Portal vein thrombosis (PVT) is a heterogeneous and clinically significant complication of liver cirrhosis, primary hepatobiliary malignancy, and various systemic prothrombotic states. It is associated with advanced portal hypertension, increased surgical complexity during liver transplantation, and higher mortality. The aim of this manuscript is to provide a narrative review of PVT and portal vein recanalization combined with transjugular intrahepatic portosystemic shunt (PVR-TIPS), detailing epidemiology, pathophysiology, and diagnostic classifications while exploring evolving medical and interventional management strategies. A comprehensive narrative review of the existing literature was conducted, incorporating clinical practice guidelines from major societies (AASLD, Baveno VII, EASL, and AGA) and recent prospective and retrospective studies regarding the management of non-malignant PVT in both cirrhotic and non-cirrhotic patients. PVT occurs in approximately 1% of the general population but affects up to 44% of candidates for liver transplantation (LT). Its development is governed by Virchow's triad, with reduced portal flow velocity (<15 cm/s) being the primary independent predictor in cirrhosis. Diagnosis relies on Doppler ultrasound as a first-line screening tool, followed by contrast-enhanced computed tomography or magnetic resonance imaging to define the degree of occlusion, extent, and chronicity using standardized nomenclature. Medical management with anticoagulation is the cornerstone for recent PVT (<6 months), achieving recanalization in 40%–75% of cases. For chronic obliterative PVT or refractory complications (variceal bleeding or refractory ascites), PVR-TIPS has emerged as a safe and highly successful intervention, with technical success rates ranging from 75% to 100% in expert centers. PVR-TIPS facilitates physiologic end-to-end portal anastomosis during LT in up to 96%–100% of cases, significantly improving transplant feasibility and outcomes. The management of PVT has transitioned toward highly individualized strategies. Standardized classification remains essential for guiding therapy. While medical management is effective for recent-onset disease, PVR-TIPS represents a transformative interventional advancement for chronic obliterative PVT, restoring physiologic flow and optimizing candidates for curative liver transplantation.
Introducción En artritis reumatoide (AR), espondiloartritis axial (EspAax) y artritis psoriásica (APs), el control sostenido de la actividad de la enfermedad con fármacos biológicos e inhibidores de la cinasa Janus (JAK) plantea decisiones prácticas sobre reducción del tratamiento. La evidencia es heterogénea en definiciones, esquemas y rescate, lo que dificulta estandarizar conductas en la práctica clínica. Objetivo Generar recomendaciones basadas en la evidencia y la experiencia clínica para la reducción y descontinuación de fármacos biológicos e inhibidores de JAK en adultos con AR, EspAax y APs en Colombia, dirigidas a reumatólogos y tomadores de decisión del sistema de salud. Métodos Se realizó un consenso colombiano de expertos mediante técnica Delphi y con síntesis estructurada de evidencia. Se buscaron publicaciones en Medline/PubMed y LILACS, se complementó con repositorios de guías y sociedades científicas, y se priorizó la evidencia reciente. Cada enunciado se calificó en escala Likert de cinco puntos y el consenso se definió, a priori, como ≥ 70% de acuerdo. Los ítems sin consenso se ajustaron tras discusión y se volvieron a votar. Resultados El panel aprobó 29 declaraciones, organizadas en definiciones y metas, elegibilidad, estrategia de reducción, seguimiento y manejo de recaída. La recomendación central fue realizar reducción gradual, individualizada y reversible, generalmente preferible a la suspensión completa. El tiempo mínimo de control sostenido antes de iniciar la reducción del tratamiento se definió en seis a 12 meses para AR y en 12 meses o más para EspAax y APs. El primer paso de la estrategia de reducción consistió en una disminución del 25% de la dosis total, ya fuese mediante reducción de dosis o ampliación de los intervalos de administración. La progresión a etapas posteriores solo se consideró si se mantenía el objetivo terapéutico durante al menos seis meses. Asimismo, se establecieron acciones de rescate específicas en casos de recaída según la enfermedad y la gravedad de las manifestaciones clínicas. Conclusiones Estas recomendaciones operativas facilitan decisiones consistentes para la reducción de terapias avanzadas en Colombia e integran clinimetría validada, decisión compartida, seguimiento estructurado y rescate predefinido.
Abstract Background: Leg ulcers represent a global health challenge, especially affecting women and older individuals, leading to significant morbidity and a decrease in the quality of life. Its inter-disciplinary management puts economic strain on health systems. Dermatologists are frequently consulted; however, data on factors associated with healing are scarce. Aims and Objectives: To provide data on factors associated with improvement of leg ulcers. Methods: A retrospective cohort study approved by CES University Human Research Ethics Committee, following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, was carried out. Medical records of patients with lower limb ulcers referred to the Dermatology Service of a tertiary hospital in Medellín, Colombia, between 2015 and 2022 were reviewed. Entry was defined as the dermatological consultation, with follow-up until specialised discharge. Results: Among 207 patients, 63.8% (n = 132) were women, with an average age of 64 years, and 40% had previously had ulcers. Co-morbidities, such as hypertension, diabetes, anaemia, malnutrition, and internal malignancy, were associated with a lower probability of improvement. Deeper ulcers were statistically significantly associated with a poor response to treatment. Specific topical and systemic treatments were positively correlated with improvement. Conclusions: Several factors highlight the need for timely recognition of lower limb ulcers. A poor response to treatment correlates with pain, ulcer depth, diabetes, and malnutrition, emphasising the need for multi-disciplinary management for effective results.
