Transhepatic catheter-directed thrombectomy and thrombolysis of acute superior mesenteric venous thrombosis

J Vasc Interv Radiol. 2005 Dec;16(12):1685-91. doi: 10.1097/01.RVI.0000182156.71059.B7.

Abstract

Purpose: To evaluate clinical outcomes after percutaneous treatment of superior mesenteric vein (SMV) thrombosis.

Materials and methods: A retrospective chart review was conducted of all patients with SMV thrombosis treated with percutaneous catheter-directed thrombectomy/thrombolysis. The demographics of the study population, potential causative factors contributing to SMV thrombosis, and morbidity and mortality associated with therapy were assessed.

Results: Eleven patients (mean age, 44.3 years +/- 12.8) with SMV thrombosis were treated with percutaneous transhepatic catheter-directed thrombectomy/thrombolysis. Potential causative factors included recent major abdominal surgery, thrombophilic conditions, pancreatitis, and repetitive abdominal trauma. The mean duration between the onset of symptoms and percutaneous treatment was 8.6 days +/- 6.5. Computed tomography confirmed the clinical diagnosis in nine patients (81.8%). One patient (9.1%) had a bleeding complication, which was treated by chest tube drainage without long-term sequelae. One patient (9.1%) with refractory SMV thrombosis died of sepsis and multiple organ failure. No recurrent episode of SMV thrombosis or mortality was documented during a mean follow-up of 42 months +/- 22.5.

Conclusions: Percutaneous transhepatic catheter-directed thrombectomy/thrombolysis for SMV thrombosis is associated with a rapid improvement in symptoms and low incidences of long-term morbidity and mortality. Percutaneous thrombectomy and thrombolysis should be considered in all patients with acute SMV thrombosis without evidence of bowel necrosis.

MeSH terms

  • Acute Disease
  • Adult
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Follow-Up Studies
  • Humans
  • Male
  • Mesenteric Vascular Occlusion / diagnostic imaging
  • Mesenteric Vascular Occlusion / etiology
  • Mesenteric Vascular Occlusion / therapy*
  • Mesenteric Veins* / diagnostic imaging
  • Middle Aged
  • Portal Vein / diagnostic imaging
  • Radiography, Interventional
  • Recombinant Proteins / therapeutic use
  • Retrospective Studies
  • Thrombectomy*
  • Thrombolytic Therapy / methods*
  • Tissue Plasminogen Activator / therapeutic use
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Urokinase-Type Plasminogen Activator / therapeutic use
  • Venous Thrombosis / diagnostic imaging
  • Venous Thrombosis / etiology
  • Venous Thrombosis / therapy*

Substances

  • Fibrinolytic Agents
  • Recombinant Proteins
  • Tissue Plasminogen Activator
  • Urokinase-Type Plasminogen Activator