Diagnosis and treatment of portal vein thrombosis

Portal vein thrombosis （PVT） involves the main portal vein and its tributaries， and acute PVT can cause intestinal ischemia and necrosis， while chronic PVT can cause cavernous transformation of the portal vein and portal hypertension-related complications （such as ascites and gastroesophageal variceal bleeding）. Liver cirrhosis is the main risk factor for PVT. the Classification of PVT provides a basis for clinical diagnosis. Ultrasound is the preferred method for screening， and contrast-enhanced computed tomography is the gold standard for diagnosis， while magnetic resonance imaging/magnetic resonance venography can help to identify acute or chronic thrombosis. Treatment emphasizes individualized strategies： anticoagulant therapy is the first-line therapy for acute PVT， and direct oral anticoagulants have shown great potential in clinical practice； thrombolytic therapy is appropriate for severe acute PVT， and it is needed to strictly control the risk of bleeding； transjugular intrahepatic portosystemic shunt is an important method for the diagnosis and treatment of PVT-related ascites and gastroesophageal variceal bleeding； surgical operation can be used for the treatment of patients with no response to pharmacotherapy or those with serious complications such as intestinal necrosis. Future diagnosis and treatment of PVT should be based on multidisciplinary collaboration， focusing on the optimization of individualized regimens， balancing efficacy and safety， and continuously leveraging technological advances to improve clinical practice.