Ep. 580 How to Manage Portal Vein Thrombosis with Dr. Vijay Ramalingam

When a patient presents with portal vein thrombosis (PVT), how do you decide between anticoagulation, intervention, and adjunct therapies? In this episode, Dr. Vijay Ramalingam, vascular and interventional radiologist from Beth Israel Deaconess Medical Center, joins Backtable host Dr. Chris Beck to share his approach to evaluation and management of both acute and chronic PVT.
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SYNPOSIS
The discussion begins with an overview of the Splanchnic Vein Thrombosis Multidisciplinary Clinic at Beth Israel– a collaboration between Interventional Radiology, Hepatology/Gastroenterology, Surgery and Hematology. Dr. Ramalingam details the clinic's workflow, from initial case conference to the comprehensive single-day patient workup that includes imaging, lab work, and consultations with all three specialties. He shares his algorithm for treatment decisions, breaking down the distinct management pathways for patients with and without cirrhosis, and for those with acute vs. chronic thrombosis.
Finally, Dr. Ramalingam details his portal vein recanalization technique during procedure, providing a step-by-step guide to his preferred dual-access approach for complex cases, including his method for trans-splenic access and his trick on how to safely close the splenic tract. He also explains when it’s appropriate to use adjunctive therapies like suction thrombectomy and catheter-directed lysis, and describes preliminary data showing that their comprehensive approach leads to a change in management for about 40% of patients.
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TIMESTAMPS
00:00 - Introduction
05:35 - Splanchnic Vein Thrombosis Multidisciplinary Clinic
22:24 - Multidisciplinary Approach
26:17 - PVT Classification
38:47 - Treatment Evaluation and Intervention
44:21 - Alternative Treatment Options for PVT
49:00 - Procedural Techniques
59:53 - Adjunct Techniques and Case Studies
01:02:58 - Review of Preliminary Data & Final Thoughts