What is the optimal treatment of superior mesenteric vein/portal vein thrombosis after bariatric surgery? Is SMA-directed t-PA the answer?

Belnap, Le Grand; Zaveri, Hinali; Cottam, Daniel; Surve, Amit; Rodgers, George M.; Drury, Cara

doi:10.1016/j.soard.2016.11.015

Cited by 8 publications

(11 citation statements)

References 14 publications

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“…These in contrast to another study (10), which suggested a failure rate of exceeding 65% (10) with heparin anticoagulation alone. Therefore, for a symptomatic patient with occlusive, partial to complete thrombosis bowel more rapid recanalization by adopting a combined therapy of systemic IV anticoagulation and CDT is needed (7,10). This was evidenced in 75 to 100% of PMVT patients with at partial venous recanalization was observed in patients receiving the combined with overall excellent success rates (11,12).…”

Section: Discussioncontrasting

confidence: 84%

“…While in another study, it was indicated that approximately 30 to 50% of patients would show signi cant results after systemic IV anticoagulation alone (9). These in contrast to another study (10), which suggested a failure rate of exceeding 65% (10) with heparin anticoagulation alone. Therefore, for a symptomatic patient with occlusive, partial to complete thrombosis bowel more rapid recanalization by adopting a combined therapy of systemic IV anticoagulation and CDT is needed (7,10).…”

Section: Discussionmentioning

confidence: 90%

“…This was evidenced in 75 to 100% of PMVT patients with at partial venous recanalization was observed in patients receiving the combined with overall excellent success rates (11,12). However, more critically symptomatic cases can form great clinical challenge necessitating alternative more invasive interventions to reduce the thrombus burden (10). Emergency laparotomy, open thrombectomy and bowel resection, therefore, should not be delayed in suspected infarction or subsequent perforation (13).…”

Section: Discussionmentioning

confidence: 99%

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Catheter-Directed Thrombolysis in the Treatment of Acute Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy

Barah¹,

Al-Hashimi²,

Kassamali³

et al. 2021

Preprint

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Background: Portomesenteric vein thrombosis (PMVT) following Laparoscopic Sleeve Gastrectomy (LSG) is an uncommon but potentially debilitating complication. Catheter-directed thrombolysis (CDT) has an evolving role in recanalizing the venous flow and preventing thrombus propagation. It can be used as an alternative or in combination with systemic anticoagulants in selected patients. We report two cases of trans-hepatic and trans-splenic CDT of acute PMVT developed in post LSG. The patient's clinical details, radiological findings, safety, and efficacy are reported.Cases presentation: Two patients presented to the emergency department (ED) within 14 days of surgery. The presenting complaints were generally nonspecific. The diagnosis of PMVT was established in both patients based on abdominal contrast-enhanced computed tomography (CECT). The two patients received a combined therapy of intravenous (IV) heparinization and CDT using trans-hepatic approach in case 1 and trans-splenic approach in case 2, determined by the extent of thrombosis. Subsequent post-procedure venograms and CECT were performed and showed significant thrombus resolution. Both patients received long-term anticoagulant therapy upon discharge with a successful overall recovery. Conclusion: PMVT is an infrequent and severe post LSG complication. Various approaches for re-establishing the portal venous flow have been described according to the severity of venous thrombosis. This article describes CDT therapy as a safe and effective option for treating PMVT in symptomatic patients.

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Section: Discussioncontrasting

confidence: 84%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Catheter-Directed Thrombolysis in the Treatment of Acute Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy

Barah¹,

Al-Hashimi²,

Kassamali³

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…Alternatively, indirect catheter-directed thrombolysis can be performed by infusing thrombolytic agents via the superior mesenteric artery. This intervention method for treatment of acute PMV thrombosis has been reported to result in near complete resolution of the thrombosis in up to 56% of patients (18,35). This approach may be warranted in patients with unsuccessful access to the PMV system or diffuse mesenteric venous thrombosis.…”

Section: Endovascular Thrombectomy and Pharmacologicmentioning

confidence: 97%

“…However, the failure rate associated with this treatment can be as high as 62%, especially when other comorbidities such as ascites are present. Anticoagulation therapy may be particularly ineffective when a shunt is created in the setting of occlusive thrombus (Fig 10) (15)(16)(17)(18).…”

Section: Pmv Interventions Anticoagulationmentioning

confidence: 99%

Portomesenteric Venous Complications after Pancreatic Surgery with Venous Reconstruction: Imaging and Intervention

et al. 2020

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Pancreatic surgery with en bloc venous resection and reconstruction is becoming increasingly common in the current era of expanding neoadjuvant oncologic therapies and advanced surgical techniques for patients with more anatomically complex tumors. However, patients who have alterations in their venous outflow are at increased risk for postoperative portomesenteric venous stenosis and/or thrombosis. Cross-sectional imaging for postoperative surveillance, including multiphase CT or MRI, is critical for recognizing portomesenteric venous complications and thus implementing early intervention and preventing complications related to portomesenteric venous hypertension. Hypertension-related complications include ascites, variceal or gastrointestinal bleeding, postprandial abdominal pain, intestinal edema, protein-losing enteropathy, malabsorptive diarrhea, and splenomegaly. Percutaneous transhepatic, transsplenic, and transjugular portomesenteric interventions, including venoplasty, stent placement, and thrombectomy or thrombolysis, are safe and effective options for restoring patency to the portomesenteric venous system. Preintervention CT or MRI and diagnostic catheter venography are important for procedural planning, while postintervention CT or MRI surveillance is critical for detecting recurrent stenosis or thrombosis, or de novo portomesenteric venous disease.

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The Safety and Efficacy of Apixaban (Eliquis) in 5017 Post-bariatric Patients with 95.3% Follow-up: a Multicenter Study

Surve¹,

Potts²,

Cottam³

et al. 2022

OBES SURG

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What is the optimal treatment of superior mesenteric vein/portal vein thrombosis after bariatric surgery? Is SMA-directed t-PA the answer?

Cited by 8 publications

References 14 publications

Catheter-Directed Thrombolysis in the Treatment of Acute Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy

Catheter-Directed Thrombolysis in the Treatment of Acute Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy

Portomesenteric Venous Complications after Pancreatic Surgery with Venous Reconstruction: Imaging and Intervention

The Safety and Efficacy of Apixaban (Eliquis) in 5017 Post-bariatric Patients with 95.3% Follow-up: a Multicenter Study

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