Acute symptomatic mesenteric venous thrombosis: treatment by catheter-directed thrombolysis with transjugular intrahepatic route

Abstract

Objective: To assess the feasibility and effectiveness of transjugular intrahepatic route aspiration thrombectomy and catheter-directed thrombolytic therapy in patients with acute superior mesenteric venous thrombosis. Materials and methods: During a period of 8 years, 12 patients with acute thrombosis of the superior mesenteric vein (SMV) were treated by transjugular intrahepatic approach. The mean age was 41.2 years. After access to the portal system via the transjugular approach, the pigtail catheter fragmentation of the thrombus, local urokinase injection, and manual aspiration thrombectomy were used for treatment of the SMV thrombosis initially, followed by continuous thrombolytic therapy via an indwelling infusion catheter in the SMV, which was performed for 2 to 6 days (4.2 ± 1.8 days). The adequacy of anticoagulation was performed during treatment, throughout hospitalization, and after discharge. Results: Technical success was achieved in all 12 patients. Substantial clinical improvement was seen in these patients after the procedure. Minor complications at the jugular puncture site were observed in 4 patients, but the thrombolytic therapy was not interrupted. Contrast-enhanced computed tomography (CT) scan before discharge demonstrated nearly complete disappearance of SMV thrombosis in all patients. The 12 patients were discharged 5–10 days (7.6 ± 2.0) after admission. Mean duration of follow-up after hospital discharge was 37.7 months, and no recurrent episodes of SMV thrombosis developed during that time period. Conclusion: Catheter-directed thrombus aspiration, mechanical fragmentation, and local thrombolytic infusion via the transjugular intrahepatic route is a safe and effective therapy for the management of patients with acute symptomatic SMV thrombosis.

Multidisciplinary Stepwise Management Strategy for Acute Superior Mesenteric Venous Thrombosis: An Intestinal Stroke Center Experience

“…Recently, experience of catheter-directed thrombolysis for ASMVT by different approaches in several centers has been reported [32][33][34]. The indirect SMA approach provides the least doses of thrombolytic agents due to preferential flow to the collateral vessels [35].…”

Portal Vein Thrombosis

“…However all these patients had failed anticoagulation therapy and subsequently intervened by thrombolysis. 131 Another 12 patient series of thrombolysis showed complete success in three and partial in four patients. Minor bleeding was noted in two (17%) and major bleeding in six (50%) with a fatal outcome in two.…”

Venous acute disturbance of mesenteric circulation: diagnosis and treatment

“…Тромболитическая терапия осуществляется из чрескожного транспеченочного, трансъюгулярного интрапеченочного доступа или непосредственно путем введения тромболитика в верхнюю брыжеечную артерию [31,78,84]. В работе S. Yang и соавт.…”