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

Rabuffi, Paolo; Vagnarelli, Simone; Bruni, Antonio; Antonuccio, Gabriele; Ambrogi, C

doi:10.1007/s00270-019-02354-y

Cited by 15 publications

(14 citation statements)

References 28 publications

(37 reference statements)

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“…In our study, percutaneous thrombectomy was used to treat 14 patients, most commonly using pharmacomechanical thrombectomy through rheolysis and less commonly using aspiration thrombectomy, either in combination with other modalities, especially CDT, or alone, in case CDT was contraindicated or not indicated. Rabuffi et al [ 10 ] evaluated the outcomes of 8 patients who were treated by a pharmacomechanical thrombectomy, and showed survival rate of 87.5% and a 12.5% major complication rate at mean follow up of 37 mo, compared to 78.6% and 7.1% in our study at median follow-up of 23 mo.…”

Section: Discussionmentioning

confidence: 43%

Superior mesenteric venous thrombosis: Endovascular management and outcomes

Alnahhal¹,

Toskich²,

Nussbaum³

et al. 2022

WJCC

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BACKGROUND Superior mesenteric venous thrombosis (SMVT) is a rare but fatal condition that is typically treated initially with anticoagulation therapy, and if this fails, with endovascular interventions. However, due to its rarity, there are not many studies that have explored the effectiveness of anticoagulation and endovascular therapies in treating SMVT. AIM To evaluate patients diagnosed with SMVT who received endovascular therapy in addition to anticoagulation and report technical and clinical outcomes. METHODS A retrospective analysis of the patients who underwent endovascular treatment for SMVT at Mayo Clinic from 2000-2019 was performed. Technical success was defined as angiographic improvement in SMV flow after intervention. Primary patency was defined as the interval from reestablishing mesenteric venous flow until the first repeat thrombotic event or need for additional intervention. Secondary patency was defined as successful restoration of flow after repeat intervention until rethrombosis or last follow-up. The adverse events were reported through Clavien-Dindo classification. RESULTS Twenty-four patients were included for analysis. The median age at intervention was 60 years (35-74 years) and 16 (67%) were men. Nineteen patients presented with acute thrombosis (79.2%) and 5 with chronic thrombosis with acute manifestations (20.8%). The most commonly used endovascular modalities were thrombectomy in 12 patients (50.0%) and catheter-directed thrombolysis in 10 patients (41.7%). Technical success was achieved in 18 patients (75%). The 14-d and 30-d primary patency rates were 88.9% and 83.3%, respectively. Adverse events were reported in two patients (8.3%), one marked as grade IIIB, and 1 death marked as grade V. Five-year overall survival rate was 82% (58%-100%). CONCLUSION Endovascular intervention with anticoagulation appears to be effective for managing SMVT. This treatment combination may be considered as first-line therapy for SMVT management in select patients.

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Section: Discussionmentioning

confidence: 43%

Superior mesenteric venous thrombosis: Endovascular management and outcomes

Alnahhal¹,

Toskich²,

Nussbaum³

et al. 2022

WJCC

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“…Over the last two decades, transcatheter therapies such as thrombectomy, thrombolysis or both, have been described due to the low success rate of systemic anticoagulation alone. While open thrombectomy is associated with high morbidity [ 20 ], endovascular approaches to thrombectomy include percutaneous, transhepatic, transfemoral and transjugular, with transjugular approach are getting more used widely [ 1 ]. Thrombolytic agents are used in conjunction with thrombectomy, usually streptokinase or tissue plasminogen activator (tPA), with the latter more efficacious in dissolving thrombi due to its high selectivity to fibrin [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with no evidence of bowel infarction or perforation will be exempted from a laparotomy. Patients requiring laparotomy due to bowel infarction can also be benefit from catheter-directed first approach as there is no need to explore portal vein and the limit extent of bowel resection if rapid recanalization can be achieved [ 20 ]. The procedure can also be repeated without much additional trauma if there is residual thrombosis as long as the sheath was kept in situ.…”

Section: Discussionmentioning

confidence: 99%

Early transcatheter thrombectomy and thrombolytic therapy in acute non-cirrhotic and non-malignant mesenteric vein thrombosis: Case report of two cases and literature review

Chan

Lee

et al. 2021

International Journal of Surgery Case Reports

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“…The different dosages could themselves explain the different bleeding complicating rates, rather than the different approach routes. Even in Rabu series 14 , they adopted the transhepatic route to treat 3 acute PMVT patients by a 10-Fr atherectomy device and followed by infusion of 80,000-100,000 IU urokinase per hour without bleeding complication encountered. Accordingly, we can conclude that the major bleeding complication of the thrombolytic therapy is more dose-related other than the transhepatic route approach.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies with small patient cohorts attempting the prompt restoration of the porto-mesenteric ow in the non-cirrhotic PMVT patients using either catheter-directed thrombolysis (CDT) alone or with the aid of thrombectomy devices have been reported in the literature [7][8][9][10][11][12][13][14][15] . These procedures were performed via the transhepatic, transjugular and/or indirect superior mesenteric artery routes.…”

Section: Introductionmentioning

confidence: 99%

Primary Catheter-Directed Thrombolysis For Porto-Mesenteric Venous Thrombosis (PMVT) In Non-Cirrhotic Patients.

Chiang

Liang

2021

Preprint

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Purpose: To report our technique, treatment strategy and clinical outcomes for porto-mesenteric venous thrombosis (PMVT) in non-cirrhotic patients.Methods: 16 non-cirrhotic PMVT patients (mean age: 48.6 years) with imminent intestinal ischemia were enrolled from 2004-2020. 8 patients presented thrombus extension into the peripheral mesenteric vein, close to the venous arcade. Transhepatic catheter-directed thrombolysis (CDT) was performed by urokinase infusion (60,000-30,000 IU/hour concomitant with heparin 300-400 IU/hour), catheter aspiration and/or balloon dilation/stent placement. Additional intra-arterial mesenteric infusion of urokinase (30,000 IU/hour) was given in patients with the peripheral mesenteric venules involved. Transjugular intrahepatic porto-systemic shunt (TIPS) was created in patients with poor recanalization of the intrahepatic portal flow (PV). Results: The transhepatic route was adopted in all patients, with adjunct indirect mesenteric arterial thrombolytic infusion in 8 patients. A total of up to 20.4 million IU urokinase was infused for 1-30 days’ treatment duration. TIPS was created in 3 patients with recanalization failure of the intrahepatic PV. Technical success was achieved in 100% of patients with complete recanalization of 80% and partial recanalization of 20%. No major procedure-related complications were encountered. The 30-day mortality rate was 6.7%. The overall 1- and 2-year primary and secondary patency were both 74.0% and 84.6% respectively. Conclusions: CDT can be performed as a primary salvage treatment once the diagnosis is made. CDT via the transhepatic route with tailored thrombolytic regimen is safe and effective for both acute and chronic PMVT . TIPS creation can be preserved in non-cirrhotic PMVT patients if intrahepatic PV recanalization fails.

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

Abstract: Purpose To evaluate the safety and the efficacy of percutaneous pharmaco-mechanical thrombectomy (PPMT) of acute superior mesenteric vein (SMV) thrombosis.

Cited by 15 publications

References 28 publications

Superior mesenteric venous thrombosis: Endovascular management and outcomes

Superior mesenteric venous thrombosis: Endovascular management and outcomes

Early transcatheter thrombectomy and thrombolytic therapy in acute non-cirrhotic and non-malignant mesenteric vein thrombosis: Case report of two cases and literature review

Primary Catheter-Directed Thrombolysis For Porto-Mesenteric Venous Thrombosis (PMVT) In Non-Cirrhotic Patients.

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