Hepatic and Intestinal Vascular and Thrombotic Disorders Program
Thrombosis is the formation of a blood clot within a blood vessel; this affects the livers and intestines of pediatric and adult patients. Our world-renowned physicians diagnose and treat patients suffering from thrombotic disorders.
Physicians and specialists at the Mount Sinai Health System can diagnosis and treat adult and pediatric patients suffering from various blood clotting issues affecting the liver and intestines. We do all we can to avoid the need for a transplant.
We have treated patients living with the following conditions:
- Non-cirrhotic portal hypertension
- Cirrhosis is scarring of the liver and poor liver function as a result of chronic (long lasting) liver disease. Cirrhosis can sometimes cause high blood pressure, but not always. When patients experience high blood pressure from non-cirrhosis-related liver dysfunction, it is known as non-cirrhotic portal hypertension. The liver pathologists at Mount Sinai are national experts especially for a non-cirrhotic portal hypertension diagnosis.
- Budd-Chiari syndrome
- This is a rare liver disease in which the veins that drain blood from the liver are blocked or narrowed. This disorder occurs when a clot completely or partially blocks the large veins that carry blood from the liver (hepatic veins) into the inferior vena cava. The inferior vena cava is the large vein that receives blood from the lower extremities, pelvis and abdomen and delivers it to the heart.
- Portomesenteric thrombosis
- This is a form of thrombosis affecting the portal vein. The portal vein carries blood from the digestive organs (mouth, esophagus, stomach, small and large intestines, pancreas, and gallbladder) and spleen to the liver. If blood cannot reach the liver, it can result in the patient experiencing high blood pressure and reduced blood supply to the liver. Our surgeons are sometimes able to treat portomesenteric thrombosis without a transplant.
Our multidisciplinary team of experts in the fields of liver, liver surgery, hematology, endoscopy, pathology, and interventional radiology use innovative endoscopic, surgical and radiologic procedures to treat abnormally enlarged and lengthened vein and blood clots.
- Endoscopic procedures are minimally invasive and allow our team to look inside your body using an instrument called an endoscope.
- Radiologic procedures are when the team uses radiant energy (such as X-rays or ultrasound) in the diagnosis and treatment of diseases.
Through these procedures, we can often avoid the need for transplantation, which is subject to donor availability.
Our procedures include:
- Balloon retrograde transvenous obliteration of gastric varices (BRTO)
- This is a procedure that involves shutting off or obstructing the portosystemic shunt using a balloon. The shunt is an abnormal vessel that allows blood to go around, or bypass, the liver. We do not want this to happen, therefore, we need to block it with the balloon. If the blood bypasses the liver, the blood is not cleansed by the liver, which is one of the main jobs of the liver.
- Cyanoacrylate endoscopic injection of gastric varices
- In this procedure, physicians inject medication into the blood vessels to stop the bleeding, as an endovascular treatment is not possible. This procedure is only offered at a handful of centers in the country.
- Rex shunt. This is a surgical procedure used to redirect blood back into the liver around an area of blockage. This is the treatment of choice for children with extra-hepatic portal vein thrombosis.
- Transjugular intrahepatic portosystemic shunt (TIPS). A small, tubular synthetic device, commonly called a stent, is placed in the veins in the liver to permit blood flow to bypass the liver.
- Other surgical approaches for portal hypertension, vascular stenting and direct thrombolytic therapies
For those patients in need of transplantation, Mount Sinai is exceptionally skilled in liver, small intestine and multivisceral transplants. Our hematologists are nationally recognized in the field of coagulation and the diagnosis of difficult and unique clotting disorders, with ongoing clinical trials available to treat myeloproliferative disorders.