Initial transcatheter thrombolysis for acute superior mesenteric venous thrombosis.
OBJECTIVE
To determine the optimal initial treatment modality for acute superior mesenteric vein thrombosis (ASMVT) in patients with circumscribed peritonitis.


METHODS
A retrospective review was made of the Vascular Surgery Department's medical records to identify adult patients (≥ 18 years old) presenting with circumscribed peritonitis and diagnosed with ASMVT by imaging or endoscopic examination. Patients were selected from the time period between October 2009 and October 2012 to assess the overall performance of a new first-line treatment policy implemented in May 2011 for patients with circumscribed peritonitis, which recommends transcatheter thrombolysis with local anticoagulation and endovascular mechanical thrombectomy. Of the 25 patients selected for study inclusion, 12 had undergone emergency surgical exploration (group 1) and 13 had undergone the initial catheter-directed thrombolysis (group 2). Data extracted from each patient's records for statistical analyses included method of diagnosis, symptoms, etiology and risk factors, thrombus location, initial management, morbidity, mortality, duration and total cost of hospitalization (in Renminbi, RMB), secondary operation, total length of bowel resection, duration of and findings in follow-up, and death/survival.


RESULTS
The two treatment groups showed similar rates of morbidity, 30-d mortality, and 1-year survival, as well as similar demographic characteristics, etiology or risk factors, computed tomography characteristics, symptoms, findings of blood testing at admission, complications, secondary operations, and follow-up outcomes. In contrast, the patients who received the initial non-operative treatment of transcatheter thrombolysis had significantly shorter durations of admission to symptom elimination (group 1: 18.25 ± 7.69 d vs group 2: 7.23 ± 2.42 d) and hospital stay (43.00 ± 13.77 d vs 20.46 ± 6.59 d), and early enteral or oral nutrition restoration (20.50 ± 5.13 d vs 8.92 ± 1.89 d), as well as significantly less total length of bowel resection (170.83 ± 61.27 cm vs 29.23 ± 50.24 cm) and lower total cost (200020.4 ± 91505.62 RMB vs 72785.6 ± 21828.16 RMB) (P < 0.05 for all). Statistical analyses suggested that initial transcatheter thrombolysis is correlated with quicker resolution of the thrombus, earlier improvement of symptoms, stimulation of collateral vessel development, reversal of intestinal ischemia, receipt of localizing bowel resection to prevent short bowel syndrome, shorter hospitalization, and lower overall cost of treatment.


CONCLUSIONS
For ASMVT patients with circumscribed peritonitis, early diagnosis is key to survival, and non-operative transcatheter thrombolysis is feasible and effective as an initial treatment.
Shuo-Fei Yang, Bao-Chen Liu, Wei-Wei Ding, Chang-Sheng He, Xing-Jiang Wu, Jie-Shou Li, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China.
Shuo-Fei
SF
Yang
Shuo-Fei Yang, Bao-Chen Liu, Wei-Wei Ding, Chang-Sheng He, Xing-Jiang Wu, Jie-Shou Li, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China.
Bao-Chen
BC
Liu
Shuo-Fei Yang, Bao-Chen Liu, Wei-Wei Ding, Chang-Sheng He, Xing-Jiang Wu, Jie-Shou Li, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China.
Wei-Wei
WW
Ding
Shuo-Fei Yang, Bao-Chen Liu, Wei-Wei Ding, Chang-Sheng He, Xing-Jiang Wu, Jie-Shou Li, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China.
Chang-Sheng
CS
He
Shuo-Fei Yang, Bao-Chen Liu, Wei-Wei Ding, Chang-Sheng He, Xing-Jiang Wu, Jie-Shou Li, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China.
Xing-Jiang
XJ
Wu
Shuo-Fei Yang, Bao-Chen Liu, Wei-Wei Ding, Chang-Sheng He, Xing-Jiang Wu, Jie-Shou Li, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China.
Jie-Shou
JS
Li
D015746:Abdominal Pain / Q000188:drug therapy / Q000209:etiology; D000208:Acute Disease; D000328:Adult; D015901:Angiography, Digital Subtraction; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D018810:Magnetic Resonance Angiography; D008297:Male; D008642:Mesenteric Veins / Q000000981:diagnostic imaging / Q000187:drug effects*; D008875:Middle Aged; D010538:Peritonitis / Q000188:drug therapy / Q000209:etiology; D010690:Phlebography / Q000379:methods; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000401:mortality
D005343:Fibrinolytic Agents
Acute superior mesenteric venous thrombosis; Circumscribed peritonitis; Initial management; Transcatheter thrombolysis