title: Acute superior mesenteric venous thrombosis: transcatheter thrombolysis and aspiration thrombectomy therapy by combined route of superior mesenteric vein and artery in eight patients.
abstract: OBJECTIVE
  To assess the feasibility, effectiveness, and safety of catheter-directed thrombolysis and aspiration thrombectomy therapy by combined route of superior mesenteric vein and artery (SMV+SMA) for acute superior mesenteric venous thrombosis (ASMVT).
  
  
  METHODS
  This retrospective study reviewed eight ASMVT patients with transcatheter direct thrombolysis and aspiration thrombectomy therapy via SMV and indirect thrombolysis via SMA during a period of 14 months. The demographics, etiology, risk factors, therapeutic effect, complications, mortality, and follow-up of the study population were assessed. Anatomic and imaging classification of location and extent of thrombus at diagnosis and degree of thrombus lysis were described.
  
  
  RESULTS
  Technical success was achieved with substantial improvement in symptoms and thrombus resolution after thrombolytic therapy in all patients. The local urokinase infusion by SMA and SMV was performed for 5-7 (6.13 ± 0.83) and 7-15 (12 ± 2.51) days. Anticoagulation was performed catheter-directed and then orally throughout hospitalization and after discharge. Four patients required delayed localized bowel resection after thrombolytic therapy with no death. Thrombolytic therapy was not interrupted despite minor bleeding at the puncture site in two patients and sepsis in another two postoperatively. Nearly complete removal of thrombus was demonstrated by contrast-enhanced CT scan and portography before discharge. Patients were discharged in 10-27 (19.25 ± 4.89) days after admission. No recurrence developed during the follow-up of 10-13 (12.13 ± 0.99) months.
  
  
  CONCLUSIONS
  Catheter-directed thrombolytic and aspiration therapy via SMV+SMA is beneficial for ASMVT in avoiding patient death, efficient resolving thrombus, rapid improving symptoms, reversing extensive intestinal ischemia, averting bowel resection, or localizing infarcted bowel segment and preventing short bowel syndrome.
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, People's Republic of China, yangshuofei@gmail.com.
authors.forename: Shuofei
authors.initials: S
authors.lastname: Yang
authors.forename: Baochen
authors.initials: B
authors.lastname: Liu
authors.forename: Weiwei
authors.initials: W
authors.lastname: Ding
authors.forename: Changsheng
authors.initials: C
authors.lastname: He
authors.forename: Xingjiang
authors.initials: X
authors.lastname: Wu
authors.forename: Jieshou
authors.initials: J
authors.lastname: Li
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging*; D008642:Mesenteric Veins / Q000000981:diagnostic imaging*; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D013396:Suction; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000628:therapy*