Transcatheter Thrombolytic Therapy for Acute Mesenteric and Portal Vein Thrombosis

Hollingshead, Michael; Burke, Charles T.; Mauro, Matthew A.; Weeks, Susan M.; Dixon, Robert G.; Jaques, Paul F.

doi:10.1097/01.rvi.0000156265.79960.86

Cited by 281 publications

(225 citation statements)

References 28 publications

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“…[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.…”

Section: Thrombolysis In Non-cirrhotic Acute Portal Vein Thrombosismentioning

confidence: 99%

Portal Vein Thrombosis

Chawla

Bodh

2015

Journal of Clinical and Experimental Hepatology

151

147

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Portal vein thrombosis is an important cause of portal hypertension. PVT occurs in association with cirrhosis or as a result of malignant invasion by hepatocellular carcinoma or even in the absence of associated liver disease. With the current research into its genesis, majority now have an underlying prothrombotic state detectable. Endothelial activation and stagnant portal blood flow also contribute to formation of the thrombus. Acute non-cirrhotic PVT, chronic PVT (EHPVO), and portal vein thrombosis in cirrhosis are the three main variants of portal vein thrombosis with varying etiological factors and variability in presentation and management. Procoagulant state should be actively investigated. Anticoagulation is the mainstay of therapy for acute non-cirrhotic PVT, with supporting evidence for its use in cirrhotic population as well. Chronic PVT (EHPVO) on the other hand requires the management of portal hypertension as such and with role for anticoagulation in the setting of underlying prothrombotic state, however data is awaited in those with no underlying prothrombotic states. TIPS and liver transplant may be feasible even in the setting of PVT however proper selection of candidates and type of surgery is warranted. Thrombolysis and thrombectomy have some role. TARE is a new modality for management of HCC with portal vein invasion. ( J CLIN EXP HEPATOL 2015;5:22-40)

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Section: Thrombolysis In Non-cirrhotic Acute Portal Vein Thrombosismentioning

confidence: 99%

Portal Vein Thrombosis

Chawla

Bodh

2015

Journal of Clinical and Experimental Hepatology

151

147

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“…There has been a high incidence of major bleeding also. 29,72 There is no data to support this option in this setting.…”

Section: Tips and Thrombolysismentioning

confidence: 99%

Portal Vein Thrombosis in Cirrhosis

Raja

Jacob

Asthana

2014

Journal of Clinical and Experimental Hepatology

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Portal vein thrombosis (PVT) is being increasingly recognized in patients with advanced cirrhosis and in those undergoing liver transplantation. Reduced flow in the portal vein is probably responsible for clotting in the spleno-porto-mesenteric venous system. There is also increasing evidence that hypercoagulability occurs in advanced liver disease and contributes to the risk of PVT. Ultrasound based studies have reported a prevalence of PVT in 10-25% of cirrhotic patients without hepatocellular carcinoma. Partial thrombosis of the portal vein is more common and may not have pathophysiological consequences. However, there is high risk of progression of partial PVT to complete PVT that may cause exacerbation of portal hypertension and progression of liver insufficiency. It is thus, essential to accurately diagnose and stage PVT in patients waiting for transplantation and consider anticoagulation therapy. Therapy with low molecular weight heparin and vitamin K antagonists has been shown to achieve complete and partial recanalization in 33-45% and 15-35% of cases respectively. There are however, no guidelines to help determine the dose and therapeutic efficacy of anticoagulation in patients with cirrhosis. Anticoagulation therapy related bleeding is the most feared complication but it appears that the risk of variceal bleeding is more likely to be dependent on portal pressure rather than solely related to coagulation status. TIPS has also been reported to restore patency of the portal vein. Patients with complete PVT currently do not form an absolute contraindication for liver transplantation. Thrombectomy or thromboendovenectomy is possible in more than 75% of patients followed by anatomical end-to-end portal anastomosis. When patency of the portal vein and/or superior mesenteric vein is not achieved, only non-anatomical techniques (reno-portal anastomosis or cavo-portal hemitransposition) can be performed. These techniques, which do not fully reverse portal hypertension, are associated with higher morbidity and mortality risks in the short term. ( J CLIN EXP HEPATOL 2013;4:320-331)

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“…Systemic anticoagulant and/or thrombolytic therapy is of limited value in extensive PV-SMV thrombosis, as it has low efficacy and is time consuming [2] . In patients with acute or subacute symptomatic PV-SMV thrombosis, endovascular interventional treatment has been reported with encouraging initial results [10][11][12][13][14][15][16][17] . With this approach, PV-SMV thrombosis can be managed by pharmacologic thrombolysis and/or mechanical thrombectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, endovascular interventional techniques have been recognized as promising alternatives for the treatment of PV-SMV thrombosis. Case reports of the successful treatment of PV-SMV thrombosis include intra-arterial infusion of thrombolytics via the superior mesenteric artery (SMA) by the transfemoral artery [10,11] , thrombolysis via a transjugular intrahepatic approach [12][13][14] , and percutaneous transhepatic mechanical or pharmacologic thrombolysis [15][16][17] . The aim of the present study is to report the clinical outcome of 6 patients with acute symptomatic PV and SMV thrombosis after splenectomy who were treated with transjugular intrahepatic portal access aspiration thrombectomy and catheter-directed thrombolysis at our hospital.…”

Section: Introductionmentioning

confidence: 99%