Superior mesenteric venous thrombosis: Endovascular management and outcomes

Abstract

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.

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

“…Only two patients had complications requiring intervention. A technical success rate of 75–82% has been reported for EVTs [ 17 , 24 , 25 , 32 ]; therefore, we achieved a high recanalization rate. In terms of complications, Hollingshead et al reported that 60% of their patients experienced major complications, and one patient died of gastrointestinal bleeding and sepsis [ 24 ].…”

“…In terms of complications, Hollingshead et al reported that 60% of their patients experienced major complications, and one patient died of gastrointestinal bleeding and sepsis [ 24 ]. Alnahhal et al reported a complication rate of 8.3% [ 17 ]. Contrastingly, although the complication rate in our study was high, no procedure-related death occurred, and all complications could be treated with either transfusion or transarterial embolization.…”

“…The percutaneous transhepatic and trans-splenic and transjugular approaches, and transileocolic approaches to PV under laparotomy are known [ 13 , 16 , 17 , 25 ]. The percutaneous approach is less invasive than the transileocolic approach [ 16 , 33 – 35 ].…”

“…A novel endovascular method for acute–subacute PVMVT is a combination of thrombectomy (including AT, POBA, a single-shot injection of thrombolytic agents, and stent placement) and continuous CDT. 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 ].…”

A clinical analysis of intestinal mucosal necrosis and exfoliation induced by superior mesenteric vein thrombosis: A case report

“…In recent years, the application of interventional therapy for this type of vascular disease has become increasingly extensive, which can significantly shorten hospitalization time and trauma, accelerate postoperative recovery, and restore the blood vessels of the infarcted intestinal tract as soon as possible ( 2 ). The surgical methods of interventional therapy include fragmentation, crushing, and suction, especially percutaneous mechanical thrombectomy in the treatment of thrombus, which can reduce the dose of thrombolytic agents and speed up the postoperative recovery of patients ( 12 , 13 ). In 46 patients with portal vein PV-SMV thrombosis, Liu et al found that the efficacy of direct injection of a thrombolytic agent into the catheter significantly improved the thrombolytic effect and reduced related bleeding complications ( 14 ).…”