Combined mechanical and pharmacologic thrombolysis for portal vein thrombosis in liver-graft recipients and in candidates for liver transplantation.
Portal vein thrombosis (PVT) is an uncommon cause for presinusoidal portal hypertension and can occur even in liver-graft recipients. Interventional radiology by percutaneous approach may represent a valid and less invasive alternative to surgical treatment. We describe three cases of PVT (2 liver-transplant patients and a cirrhotic patient candidate for liver transplantation) treated by combined mechanical and pharmacologic thrombolysis. The Arrow-Trerotola device was used along with the infusion of urokinase by way of a percutaneous-transhepatic approach. In all cases, a recanalization of the portal system was obtained and maintained during the follow-up. The best result was achieved when mechanical thrombectomy was performed before urokinase infusion. The combined locoregional treatment with mechanical thrombectomy and pharmacologic thrombolysis appears to be a promising approach for PVT because of its rapid and durable effect and its ability to reduce the dose of urokinase required to achieve recanalization.
Rossi
Cristina
C
Dipartimento di Scienze Radiologiche ed Istocitopatologiche, University of Bologna, Bologna, Italy.
Zambruni
Andrea
A
Ansaloni
Fabio
F
Casadei
Andrea
A
Morelli
Cristina
C
Bernardi
Mauro
M
Trevisani
Franco
F
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods* / Q000502:physiology; D008875:Middle Aged; D011169:Portal Vein; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000601:surgery / Q000628:therapy*; D014850:Waiting Lists; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin