Portal Hypertension · IR Playbook

Portal Vein Recanalization, Thrombectomy and Stenting (PVR)

Portal vein recanalization restores a hepatopetal channel through a thrombosed, stenosed or chronically occluded portomesenteric segment; thrombectomy removes recent clot, angioplasty expands a fixed lesion and stenting scaffolds recoil or persistent obstruction. It is an escalation procedure rather than routine first-line therapy for uncomplicated portal vein thrombosis: the intended benefit is prevention of bowel ischemia, relief of clinically significant portal hypertension, restoration of graft or liver inflow, or creation of transplantable portal anatomy. Success depends on both adequate mesenteric-splenic inflow and patent intrahepatic outflow; failure to correct either promotes early rethrombosis, while transhepatic and transsplenic access create potentially major bleeding risks.

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