Endovascular management of bowel ischemia secondary to portal and mesenteric vein thrombosis

Garge, Shaileshkumar; Vyas, Pooja D; Rasool, Bushra B; Rathod, Krantikumar; Talwar, Inder

doi:10.4103/1110-7782.159474

Cited by 2 publications

(2 citation statements)

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“…Studies and case reports on the efficacy of this method are limited [ 17 , 25 – 28 ]. There are even fewer reports on completely occlusive acute–subacute PVMVT [ 25 , 26 , 28 , 29 ]. Therefore, this study aimed to evaluate the efficacy and factors related to the outcome of EVTs for completely occlusive acute–subacute PVMVT (symptom onset < 40 days) with severe complications.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of endovascular treatment for completely occlusive acute–subacute portal and mesenteric vein thrombosis with severe complications in patients without cirrhosis

et al. 2023

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Purpose Completely occlusive acute–subacute portal and mesenteric vein thrombosis (PVMVT) with severe complications is fatal. Endovascular treatments (EVTs) of acute–subacute PVMVT are not standardized. Thrombectomy combined with continuous catheter-directed thrombolysis is considered an effective treatment. Here, we aimed to evaluate the outcome of EVTs of completely occlusive acute–subacute PVMVT with severe complications in patients without cirrhosis. Materials and methods Nineteen patients (nine men and 10 women; age, 60.1 ± 16.8 years) with completely occlusive acute–subacute PVMVT were retrospectively assessed. Acute–subacute PVMVT was defined as symptom onset within 40 days, with no cavernous transformation observed on contrast-enhanced computed tomography. The patients were treated with EVTs, a combination of thrombectomy (including aspiration thrombectomy, plain old balloon angioplasty, single injection of thrombolytic agents, and stent placement) and continuous catheter-directed thrombolysis. Kaplan–Meier analyses were performed to assess all-cause mortality, acute–subacute PVMVT-related mortality, and portal vein (PV) patency. The degree of recanalization and patency of PV, complications, factors related to acute–subacute PVMVT-related mortality, and factors related to patency of PV were also evaluated. Results The all-cause and acute–subacute PVMVT-related mortality rates were 36.8% (7/19) and 31.6% (6/19), respectively. Seven (36.8%) and 11 (57.9%) patients achieved complete and partial recanalization, respectively. Among the 18 patients who achieved recanalization, follow-up images after 608.7 ± 889.5 days confirmed recanalization in 83.3% (15/18) patients, and 53.3% (8/15) of these patients achieved patency of PV. Seven patients (36.8%) developed complications, and two (10.5%) required interventional treatment for complications. Deterioration of liver function significantly worsened the prognosis ( P = 0.046), while anticoagulation therapy significantly maintained portal patency ( P = 0.03). Conclusion This endovascular method for acute–subacute PVMVT, which combines thrombectomy and continuous catheter-directed thrombolysis EVT approach was effective for thrombus resolution. However, further studies must define conditions that improve patient prognosis.

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Section: Introductionmentioning

confidence: 99%

Efficacy of endovascular treatment for completely occlusive acute–subacute portal and mesenteric vein thrombosis with severe complications in patients without cirrhosis

et al. 2023

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“…The diagnosis of portal venous thrombosis and consecutive mesenteric thrombosis is usually delayed because of nonspecific complaints of the patient and can lead to serious life-threatening complications [3,4]. The gold-standard to diagnose this condition is computed tomography angiography (CTA) where the thrombus can easily be visualized.…”

Section: Introductionmentioning

confidence: 99%

Complicated idiopathic portal and mesenteric venous thrombosis: A case report

Bele

2023

Acta Marisiensis - Seria Medica

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Introduction: Acute mesenteric ischemia is a life-threatening condition that can lead to intestinal ischemia, bowel obstruction and peritonitis. It is predominantly caused by arterial occlusion (acute arterial thromboembolism or thrombosis); however, it can rarely be secondary to mesenteric or portal vein thrombosis. Case presentation: We present the case of a 61-year-old man admitted to the emergency service for intense abdominal pain and lack of bowel movement. A computed tomography angiography (CTA) was performed, revealing portal and mesenteric vein thrombosis. Anticoagulant treatment was established. To appraise the extension of the necrotic tissue, the surgical team performed exploratory laparotomy, followed by segmental enterectomy. The following day, the patient complained of acute pain in the left lower limb and a CTA was performed indicating acute ischemic phenomenon. The surgical team performed thrombectomy using a Fogarty catheter. The ischemic enteral region extended, and the patient developed an enterocutaneous fistula that required surgical reintervention (enterectomy and right hemicolectomy). Conclusion: Conservative treatment with anticoagulants is the first line treatment, followed by surgical treatment only in case of complications. Even though venous thrombosis is an exceptional cause of intestinal infarction, it can be the cause of life-threatening complications such as necrosis, peritonitis and septic shock.

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Endovascular management of bowel ischemia secondary to portal and mesenteric vein thrombosis

Cited by 2 publications

References 8 publications

Efficacy of endovascular treatment for completely occlusive acute–subacute portal and mesenteric vein thrombosis with severe complications in patients without cirrhosis

Efficacy of endovascular treatment for completely occlusive acute–subacute portal and mesenteric vein thrombosis with severe complications in patients without cirrhosis

Complicated idiopathic portal and mesenteric venous thrombosis: A case report

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