Acute extensive portal and mesenteric venous thrombosis after splenectomy: treated by interventional thrombolysis with transjugular approach.
OBJECTIVE
To present a series of cases with symptomatic acute extensive portal vein (PV) and superior mesenteric vein (SMV) thrombosis after splenectomy treated by transjugular intrahepatic approach catheter-directed thrombolysis.


METHODS
A total of 6 patients with acute extensive PV-SMV thrombosis after splenectomy were treated by transjugular approach catheter-directed thrombolysis. The mean age of the patients was 41.2 years. After access to the portal system via the transjugular approach, pigtail catheter fragmentation of clots, local urokinase injection, and manual aspiration thrombectomy were used for the initial treatment of PV-SMV thrombosis, followed by continuous thrombolytic therapy via an indwelling infusion catheter in the SMV, which was performed for three to six days. Adequate anticoagulation was given during treatment, throughout hospitalization, and after discharge.


RESULTS
Technical success was achieved in all 6 patients. Clinical improvement was seen in these patients within 12-24 h of the procedure. No complications were observed. The 6 patients were discharged 6-14 d (8 +/- 2.5 d) after admission. The mean duration of follow-up after hospital discharge was 40 +/- 16.5 mo. Ultrasound and contrast-enhanced computed tomography confirmed patency of the PV and SMV, and no recurrent episodes of PV-SMV thrombosis developed during the follow-up period.


CONCLUSIONS
Catheter-directed thrombolysis via transjugular intrahepatic access is a safe and effective therapy for the management of patients with symptomatic acute extensive PV-SMV thrombosis.
Wang
Mao-Qiang
MQ
Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China. wangmq@vip.sina.com
Lin
Han-Ying
HY
Guo
Li-Ping
LP
Liu
Feng-Yong
FY
Duan
Feng
F
Wang
Zhi-Jun
ZJ
D000328:Adult; D002404:Catheterization / Q000379:methods; D000075202:Contraindications; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000601:surgery*; D008297:Male; D008642:Mesenteric Veins / Q000473:pathology*; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology*; D013156:Splenectomy / Q000009:adverse effects*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000628:therapy