title: [Transradial approach for transcatheter selective superior mesenteric artery urokinase infusion therapy in patients with acute extensive portal and superior mesenteric vein thrombosis].
abstract: OBJECTIVE
  To evaluate the feasibility and efficacy of urokinase infusion therapy via a transradial approach for transcatheter superior mesenteric artery (SMA) in patients with acute extensive portal and superior mesenteric venous thrombosis.
  
  
  METHODS
  During a period of 8 years, 47 patients with acute extensive thrombosis of portal vein (PV) and superior mesenteric veins (SMV) received urokinase infusion therapy by transcatheter selective SMA via radial artery. Their mean age was 44 ± 13 years (range: 19 - 65). Through radial sheath, a 5F catheter was placed into SMA and subsequently the infusion of urokinase was given for 5 - 11 days (mean: 7.1 ± 2.5). Adequate anticoagulation was initiated during treatment, throughout hospitalization and post-discharge. Follow-up contrast-enhanced computed tomography (CT) was performed in each patient every 3 days and before the removal of infusion catheter. Termination of urokinase infusion therapy was decided on the basis of clinical and radiographic findings.
  
  
  RESULTS
  Technical success was achieved in all patients. Two patients had worsening abdominal pain, developed the signs of peritonitis at 24 hours after interventional treatment and underwent eventual laparotomy with the resection of necrotic bowel. Substantial clinical improvement was observed in 45 (95.7%) of them after the procedure. Minor complications at the radial puncture site were observed in 7 patients (14.9%) and infusion therapy continued. Follow-up CT scans at pre-discharge demonstrated a nearly complete disappearance of PV-SMV thrombosis in 29 patients (64.4%) and partial recanalization of PV-SMV thrombosis in 16 patients (35.6%). They were discharged at 9 - 20 days (mean: 12 ± 6) post-admission. The mean post-discharge duration of follow-up was 48 ± 20 months. Recurrent episodes of PV and SMV thrombosis were observed in 2 (4.4%) patients at 6 months and 5 years respectively post-discharge and they were treated successfully with urokinase infusion.
  
  
  CONCLUSIONS
  The transcatheter SMA urokinase infusion therapy via a transradial approach for plus anticoagulation is both safe and effective for the management of patients with acute extensive PV-SMV thrombosis.
authors.affiliation: Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.forename: Mao-qiang
authors.initials: MQ
authors.lastname: Wang
authors.forename: Feng-yong
authors.initials: FY
authors.lastname: Liu
authors.forename: Zhi-jun
authors.initials: ZJ
authors.lastname: Wang
authors.forename: Feng
authors.initials: F
authors.lastname: Duan
authors.forename: Peng
authors.initials: P
authors.lastname: Song
mesh_terms: D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior; D008641:Mesenteric Vascular Occlusion / Q000628:therapy*; D008642:Mesenteric Veins; D008875:Middle Aged; D011169:Portal Vein; D017534:Radial Artery; D015912:Thrombolytic Therapy / Q000379:methods*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*; D020246:Venous Thrombosis / Q000628:therapy*; D055815:Young Adult
chemical_list: D014568:Urokinase-Type Plasminogen Activator