Liver Thrombosis Program
The Liver Thrombosis Program at Mount Sinai Health System in New York City is an international referral center for adults and children with difficult to diagnose and unique blood clotting disorders affecting the liver and intestines. It is the only program of its kind in the United States, with physician-scientists who are leading national experts in the field of blood coagulation and thrombosis.
We offer a multidisciplinary team approach that brings together specialists in hepatology, liver surgery, intestinal surgery, hematology, endoscopy, liver pathology, and interventional radiology to provide comprehensive, coordinated care tailored to the needs of each individual. As part of one of the nation's leading hospitals and a highly-ranked medical school, we are able to draw on its vast resources including medical experts and researchers in a wide range of disciplines.
Conditions We Treat
We evaluate, diagnose, treat, and manage the following conditions, in addition to other thrombotic disorders:
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 in the liver. When patients experience this 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 in making the very difficult diagnosis of non-cirrhotic portal hypertension based on liver biopsy.
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) via the inferior vena cava and back to the heart.
Portomesenteric thrombosis: This is a form of thrombosis affecting the portal vein, splenic vein or superior mesenteric 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.
Using innovative endoscopic, surgical and radiologic procedures (such as X-rays and ultrasound), we are able to treat abnormally blocked or narrowed blood vessels and the damage that they cause, thereby eliminating the need for liver transplantation in many patients. (Endoscopic procedures are minimally invasive and allow our team to look inside the body using an instrument called an endoscope.)
Among the state-of-the-art procedures we offer are:
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, also known as a liver shunt, is an abnormal vessel in the body that allows blood to go around, or bypass, the liver. This is a dangerous condition because if the blood bypasses the liver, the liver is unable to perform one of its main functions which is to cleanse the blood.
Cyanoacrylate endoscopic injection of gastric varices. In this procedure, our physicians inject medication into the blood vessels to stop the bleeding, when an endovascular treatment is not possible. This procedure is only offered at a handful of medical centers in the United States.
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 are also available for portal hypertension, vascular stenting and direct thrombolytic therapies.
Although we do all we can to avoid the need for transplantation, we work closely within The Recanati/Miller Transplantation Institute (RMTI) at Mount Sinai to guide patients through the transplant process. RMTI is honored to be regarded as one of the leading centers in the world performing liver, small intestine, and multivisceral transplantation in patients with thromboses and clotting disorders that require transplantation.
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