Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis.
OBJECTIVE
To summarize our methods and experience with interventional treatment for symptomatic acute-subacute portal vein and superior mesenteric vein thrombosis (PV-SMV) thrombosis.


METHODS
Forty-six patients (30 males, 16 females, aged 17-68 years) with symptomatic acute-subacute portal and superior mesenteric vein thrombosis were accurately diagnosed with Doppler ultrasound scans, computed tomography and magnetic resonance imaging. They were treated with interventional therapy, including direct thrombolysis (26 cases through a transjugular intrahepatic portosystemic shunt; 6 through percutaneous transhepatic portal vein cannulation) and indirect thrombolysis (10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization).


RESULTS
The blood reperfusion of PV-SMV was achieved completely or partially in 34 patients 3-13 d after thrombolysis. In 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased significantly. Symptoms in these 45 patients were improved dramatically without severe operational complications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment. In 3 patients with interventional treatment, thrombi re-formed 1, 3 and 4 mo after treatment. In these 3 patients, indirect PV-SMV thrombolysis was performed again and was successful.


CONCLUSIONS
Interventional treatment, including direct or indirect PV-SMV thrombolysis, is a safe and effective method for patients with symptomatic acute-subacute PV-SMV thrombosis.
Department of Interventional Radiology, Clinical Division of Internal Medicine, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Feng-Yong
FY
Liu
Mao-Qiang
MQ
Wang
Qing-Sheng
QS
Fan
Feng
F
Duan
Zhi-Jun
ZJ
Wang
Peng
P
Song
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005762:Gastroenterology / Q000379:methods*; D006801:Humans; D008297:Male; D008638:Mesenteric Arteries / Q000473:pathology; D008641:Mesenteric Vascular Occlusion / Q000473:pathology*; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods; D017534:Radial Artery / Q000473:pathology; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000628:therapy*