Thrombosis of a Superior Mesenteric Vein Aneurysm: Transarterial Thrombolysis and Transhepatic Aspiration Thrombectomy

Crook, David; Widmer, Urs; Wildermuth, Simon; Pfammatter, Thomas

doi:10.1007/s00270-004-0020-x

Cited by 15 publications

(13 citation statements)

References 22 publications

(26 reference statements)

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“…Indirect thrombolytic therapy via the SMA is less technically demanding and has been described for its potential benefits in infusing thrombolytic agents into small mesenteric venous branches [15, 16]. However, this approach does not allow direct infusion into the thrombus, may result in lytic agents diverting through patent branches and collaterals, and possible prolongation of the total infusion time via the SMA [8–10], which may result in an increased risk of bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Direct access to the portal vein by a transjugular or transhepatic route directly targets the SMV thrombosis, leading to fast removal of the thrombus and flow improvement, and an improvement of symptoms [14, 15, 19]. Compared to indirect method, lysis by direct access to the SMV has advantages: it is more efficient, is less time-consuming, and decreases the dose of the thrombolytic agent, lowering the risk of related complications [8, 12, 16, 17].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2010

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2010

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“…The disadvantages of TIPS are its complexity and difficulties in performing it [31] . The procedure for percutaneous transhepatic portal vein cannulation is simpler, easier and cheaper than TIPS [25,32] . It is suitable for patients without ascites and coagulative dysfunction [33] .…”

Section: Discussionmentioning

confidence: 99%

Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

Liu¹,

Wang²,

Fan³

et al. 2009

WJG

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AIM:To summarize our methods and experience with interventional treatment for symptomatic acute-subacute portal vein and superior mesenteric vein thrombosis (PV-SMV) thrombosis. METHODS:Forty-six patients (30 males, 16 females, aged 17-68 years) with symptomatic acute-subacute portal and superior mesenteric vein thrombosis were accurately diagnosed with Doppler ultrasound scans, computed tomography and magnetic resonance imaging. They were treated with interventional therapy, including direct thrombolysis (26 cases through a transjugular intrahepatic portosystemic shunt; 6 through percutaneous transhepatic portal vein cannulation) and indirect thrombolysis (10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization). RESULTS:The blood reperfusion of PV-SMV was achieved completely or partially in 34 patients 3-13 d after thrombolysis. In 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased significantly. Symptoms in these 45 patients were improved dramatically without severe operational complications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment. In 3 patients with interventional treatment, thrombi re-formed 1, 3 and 4 mo after treatment. In these 3 patients, indirect PV-SMV thrombolysis was performed again and was successful. CONCLUSION:Interventional treatment, including direct or indirect PV-SMV thrombolysis, is a safe and effective method for patients with symptomatic acutesubacute PV-SMV thrombosis.

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“…Although we did not observe any complications in our 6 patients with the transjugular approach, significant intra-abdominal bleeding is a potential serious complication [22] . Mechanical thrombectomy devices and aspiration thrombectomy are feasible and effective in the reestablishment of portal and mesenteric circulation in patients with acute extensive thrombosis [12,21] . Good results have been obtained with thrombectomy devices such as the Arrow-Trerotola, Oasis, Amplatz thrombectomy, and AngioJet, although the clinical experience with these thrombectomy devices in PV-SMV thrombosis is limited [12,23,24] .…”

Section: C B Amentioning

confidence: 99%

“…Usually, this approach is suitable for the removal of larger clots within the trunk of the PV and SMV. The drawbacks of the percutaneous transhepatic route include the development of intraperitoneal or subcapsular hepatic hemorrhage [16,21] . This is likely to occur given that the transhepatic route for mechanical thrombectomy of splanchnic venous thrombosis requires traversing the hepatic capsule and is followed by thrombolysis and possibly systemic anticoagulation.…”

Section: C B Amentioning

confidence: 99%

Acute extensive portal and mesenteric venous thrombosis after splenectomy: Treated by interventional thrombolysis with transjugular approach

Wang

Lin²,

Guo³

et al. 2009

WJG

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Thrombosis of a Superior Mesenteric Vein Aneurysm: Transarterial Thrombolysis and Transhepatic Aspiration Thrombectomy

Cited by 15 publications

References 22 publications

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

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

Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

Acute extensive portal and mesenteric venous thrombosis after splenectomy: Treated by interventional thrombolysis with transjugular approach

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