Mesenteric vein thrombosis can be safely treated with anticoagulation but is associated with significant sequelae of portal hypertension

Maldonado, Thomas S.; Blumberg, Sheila; Sheth, Sharvil U.; Perreault, Gabriel; Sadek, Mikel; Berland, Todd; Adelman, Mark A.; Rockman, Caron B.

doi:10.1016/j.jvsv.2016.05.003

Cited by 28 publications

(40 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Surgery is mandatory in the presence of severe peritonitis or perforation [5], but even when the diagnosis is established promptly, 30-day mortality rates in acute SMV thrombosis range from 13 to 50% with traditional treatment of anticoagulation and bowel resection [10]. However, endovascular treatment by means of transcatheter thrombolysis alone may require high dosages and long infusion times, with an increase of up to 60% in the risk of bleeding and intracranial or gastrointestinal hemorrhage [11,12]. Thrombectomy by manual aspiration or by devices which mechanically debulk and aspire the thrombus has been used in the last years and has demonstrated encouraging results [13].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Pharmaco-Mechanical Thrombectomy of Acute Symptomatic Superior Mesenteric Vein Thrombosis

Rabuffi

Vagnarelli

Bruni

et al. 2019

Cardiovasc Intervent Radiol

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Percutaneous Pharmaco-Mechanical Thrombectomy of Acute Symptomatic Superior Mesenteric Vein Thrombosis

Rabuffi

Vagnarelli

Bruni

et al. 2019

Cardiovasc Intervent Radiol

View full text Add to dashboard Cite

show abstract

“…In a radiological report on patients with acute MVT, 80% showed signs of evolution towards chronic MVT such as vein stenosis or occlusion and development of collateral veins [15]. It was reported that patients with short, isolated central MVT in a wide vein had a better chance of complete radiologic recovery [16]. Long-term imaging sequelae of portal venous hypertension, defined as esophageal varices, portal vein cavernous transformation, splenomegaly, or hepatic atrophy, were reported in 50% of MVT patients, and these radiological findings were associated with lower thrombus recanalization rate and more extensive thrombotic disease at initial C T [ 1 6 ] .…”

Section: Discussionmentioning

confidence: 99%

Clinical implications of CT findings in mesenteric venous thrombosis at admission

et al. 2018

View full text Add to dashboard Cite

Purpose The main aim of this study was to evaluate the association of computed tomography (CT) findings at admission and bowel resection rate in patients with mesenteric venous thrombosis (MVT). It was hypothesized that abnormal intestinal findings on CT were associated with a higher bowel resection rate. Methods Retrospective study of MVT patients treated between 2004 and 2017. CT images at admission and at follow-up were scrutinized according to a predefined protocol. Successful recanalization was defined as partial or complete recanalization of the portomesenteric venous thrombosis at the latest CT follow-up (n = 70). Results We studied 102 patients (median age 58 years, 61 men). Lifelong anticoagulation was initiated in 64 patients, and bowel resection rate was 17%. No referral letter indicated suspicion of MVT, whereas three indicated suspected intestinal ischemia. Previous venous thromboembolism was associated with increased bowel resection rate (p = 0.049). No patient with acute pancreatitis (n = 17) underwent bowel resection (p = 0.068). The presence of mesenteric oedema (p = 0.014), small bowel wall oedema (p < 0.001), small bowel dilatation (p = 0.005), and ascites (p = 0.021) were associated with increased bowel resection rate. Small bowel wall oedema remained as an independent risk factor associated with bowel resection ). Successful thrombus recanalization was achieved in 66% of patients. Conclusion The presence of abnormal intestinal findings secondary to MVT confers an excess risk of need of bowel resection due to infarction. Responsible physicians should therefore scrutinize the CT images at diagnosis together with the radiologist to better tailor clinical surveillance.

show abstract

“…AMVT can cause lethal outcomes, and the mortality is up to 20% [3]. The natural history and long-term sequelae of AMVT are little known [4]. In the short term, AMVT can cause intestinal infarction, which is the main cause of poor prognosis, and secondary short bowel syndrome and recurrent thrombosis can also affect outcomes [1].…”

Section: Page 3/19mentioning

confidence: 99%

Clinical Profile, Response to therapy and outcomes of post-ischemic intestinal stenosis Secondary to Acute Mesenteric Venous Thrombosis: a retrospective case series study

Sun

Wang

Chu

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Acute mesenteric venous thrombosis (AMVT) can not only cause acute bowel infarction but result in post-ischemic intestinal stenosis (PIIS), which is rarely reported. Methods Consecutive patients diagnosed with PIIS secondary to AMVT (during the post-thrombotic course, confirmed segmental bowel stenosis) from January 2010 to June 2018 were enrolled. We evaluated the clinical profile, response to therapy, and outcomes of this complication managed at the intestinal stroke center in China. Clinical data are retrospectively analyzed and Wilcoxon signed-rank test was used to evaluate the efficiency of conservative treatment. Results 42 patients with PIIS secondary to AMVT were evaluated. 20 (5-150) days after discharge for AMVT, symptoms of PIIS appeared, and the interval between symptom onset and consultation was 29.5 (2-180) days. In addition, abdominal pain (90.5%), abdominal distension (76.2%), weight loss (71.4%), and nausea or vomiting (54.8%) were the common presentations. Hypoproteinemia was observed in 61.9% of patients, while leukocytosis, anemia and electrolyte disorders were present in 11.9%, 45.2% and 35.7% of patients, respectively. CT excluded thrombosis recurrence and revealed extensive collateral circulation or portal cavernous transformation in 83.3% of patients. Enterography was required only in 81.0% of patients, with positive findings in all patients, including complete obstruction (23.5%), intestinal stricture (64.7%), and extensive mucosal erosion (11.8%). Prompt conservative treatment achieved significantly increases of albumin and pre-albumin levels and correction of electrolyte disorders (all p < 0.05). However, only 4 (9.5%) patients improved after conservative therapy and laparotomy was required in other patients. A median length of 20 (2-100) cm of involved bowel was resected, mainly involving the jejunum (76.3%). Only 1 patient died due to uncontrolled transverse colon bleeding, and other patients’ postoperative courses were uneventful. Conclusion During the post-thrombotic course, clinicians should be aware of the possibility of PIIS in patients with symptoms of ileus and hypoproteinemia. Patients may respond to conservative therapy; however, the majority of patients warrant surgical resection.

show abstract

Mesenteric vein thrombosis can be safely treated with anticoagulation but is associated with significant sequelae of portal hypertension

Cited by 28 publications

References 22 publications

Percutaneous Pharmaco-Mechanical Thrombectomy of Acute Symptomatic Superior Mesenteric Vein Thrombosis

Percutaneous Pharmaco-Mechanical Thrombectomy of Acute Symptomatic Superior Mesenteric Vein Thrombosis

Clinical implications of CT findings in mesenteric venous thrombosis at admission

Clinical Profile, Response to therapy and outcomes of post-ischemic intestinal stenosis Secondary to Acute Mesenteric Venous Thrombosis: a retrospective case series study

Contact Info

Product

Resources

About