Percutaneous transhepatic treatment of symptomatic mesenteric venous thrombosis

Abstract

Three patients were seen with acute mesenteric venous thrombosis. With a transhepatic access, percutaneous pharmacologic thrombolysis was performed in one patient with extensive thrombosis of the portal and mesenteric veins, resulting in complete thrombolysis of the portal vein and partial thrombolysis of the superior mesenteric vein. In two patients with focal thrombosis, the use of mechanical devices achieved complete thrombolysis. Percutaneous thrombolysis of portal and mesenteric veins with a transhepatic approach, followed by coil embolization, is a promising endovascular technique for treatment of symptomatic acute mesenteric venous thrombosis.

Portal Vein Thrombosis

“…[124][125][126][127] Catheterization of SMA operatively and intraarterial infusion of thrombolytic drugs like recombinant tissue plasminogen activator, 128 urokinase and streptokinase have all been shown to have gratifying results. 129 Indirect infusion of thrombolytics into SMA is technically less demanding but does not allow direct infusion into the thrombus.…”

Acute extensive portal and mesenteric venous thrombosis after splenectomy: Treated by interventional thrombolysis with transjugular approach

“…Mechanical thrombectomy devices and aspiration thrombectomy are feasible and effective in the reestablishment of portal and mesenteric circulation in patients with acute extensive thrombosis [12,21] . Good results have been obtained with thrombectomy devices such as the Arrow-Trerotola, Oasis, Amplatz thrombectomy, and AngioJet, although the clinical experience with these thrombectomy devices in PV-SMV thrombosis is limited [12,23,24] . We did not use mechanical thrombectomy devices in our small series because these devices were unavailable at that time in our angiographic laboratory.…”

“…The advantages of this technique are that a large-lumen catheter is generally available in standard angiography laboratories, is of low cost compared with the various thrombectomy devices, and is an easy device which can be as effective as the various thrombectomy devices in removing thrombus from a vessel [16,25] . In patients with acute extensive thrombosis of the PV-SMV, mechanical thrombectomy could initially be used to debulk the thrombus, and pharmacologic thrombolysis would probably still be necessary in most cases to treat residual thrombosis and to treat thrombus in the small and peripheral veins [16,23] . The combination of aspiration and local pharmacological thrombolysis via a direct access to the portal system is more effective and significantly decreases the treatment time in patients with extensive PV-SMV thrombosis compared to indirect and direct thrombolysis infusion alone [12,23,24] .…”

“…In patients with acute extensive thrombosis of the PV-SMV, mechanical thrombectomy could initially be used to debulk the thrombus, and pharmacologic thrombolysis would probably still be necessary in most cases to treat residual thrombosis and to treat thrombus in the small and peripheral veins [16,23] . The combination of aspiration and local pharmacological thrombolysis via a direct access to the portal system is more effective and significantly decreases the treatment time in patients with extensive PV-SMV thrombosis compared to indirect and direct thrombolysis infusion alone [12,23,24] . In our 6 cases, aspiration thrombectomy associated with indwelling catheter infusion of thrombolytics into the SMV was effective, resulted in a rapid improvement in symptoms, recanalization of the SMV, resolution of symptoms, and resumption of oral nutrition.…”

Mesenteric Vascular Disease

“…Uncertainties about bowel viability are assessed through laparotomy or laparoscopy; it is safer to perform a laparotomy to check for bowel viability in patients with signs of peritonitis and rebound tenderness. Endovascular treatment in combination with heparin infusion, with or without bowel resection, is an additional treatment tool (23,24,25,26,27). The indications for surgery are peritonitis, severe gastrointestinal bleeding, late small bowel perforation, and intestinal stricture; the last is often associated with chronic diarrhea.…”