Percutaneous mesenteric venous thrombectomy and thrombolysis: Successful treatment followed by liver transplantation

Abstract

Mesenteric vein thrombosis (MVT) is a rare cause of intestinal ischemia. Because of its nonspecific symptoms, diagnosis is often delayed. We describe a patient with liver cirrhosis who developed acute MVT while waiting for liver transplantation. Surgical intervention carried a high risk because of her underlying cirrhosis. Mesenteric venous thrombectomy and thrombolysis were performed with an AngioJet (Possis Medical, Minneapolis, MN) thrombectomy device and streptokinase infusion through transjugular route. The patient subsequently received an orthotopic liver transplant. We also present a review of the literature about the occurrence and treatment options for MVT.

Percutaneous Transhepatic Mechanical Thrombectomy for Acute Mesenteric Venous Thrombosis

“…[12][13][14][15] Treatment options include systemic anticoagulation, intra-arterial lytic therapy, catheter-directed thrombolysis into the SMA, 8,9 surgical thrombectomy with or without thrombolysis directly into the mesenteric veins, 14 or percutaneous transhepatic infusion of thrombolytic agents. 15 The combination of mechanical thrombectomy and pharmacological thrombolysis through a direct access to the portal system may significantly decrease treatment time in patients with extensive thrombosis and reduce the risk of postoperative bleeding with surgical thrombectomy. In addition, the combined treatment before operation in a patient with peritoneal signs may reduce the complications of bowel resection.…”

Thrombosis of a Superior Mesenteric Vein Aneurysm: Transarterial Thrombolysis and Transhepatic Aspiration Thrombectomy

“…Therefore, additional mechanical declotting was performed. Usually, percutaneous access to the portal system is gained via either a transjugular or a direct transhepatic approach [18,28]. Transjugular portal access is advantageous, in particular, if there is associated intrahepatic portal hypertension, as portal outflow can be improved by simultaneous creation of an intrahepatic portosystemic shunt (TIPS).…”

Portal vein thrombosis: What surgeons need to know

“…[ 23 ] The experience with interventional techniques in the setting of PVT is still limited, and the benefit of these procedures remains to be fully defined. [ 18 24 25 26 27 ] There are, however, an increasing number of case reports that document the successful use of interventional radiology for both mechanical and pharmacologic thrombolysis in the setting of PVT. [ 24 25 26 27 ] For example, Rossi et al .…”

“…[ 18 24 25 26 27 ] There are, however, an increasing number of case reports that document the successful use of interventional radiology for both mechanical and pharmacologic thrombolysis in the setting of PVT. [ 24 25 26 27 ] For example, Rossi et al . describe the use of percutaneous transhepatic catheterization with mechanical and pharmacologic thrombolysis.…”

“…[ 24 ] Surgical interventions such as thrombectomy or shunting are certainly more invasive and are associated with their own set of complications. [ 16 27 ]…”