Transileocolic endovascular treatment by a hybrid approach for severe acute portal vein thrombosis with bowel necrosis: Two case reports

Abstract

BACKGROUND Acute portal vein thrombosis (PVT) with bowel necrosis is a fatal condition with a 50%-75% mortality rate. This report describes the successful endovascular treatment (EVT) of two patients with severe PVT. CASE SUMMARY The first patient was a 22-year-old man who presented with abdominal pain lasting 3 d. The second patient was a 48-year-old man who presented with acute abdominal pain. Following contrast-enhanced computed tomography, both patients were diagnosed with massive PVT extending to the splenic and superior mesenteric veins. Hybrid treatment (simultaneous necrotic bowel resection and EVT) was performed in a hybrid operating room (OR). EVTs, including aspiration thrombectomy, catheter-directed thrombolysis (CDT), and continuous CDT, were performed via the ileocolic vein under laparotomy. The portal veins were patent 4 and 6 mo posttreatment in the 22-year-old and 48-year-old patients, respectively. CONCLUSION Hybrid necrotic bowel resection and transileocolic EVT performed in a hybrid OR is effective and safe.

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

“…The transileocolic approach, which requires a laparotomy and an open abdomen approach with VAC, is limited to cases requiring bowel resection [ 36 ]. However, an open abdomen approach with VAC is beneficial for the prevention of abdominal compartment syndrome and observation of further bowel necrosis and hemoperitoneum [ 28 , 37 ].…”

“…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 ].…”

“…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 ]. Therefore, this study aimed to evaluate the efficacy and factors related to the outcome of EVTs for completely occlusive acute–subacute PVMVT (symptom onset < 40 days) with severe complications.…”

Endovascular Treatment for Acute Portal Vein Thrombosis

“…However, most thrombi are insufficiently dissolved by this therapy [8,9]. Recently, EVTs such as thrombolysis, thrombectomy, angioplasty, and TIPS have emerged as effective treatment options for acute PVT in addition to systemic anticoagulation [3,[10][11][12]. EVT is performed in patients who are refractory to anticoagulation therapy or at a high risk of intestinal ischemia who require early revascularization.…”

“…However, insufficient dissolution of acute PVT was often found after systemic anticoagulation [8,9]. Recently, endovascular treatments (EVTs) such as thrombolysis, thrombectomy, angioplasty, and transjugular intrahepatic portosystemic shunt (TIPS) have been reported to be effective for acute PVT treatment in addition to systemic anticoagulation [3,6,[10][11][12][13][14][15]. Here, we reviewed the clinical and diagnostic considerations for PVT, focusing on current EVT techniques for managing acute PVT.…”