired and gastrointestinal tract, portal hypertension and cirrhosis develop. For many years, the disease was considered rare, but with improvements in diagnostic techniques that allow visualization of blood flow patterns, pilethrombosis is often identified in patients suffering from cirrhosis.

Reasons

According to modern classification, the causes of portal vein thrombosis are usually divided as follows:

local (inflammatory processes in the abdominal cavity, damage to the portal vein as a result of injuries, medical procedures);
systemic (thrombophilia - coagulation disorders with a tendency to thrombosis - hereditary and acquired).

Indirect causes of hepatic vein thrombosis are malignant neoplasms in the liver and decompensated cirrhosis. There are also risk factors that increase the likelihood of the disease - pancreatitis, cholecystitis and others inflammatory diseases abdominal organs, especially if their treatment involves surgery.

Clinical picture

According to the nature of the course, thrombosis of the hepatic portal vein can be acute or chronic.

Acute thrombosis is manifested by the following symptoms:

severe abdominal pain that occurs suddenly;
increased body temperature, persistent fever;
nausea, vomiting, stool upset;
splenomegaly (enlarged spleen).

These symptoms of portal vein thrombosis manifest simultaneously, sharply worsening the patient’s condition. A dangerous complication is intestinal infarction, i.e. necrosis of its tissue when mesenteric veins are blocked by blood clots.

The chronic variant may be asymptomatic. In this case, portal vein thrombosis is an incidental finding during studies performed for another abdominal pathology. The absence of manifestations is due to compensatory mechanisms. Among them are vasodilation (expansion) of the hepatic artery and the development of cavernoma - a network of venous collaterals (additional veins that take on an increasing load). Only when the ability to compensate is depleted do characteristic symptoms appear:

General weakness, lethargy, lack of appetite.
Syndrome portal hypertension:
- ascites (accumulation of fluid in the abdominal cavity);
- expansion of the saphenous veins of the anterior abdominal wall;
- varicose veins veins of the esophagus.
Sluggish form of pylephlebitis (inflammation of the portal vein):
- constant dull abdominal pain;
- low-grade body temperature (37–37.5 degrees Celsius) for a long time.
Hepatosplenomegaly ().

The most likely and common complication– esophageal bleeding, the source of which is varicose veins. Progressing chronic ischemia(circulatory failure) and subsequent cirrhosis (replacement connective tissue liver cells), if it was not present previously, playing a role in the development of the pathological process.

Diagnostics

To confirm the diagnosis, imaging methods are used:

Ultrasound of the abdominal organs, Dopplerography ( ultrasound examination portal vein);
computed tomography and magnetic resonance imaging of the abdominal organs;
angiography of the portal vein (X-ray examination with the introduction of a contrast agent);
splenoportography, transhepatic portography (injection of contrast into the spleen or liver);
portal scintigraphy (administration of a radiopharmaceutical drug and recording its accumulation in the portal vein).

Treatment

The treatment strategy includes several components:

Anticoagulants (heparin, pelentan). They prevent the formation of blood clots and promote recanalization (restoration of patency) of the vessel.
Thrombolytics (streptokinase, urokinase). The indication is portal vein thrombosis, the treatment of which essentially consists of eliminating the thrombus blocking the lumen.
Surgical treatment (transhepatic angioplasty, thrombolysis with intrahepatic portosystemic shunt).
Treatment of complications - bleeding from the veins of the esophagus, intestinal ischemia. It is carried out operationally.

Currently under development effective method prevention of thrombosis. As such a means, a technique has been proposed non-selective beta blockers(obzidan, timolol).

Forecast

The prognosis of portal vein thrombosis largely depends on the degree of disturbances that have occurred in the body. An acute episode when thrombolysis fails requires surgical treatment, which in itself is a risk. Chronic thrombosis manifests itself in the form of complications when the process has gone far enough in its development, and its treatment begins with the provision of emergency care. The prognosis in these cases is questionable or unfavorable. Probability successful treatment increases timely diagnosis thrombosis on early stages when compensation mechanisms are able to delay the onset of irreversible changes.

The portal vein is a very important vessel responsible for the functioning of the digestive organs. The formation of a blood clot in it disrupts blood flow, causing the development serious pathologies, therefore liver thrombosis is one of the most dangerous diseases which poses a threat to human life. Blockage of the vessel is accompanied by characteristic symptoms and requires immediate treatment.

Features of the pathology

With the help of the portal vein, blood flows to the liver from other abdominal organs. It is a blood vessel only 5–7 cm long and up to 2 cm in diameter. The portal vein has many branched vessels in the liver and is responsible for the detoxification of the blood, as well as for the work digestive system generally. None of the pathologies of this vessel goes unnoticed and causes serious consequences.
Thrombosis manifests itself in the presence of blood clots that prevent its movement towards the liver, while the pressure in the vessels increases and their cavity expands. A blockage of the vessel can form anywhere in the liver along the entire length of the portal vein.
There are different types of blood clots:

Truncular. Formed in the venous trunk.
Koreshkovy. Initially it occurs in the vessels of the stomach or spleen, and over time it spreads to the portal vein.
Terminal. Its development occurs inside the liver.

There are four stages of thrombosis development:

First. No more than half of the venous cavity is blocked, there are practically no symptoms.
Second. The first signs of the disease appear, 60% of the lumen is thrombosed, the blood flow is slightly impaired.
Third. Many veins of the abdominal cavity are affected, blood flow is significantly slowed down.
Fourth. Separation or destruction of a blood clot.

The blood flow in the veins is not as strong as in the arteries, so blood clots do not break off as often in this case. However, if this happens, the clot may break into several parts and cause simultaneous blockage of several vessels.
If left untreated, the disease can cause a number of serious complications. Among them: bleeding, liver coma, esophageal varicose veins, peritonitis, intestinal infarction.
All these pathologies can lead to fatal outcome, if you don’t start urgently surgery or drug therapy.

Signs of thrombosis

Depending on the nature of its manifestation, the disease can be acute or chronic. In the first form of thrombosis, the following manifestations are observed:
sharp pain in the abdomen;

fever, chills;
increased body temperature;
nausea;
stool disorder;
enlarged spleen;
yellowness of the skin;
swelling of the lower extremities;
dilation of the veins of the esophagus;
bloating;
bloody vomiting;
low blood pressure.

Chronic pathology has different obvious symptoms and on initial stages can only be detected through examination. This occurs due to the fact that additional veins take on the entire load. Chronic thrombosis is characterized by following signs: poor appetite, weakness, lethargy, regular dull ache in the abdomen, enlarged spleen and liver, body temperature within 37–37.5 degrees.

Reasons for the development of thrombosis

In almost half of the cases, the causes of the disease remain unknown. The most common prerequisites for the development of thrombosis are the following factors:

surgical operations;
injuries to vein walls;
compression of blood vessels by a pancreatic tumor;
pancreatic necrosis;
endocarditis;
syphilis;
infections (malaria, Ebola, tuberculosis);
ulcerative colitis;
purulent cholangitis;
Buddy-Chiari disease;
critical form of gestosis during pregnancy;
heart failure;
liver helminthiasis;
liver or intestinal cancer;
pancreatitis;
cholecystitis.

Most often, blockage of blood vessels is observed with cirrhosis of the liver. The pathology in this case is chronic nature and develops over several months and even years. Sometimes the cause of thrombosis may be wrong image the patient's life.

Inactivity and regular work in a sitting or standing position, as well as smoking and frequent use Alcoholic drinks worsen the condition of the liver.
IN in rare cases thrombosis of the portal vein of the liver is detected in women after 35–40 years of age if consumed oral contraceptives. Blocked blood vessels in newborns can be caused by an infection acquired through the umbilical cord. IN childhood The cause of thrombosis may be appendicitis. This happens due to infection entering the body and subsequent inflammation of the vessel.

Diagnosis of the disease

If a person has symptoms of thrombosis in the veins of the liver, they should consult a specialist. To start, you can visit a therapist. He will find out the specifics of the disease, conduct an examination, and, if necessary, refer you to the right doctor. If the patient knows that he has a chronic platelet, he should visit a gastroenterologist. There is also a hepatologist who can make a diagnosis using the most modern techniques.
The acute form of the disease is easier to identify than the chronic form. The latter is very similar in nature to other liver diseases. Diagnostics usually includes the following examinations:

General blood test.
Blood test for clotting.
Ultrasound and CT scan of the liver.
X-ray of liver vessels.
Laparoscopy.
Biopsy.

These studies help to identify an increase in the diameter of blood vessels, determine the degree of tissue density, and assess the nature and localization of the pathology that has developed in the body.

Treatment options

Usually the patient is prescribed drug treatment, which includes receiving various drugs, among them: antibiotics, anticoagulants, thrombolytic drugs and plasma replacement agents.
The doctor determines the dosage of each drug individually; it depends on several factors: the severity of the disease, the degree of liver damage, accompanying pathologies, age of the patient, drug tolerance.
Usually positive result occurs 1–3 days after starting medication. If conservative therapy didn't bring it desired effect, and the patient’s condition has worsened, they resort to surgical intervention. With its help, branches of blood vessels are recreated to renew blood flow. This operation is very dangerous to health and must be performed by an experienced surgeon. Rehabilitation period involves taking medications to reduce blood clotting.
Particularly popular is the thrombectomy method, which involves removing blood clots with a catheter, while preserving the vessel itself. The diseased vein is cut along the edge of the blood clot and an empty catheter is inserted into the hole. Then, using saline solution, the formed blood clot is pulled out. Despite the existence various techniques treatment, the outcome of hepatic thrombosis can be the most unexpected.

Preventive measures

As a preventive measure, experts recommend monitoring your health, undergoing an ultrasound of the liver annually to monitor the condition of the organ, and visiting a doctor every six months. It is forbidden to self-medicate or use folk remedies as primary therapy, it may cause serious complications. At the first symptoms of the disease, you should immediately seek help from a doctor.
The development of vein blockage can be avoided by following simple preventive measures:

You need to eat right.
You need to give up bad habits.
We must not forget to take blood thinning medications if a person has increased coagulability.
Worth taking the time active image life and physical activity.

The main rule in the prevention and treatment of thrombosis is a timely visit to the doctor. To maintain your health, you should contact a medical facility at the first alarming symptoms.

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Everyone knows that blood flows through veins from organs. But in our body there is an exception. We are talking about the portal vein. It is formed by 2 mesenteric and one splenic vein. Collects blood from the gastrointestinal tract and then enters the liver.

Portal vein thrombosis is dangerous condition when a blood clot forms in the lumen of a vessel. Accordingly, blood flow is disrupted.

Reasons

The disease can develop not only in adults. Even babies are subject to certain risks. A complication of infection of the umbilical cord stump is portal vein thrombosis. Acute appendicitis can also provoke the development of serious consequences.

Let's look at the main causes of portal vein thrombosis. The German scientist Rudolf Virchow discovered that in order to implement of this disease 3 conditions are required.

Violation of the integrity of the vascular wall. Namely the endothelium. If the surface does not have pathological changes, the formed clots move with the blood flow. Well, in case of injury or inflammatory processes the structure of the endothelium changes. The formed clots settle in these places, gradually accumulating. As a result, vessel obstruction occurs.

Surgical interventions.
Phlebitis.
Arteritis.

Increased blood clotting. The disease can be either genetically determined or acquired.

Etiological factors:

Congenital pathologies (protein S deficiency, antithrombin deficiency, protein C deficiency, antiphospholipid syndrome, hyperhomocysteinemia).
Oncological diseases.
Taking oral contraceptives.
Antitumor drugs.

Increased coagulability is also observed in pregnant women. Postpartum period also at risk of developing hypercoagulability. This is explained by physiologically based processes: the level of procoagulant factors increases and anticoagulant activity decreases.

Reduced blood flow speed.

Heart failure.
Pre- and postoperative long-term immobilization.
Sedentary lifestyle.
Long flights.

Main manifestations

The severity of the clinical picture, based on which a doctor can diagnose portal vein thrombosis, depends on the course of the disease (acute or chronic), the location of the thrombus and the length of the pathological focus.

If acute course, compensatory mechanisms They don’t manage to work on time. In case of combined portal thrombosis and mesenteric vein the outcome may be fatal.
In a chronic course, changes increase gradually. Collateral blood flow takes over the functions of the lost area. The prognosis is more favorable.

Signs

Portal hypertension.
Enlarged spleen.
Bleeding from dilated veins of the esophagus. At the same time, patients complain about severe pain, black chair. Possible vomiting of “coffee grounds”.
Pain in the intestines, flatulence, intoxication phenomena. The reason for this is paralytic ileus intestines as a result of lack of blood flow through the mesenteric veins.
Liver enlargement, pain, chills. Occurs as a result of purulent pylephlebitis.
Yellowness of the face, sclera.
As a result liver failure encephalopathy may develop.

It should be noted that a heart attack does not only develop in the heart muscle. Occlusion of the lumen of the mesenteric vein leads to serious complication- intestinal infarction. And this, in turn, causes peritonitis.

Examination of the patient

For diagnostic purposes, both laboratory and instrumental methods research. Let's look at them in more detail.

In first place, of course, is ultrasound. The doctor checks not only the lumen of the portal vein (after administration of a contrast agent), but also the condition of the liver and all organs of the digestive system. There are cases when it is necessary to conduct a comprehensive inspection to identify the root cause. Sometimes during the examination it is possible to detect liver diseases (cirrhosis, malignancy– hepatocellular carcinoma).
When performing a coagulogram, the following signs indicate thrombosis:

Elevated fibrinogen levels.
Increased PTI (prothrombin index).
Reduced blood clotting time.

Angiography. Basics instrumental study, which confirms not only the diagnosis of “portal vein thrombosis”, but also allows one to identify the exact localization of the thrombus, the extent and even the speed of blood flow both through the portal vein and through the hepatic and portacaval vessels. This is done as follows. Injected into the portal vein contrast agent. The X-ray monitor examines the uniformity of blood flow.
With the help of CT and MRI, it is possible to detect not only a thrombus, but also the accompanying pathological signs. Namely: varicose dilation of portocaval anastomoses, ascites (accumulation of fluid in the abdominal cavity), enlarged spleen.

Treatment

First of all, drug therapy is prescribed. The treatment regimen for patients diagnosed with portal vein thrombosis includes:

Thrombolytic agents. Fibrinolysin is administered intravenously (using droppers).
Anticoagulants indirect action. Neodicoumarin, Syncumar.
Reopolyglucin to replenish the required volume of circulating fluid.
Antibiotics are prescribed for the development of purulent complications.

First aid for thrombosis is Heparin (Fraxiparin). This drug belongs to the group of direct-acting anticoagulants. Apply in the first hour of development of signs of the disease.

If during conservative treatment no positive dynamics are observed, they resort to surgical intervention. The task of the latter is to recreate collaterals to restore blood flow. As a rule, a splenorenal anastomosis is performed.

Portal vein thrombosis can cause intestinal infarction, peritonitis, massive bleeding, renal and liver failure. Therefore, when you identify the first signs, you should consult a doctor. This way you can avoid dangerous complications without resorting to surgery.

Hepatic vein thrombosis (Budd-Chiari syndrome) - acute disorder blood circulation in blood vessels liver. The overlap of the lumen can be complete or partial, this determines clinical manifestations pathological condition. It is more common in older people, but can also be diagnosed in young people.

Why does it occur

The main reason for the development of pathology is a blood clot in the liver, as a result of which the free flow of blood is disrupted. Various factors can provoke the formation of a clot:

impaired hemostasis in diseases of the cardiovascular system (increased blood clotting and tendency to thrombus formation);
hemolytic anemia, accompanied by accelerated destruction of red blood cells in the liver;
deep vein thrombophlebitis, pericarditis, peritonitis;
blunt abdominal trauma (damage to abdominal organs);
systemic autoimmune and infectious diseases(lupus erythematosus, tuberculosis, syphilis, etc.);
neoplasms in the pancreas, liver, kidneys, adrenal glands;
long-term use medications (hormonal contraceptives, glucocorticosteroids, etc.);
genetic predisposition.

In children, the occurrence of the disease can be triggered by congenital narrowing of the veins, infection of blood vessels through the umbilical cord, or postoperative complications.

Symptoms

Hepatic vein thrombosis may be acute or chronic course. Symptoms depend on the degree of blockage of the lumen of the blood vessel.

Signs of an acute condition:

sharp pain in the abdomen;
nausea;
vomit;
bowel dysfunction (diarrhea);
increased body temperature, chills, weakness, sweating;
an increase in the size of the liver and spleen.

With incomplete occlusion, it develops chronic failure blood circulation in the liver. At the initial stage of the disease clinical symptoms are missing. This is due to the activation of compensatory collateral circulation, thanks to which oxygen and nutrients flow to the tissues in a roundabout way.

Weakness and lethargy gradually increase, appetite worsens, and signs of portal hypertension (increased pressure in the portal vein system) appear. The main manifestations are the development of ascites, an increase in the size of the anterior veins abdominal wall, varicose veins of the esophagus, etc. This threatens rupture of blood vessels and the development of bleeding.

Chronic inflammation of the portal vein (pylephlebitis), in which there is a narrowing of the vessel along its entire length, is accompanied by constant aching pain in the abdomen, prolonged low-grade fever. The spleen and liver gradually increase in size, which extends beyond the edge of the costal arch. Tissue ischemia increases, which provokes disruption of the functioning of hepatocytes. Hepatitis and cirrhosis of the liver develop as complications.

Diagnostics

Diagnosing liver thrombosis is extremely difficult. This is due to the absence of specific signs of the disease. Present symptoms may indicate many other pathologies.

Main research methods:

Ultrasound with Dopplerography. Makes it possible to detect clots in the blood vessels of the liver, determine the degree of blood flow disturbance, the nature of the blood clots (fused to the walls or free).
Angiography. A special injection is administered intravenously radiopaque agent. After this, a series of photographs are taken in which areas where the vein is blocked can be detected. If similar problem This is not the first time this has occurred; drugs to dissolve blood clots are simultaneously administered along with a radiocontrast agent.

From others additional ways use magnetic resonance imaging, the use of radionuclides, general clinical and biochemical tests blood.

Treatment

Thrombosis of the hepatic vessels requires complex treatment. On initial stages pathology, the use of medications is sufficient; in severe cases, surgical intervention is indicated to eliminate the occlusion.

Medicines

In the treatment of thrombosis, drugs are used to restore normal rheological properties blood, activation of blood flow and elimination of the causes that provoked the development of the disease.

For this use:

Anticoagulants (Clexane, Fragmin, etc.). They inhibit the formation of fibrin threads, from which clots subsequently form. Prevents the increase in the size of existing blood clots, activates natural processes aimed at their splitting.
Diuretics. They help remove swelling that is a consequence of thrombosis. For this purpose, Spironolactone, Furosemide, Veroshpiron, Lasix, etc. are used).
Thrombolytics (Urokinase, Alteplase, Actilyse, etc.). Helps dissolve clots, thus restoring free blood flow. The use of thrombolytics is indicated in the initial stages of the disease.

In addition, with increased blood pressure use antihypertensive drugs, for varicose veins and circulatory disorders - venotonics.

Surgery

With the development of acute occlusion, as well as if Budd-Chiari syndrome is caused by a tumor in the liver, kidneys or pancreas, removal of the formation is indicated. In some cases, a liver transplant may be needed.

When the lumen of the inferior vena cava decreases associated with chronic inflammation or education atherosclerotic plaques, angioplasty is recommended. In this case, a stent is placed to ensure that the vein is wide enough and prevent its subsequent collapse.

Shunting will help reduce the pressure in the sinusoidal spaces. This method is indicated for the formation of blood clots in the inferior vena cava.