Opinion Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 27, 2019; 11(8): 613-618
Published online Aug 27, 2019. doi: 10.4254/wjh.v11.i8.613
Is porto sinusoidal vascular disease to be actively searched in patients with portal vein thrombosis?
Stefania Gioia, Silvia Nardelli, Lorenzo Ridola, Giulia d’Amati, Oliviero Riggio
Stefania Gioia, Silvia Nardelli, Lorenzo Ridola, Oliviero Riggio, Dipartimento di Medicina Traslazionale e di Precisione, “Sapienza” Università di Roma, Roma 00185, Italy
Giulia d’Amati, Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo Patologiche, “Sapienza” Università di Roma, Roma 00185, Italy
Author contributions: Gioia S contributed to study concept and manuscript preparation; Nardelli S contributed to manuscript preparation; Ridola L contributed to manuscript preparation; d’Amati G contributed to manuscript preparation and final drafting of the manuscript; Riggio O contributed to study concept, manuscript preparation, final drafting of the manuscript, and study supervision.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Stefania Gioia, MD, Dipartimento di Medicina Traslazionale e di Precisione, “Sapienza” Università di Roma, Viale dell’Università 37, Roma 00185, Italy. stefania.gioia@uniroma1.it
Telephone: +39-6-49970463 Fax: +39-6-49972006
Received: March 26, 2019
Peer-review started: March 26, 2019
First decision: June 16, 2019
Revised: July 3, 2019
Accepted: July 16, 2019
Article in press: July 17, 2019
Published online: August 27, 2019

Porto sinusoidal vascular liver disease (PSVD) and portal vein thrombosis (PVT) are distinct vascular liver diseases characterized, respectively, by an intrahepatic and a prehepatic obstacle to the flow in the liver portal system. PVT may also occur as a complication of the natural history of PSVD, especially if a prothrombotic condition coexists. In other cases, it is associated to local and systemic pro-thrombotic conditions, even if its cause remains unknown in up to 25% despite an active search. In our opinion, the presence of PSVD should be suspected in patients with PVT especially in those with PVT “sine causa” and the active search of this condition should be included in their diagnostic work-out. However, sometimes the diagnosis of pre-existing PSVD is very hard. Biopsy cannot be fully discriminant as similar histological data have been described in both conditions. Liver stiffness may help as it has been shown to be higher in PSVD than in “pure” PVT, due to the presence of sclerosis in the portal venous radicles observable in PSVD patients. Nevertheless, comparing liver stiffness between PVT and PSVD has until now been restricted to very limited series of patients. In conclusion, even if it is still totally hypothetical, our point of view may have clinical consequences, especially when deciding to perform a liver biopsy in patients with a higher liver stiffness and suspending the anticoagulation in patients with PVT and no detectable prothrombotic factors.

Keywords: Porto sinusoidal vascular liver disease, Obliterative portal venopathy, Portal vein thrombosis, Anticoagulant therapy

Core tip: Porto sinusoidal vascular liver disease (PSVD) and chronic portal vein thrombosis (PVT) are vascular liver diseases. This review aims to discuss the possibility that (PSVD) should be suspected in patients with PVT and to analyse the possible diagnostic tools able to differentiate between these two conditions. Moreover, the review focuses on the possible and relevant clinical consequences of missing a diagnosis of PSVD in patients with PVT.