Hepatic and portal vein thrombosis in cirrhosis: Possible role in development of parenchymal extinction and portal hypertension

TLDR

Obliterative lesions of portal and hepatic veins are common in cirrhotic livers, with portal vein thrombosis well recognized but the cause of hepatic vein occlusion remaining unclear. The study aimed to clarify the prevalence, distribution, and pathogenesis of venous lesions in cirrhotic livers and their association with morphological features and clinical morbidity. The authors examined 61 transplanted cirrhotic livers to investigate these questions. Healed hepatic and portal vein thrombosis, indicated by intimal fibrosis, were found in 70 % and 36 % of livers, respectively; hepatic vein lesions were patchy and confined to 0.1–3 mm veins, while portal vein lesions were uniform, suggesting large‑vein origin with downstream propagation, and both lesion types were linked to parenchymal extinction, nodular variation, and variceal bleeding, underscoring thrombosis of medium and large veins as a frequent driver of cirrhosis progression.

Abstract

Obliterative lesions in portal veins (PVs) and hepatic veins (HVs) of all sizes are known to occur in cirrhotic livers. PV lesions have generally been attributed to thrombosis, but the pathogenesis of the HV (veno-occlusive) lesions is unknown. We have studied 61 cirrhotic livers removed at transplantation to clarify the prevalence, distribution, and pathogenesis of venous lesions, as well as the association of these lesions with other morphological features and clinical morbidity. Intimal fibrosis that is highly suggestive of healed HV or PV thrombosis was found in at least 70% and 36% of livers, respectively. The distribution of HV lesions was patchy and largely confined to veins between 0.1 and 3 mm in diameter, suggesting multifocal origin in small veins. PV lesions were more uniform throughout the liver, suggesting origin in large veins with propagation to the small veins. HV lesions were associated with regions of confluent fibrosis (focal parenchymal extinction), and PV lesions were associated with regional variation in the size of cirrhotic nodules and a history of bleeding varices. These observations suggest that thrombosis of medium and large PVs and HVs is a frequent occurrence in cirrhosis, and that these events are important in causing progression of cirrhosis.