Transhepatic Catheter-directed Thrombectomy and Thrombolysis of Acute Superior Mesenteric Venous Thrombosis

Mesenteric Venous Thrombosis

“…18 Recurrence of MVT after bowel resection is as high as 60%, with the majority of cases recurring at the site of bowel anastomosis. 15 Some recent data suggest that the use of fibrinolytic therapy with or without thrombectomy offers a lower recurrence rate.…”

“…6 Even in the absence of radiographic thrombus resolution, catheter-directed fibrinolysis results in symptomatic improvement and lower rates of bowel resection and its associated complications. 6,15 Despite an overall improvement in patient condition, the rate of complications with catheter-directed fibrinolysis, mainly bleeding, is estimated to be as high as 60%. 6 For this reason, catheter-directed fibrinolysis is usually recommended only in patients with refractory symptoms despite anticoagulation but in whom surgical intervention is not necessary.…”

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.…”

Mesenteric Venous Thrombosis

“…This study among others along with case reports suggested good outcomes using the transcatheter thrombolysis. [36][37][38] Transjugular intrahepatic portosystemic shunt (TIPS) can be used for MVT with a rationale of creating low pressure system which works as a vacuum of clot fragments and improve the effectiveness of thrombolysis in the case of acute thrombosis. The use of TIPS was associated with immediate symptomatic improvement and successful recanalization in 83% of patients treated.…”