Transhepatic catheter-directed thrombectomy and thrombolysis of acute superior mesenteric venous thrombosis.
OBJECTIVE
To evaluate clinical outcomes after percutaneous treatment of superior mesenteric vein (SMV) thrombosis.


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.
Kim
Hyun S
HS
Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 545, Baltimore, Maryland 21205, USA. sikhkim@jhmi.edu
Patra
Ajanta
A
Khan
Jawad
J
Arepally
Aravind
A
Streiff
Michael B
MB
D000208:Acute Disease; D000328:Adult; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008642:Mesenteric Veins / Q000000981:diagnostic imaging; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging; D015641:Radiography, Interventional; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D017131:Thrombectomy; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator