Portal Hypertension

What Is Portal Hypertension?

The portal venous system is a network of blood vessels that brings blood from your digestive organs back to your liver. Hypertension is another way of referring to high blood pressure. So, portal hypertension is increased pressure in the portal vein system.

Portal hypertension often happens when blood cannot flow normally through the liver. Sometimes, this is related to scarring in the liver or other liver diseases. The increased pressure in the portal vein can cause the formation of new enlarged veins that bypass the liver. These are called collateral vessels, or “portosystemic” collaterals.

One of the most common areas where these enlarged veins form is in the esophagus and stomach. These enlarged veins are called varices. Varices are thin and can bleed easily, which for some patients can even be life-threatening.

A second negative consequence of portal hypertension is fluid buildup. For many patients with portal hypertension, large amounts of fluid can collect in the abdominal cavity or chest cavity. In the abdominal cavity, this is called “ascites” and can require repeated drainage procedures. In the chest, fluid is called “pleural effusion” or “hepatic hydrothorax,” and also can require repeated drainage.

Another rare but potential complication of portal hypertension is also enlargement of the spleen. This can decrease the number of white blood cells and platelets, leading to an increased risk of infection and bleeding.

Causes of Portal Hypertension

There are two main causes of portal hypertension: cirrhosis and thrombosis.

The most common cause of portal hypertension is liver cirrhosis. Liver cirrhosis is scarring of the liver due to chronic liver injury from chronic hepatitis, alcohol abuse, non-alcoholic fatty liver disease, or autoimmune diseases. Scar tissue in the liver is the hallmark of cirrhosis and can interfere with blood flow through the liver, slowing it down and causing increased portal venous pressure.

Thrombosis, another cause of portal hypertension, is the formation of a blood clot (thrombus) within a blood vessel. Blood clots in the portal vein or the hepatic veins can also lead to this condition. When a blood clot blocks the portal vein, it prevents normal flow through the liver. Portal vein thrombosis, however, is often a result of cirrhosis. A rare condition called Budd-Chiari syndrome can impact blood flow through the liver. Other causes include congestive heart failure and abnormalities of blood coagulation.

Signs & Symptoms

In most patients, portal hypertension does not cause any symptoms early on. However, with time, many patients can develop symptoms or complications which include:

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  Black, tarry stools or red blood in stool
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  Vomiting blood
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  Upper abdominal pain
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  Ascites (abdominal fluid)
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  Pleural effusion (chest fluid)
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  Hepatic encephalopathy (confusion and poor memory)
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  Decreased platelet count

Although portal hypertension can be acute or chronic, there is no symptom time frame to distinguish between the two.

How We Treat Portal Hypertension

If conventional treatments fail to reduce portal hypertension, swelling, and bleeding, patients may need to undergo decompression procedures. At Vascular & Interventional Partners in Scottsdale, AZ, we treat patients with portal hypertension in several ways. One procedure is a minimally invasive procedure called Transjugular Intrahepatic Portosystemic Shunt (TIPS). Another procedure is called Retrograde Transvenous Obliteration, which is a minimally invasive procedure done through the veins to shut down high-risk varices.

TIPS

TIPS is a procedure performed in the hospital, to connect the hepatic vein with the portal vein using a shunt placed in the middle of the liver. The hepatic vein is a blood vessel that directs blood away from the liver. Connecting this vein with the portal vein helps reroute blood flow in the liver to relieve pressure within the portal vein.

During a TIPS procedure, specialists like the doctors at ViP use X-ray and ultrasound imaging to guide a catheter from a vein in the neck to a vein in your liver. Once in the liver, a special tube called a stent is placed to connect the portal vein to a hepatic vein. At the end of this procedure, providers may check the portal vein pressure to make sure it has gone down.

TIPS can be a life-saving procedure that immediately relieves pressure within the portal vein to stop rapid gastrointestinal bleeding. The procedure can also help with abdominal swelling by decreasing the amount of fluid that builds up.

Transvenous Obliteration

Transvenous Obliteration, sometimes called “BRTO” is a procedure performed in the hospital or an outpatient facility, to shut down flow in large veins called varices. Sometimes shutting down a vessel is referred to as an “embolization.” By shutting down these varices, we can decrease the risk of bleeding, or drive more blood flow to the liver. Sometimes, this transvenous obliteration can happen in addition to a TIPS procedure.