{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T06:02:32Z","timestamp":1785391352350,"version":"3.55.0"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Radiol."],"abstract":"<jats:p>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 (&amp;lt;15\u2005cm\/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 (&amp;lt;6 months), achieving recanalization in 40%\u201375% 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%\u2013100% 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.<\/jats:p>","DOI":"10.3389\/fradi.2026.1880540","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:40:27Z","timestamp":1785390027000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Portal vein recanalization and transjugular intrahepatic portosystemic shunt in chronic portal vein thrombosis: a narrative review"],"prefix":"10.3389","volume":"6","author":[{"given":"Valentina","family":"Mej\u00eda-Qui\u00f1ones","sequence":"first","affiliation":[{"name":"Centro de Investigaciones Cl\u00ednicas, Fundaci\u00f3n Valle del Lili","place":["Cali, Colombia"]},{"name":"Facultad de Ciencias de la Salud, Universidad Icesi","place":["Cali, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Gabriel","family":"Lotero-Robledo","sequence":"additional","affiliation":[{"name":"Radi\u00f3logo Intervencionista y de Imagen Corporal, Cl\u00ednica CES","place":["Medell\u00edn, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Miguel","family":"Hidalgo-Oviedo","sequence":"additional","affiliation":[{"name":"Radi\u00f3logo Intervencionista, Hospital Pablo Tob\u00f3n Uribe","place":["Medell\u00edn, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan S.","family":"Toro-Guti\u00e9rrez","sequence":"additional","affiliation":[{"name":"Radi\u00f3logo Intervencionista, Departamento de Intervencionismo Vascular, Fundaci\u00f3n Valle del Lili","place":["Cali, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge Mario","family":"Sastoque-G\u00f3mez","sequence":"additional","affiliation":[{"name":"Radi\u00f3logo Intervencionista, Cl\u00ednica CES","place":["Medell\u00edn, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.jceh.2014.12.008","article-title":"Portal vein thrombosis","volume":"5","author":"Chawla","year":"2015","journal-title":"J Clin Exp Hepatol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1517","DOI":"10.3390\/jcm13051517","article-title":"Portal vein thrombosis: state-of-the-art review","volume":"13","author":"Boccatonda","year":"2024","journal-title":". 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