Portal Hypertension and Splenic Venous Thrombosis Mechanisms

Portal hypertension arises from elevated pressure in the portal venous system, commonly due to cirrhotic scarring but also from prehepatic impediments such as splenic venous thrombosis. When the splenic vein is occluded, blood is diverted through short gastric and posterior gastric veins, leading to segmental, or sinistral, portal hypertension. This condition precipitates the formation of gastric and oesophageal varices, with a high risk of life-threatening haemorrhage. Mechanistically, thrombosis in the splenic vein may arise from pancreatic inflammation, neoplastic invasion, hypercoagulable states or idiopathic stenosis. The resultant increase in splenic pressure drives collateral vessel formation, while local endothelial dysfunction and coagulopathy exacerbate thrombus progression. Key therapeutic strategies target the underlying aetiology and aim to decompress the congested venous territory. Treatments range from splenectomy, which removes the source of elevated pressure, to interventional radiological techniques such as splenic artery embolisation and percutaneous splenic vein stenting. Recent advances have focused on refining minimally invasive approaches, improving patient selection through predictive modelling, and elucidating the dynamic vascular remodelling that underpins chronic variceal development.

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Portal Hypertension and Splenic Venous Thrombosis Mechanisms publication trend

The graph below shows the total number of articles in portal hypertension and splenic venous thrombosis mechanisms across all publications each year (not limited to Nature Index journals).

Technical terms

Portal hypertension: Elevated pressure in the portal venous system, often resulting from hepatic or prehepatic vascular obstruction.

Splenic venous thrombosis: Occlusion of the splenic vein by a thrombus, leading to increased pressure in the splenic circulation.

Sinistral portal hypertension: Also known as left-sided portal hypertension, confined to the splenic segment, usually due to splenic vein obstruction.

Gastric varices: Dilated submucosal veins in the stomach fundus or cardia that develop under increased venous pressure.

Splenic vein stenting: Endovascular placement of a stent to re-establish patency in a stenosed or occluded splenic vein.

Splenic artery embolisation: Radiological occlusion of branches of the splenic artery to reduce inflow and lower pressure in variceal vessels.

Nomogram: A graphical calculation tool integrating multiple predictors to estimate an individual’s risk for a clinical outcome.

References

1. Dynamic Changes and Nomogram Prediction for Sinistral Portal Hypertension in Moderate and Severe Acute Pancreatitis. Frontiers in Medicine (2022).
2. The clinical applicability of percutaneous splenic vein stent implantation for pancreatic portal hypertension. BMC Gastroenterology (2022).
3. Emergent Management of Gastric Variceal Bleed in the Setting of Acute Pancreatitis-Related Sinistral Hypertension With Partial Splenic Embolization: A Series of Two Cases. Cureus (2022).
4. Left-sided portal hypertension caused by idiopathic splenic vein stenosis improved by splenectomy: a case report. Surgical Case Reports (2020).