Treatment of portal vein thrombosis by thrombectomy and regional thrombolysis.
BACKGROUND
Portal vein thrombosis is a rare disorder. The prognosis of both the acute and the chronic forms is determined by the resulting acute or chronic portal hypertension. The therapeutic approach of choice is controversial.


METHODS
A case of etiologically unclear thrombosis of the portal vein system in a young man is reported, which was treated successfully by means of portal vein thrombectomy combined with intraoperative and postoperative thrombolysis with recombinant tissue plasminogen activator (rTPA).


RESULTS
Initial thrombectomy established sufficient venous return. However, rethrombosis of the portal vein occurred 2 days later. In a second operation rethrombectomy was followed by intraoperative regional application of rTPA, which was continued after operation during a period of 48 hours through a catheter inserted in a mesenteric vein. Patency of the portal system was confirmed 1 week after the procedure. The 1-year follow-up reconfirmed this result (through indirect portography and Doppler sonography). The patient received the anticoagulant phenprocoumon.


CONCLUSIONS
The combination of surgical thrombectomy and regional thrombolysis with rTPA could offer a feasible therapeutic option for selected patients with acute prehepatic portal vein thrombosis.
Demertzis
S
S
Department of Cardiology, Hannover Medical School, Germany.
Ringe
B
B
Gulba
D
D
Rosenthal
H
H
Pichlmayr
R
R
D000208:Acute Disease; D000328:Adult; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D008297:Male; D011169:Portal Vein; D011994:Recombinant Proteins / Q000627:therapeutic use; D012008:Recurrence; D012086:Reoperation; D017131:Thrombectomy; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000150:complications / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014654:Vascular Patency
D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator