title: Endovascular treatment of acute portal vein thrombosis using ultrasound-accelerated catheter-directed thrombolysis.
abstract: We report a case of extensive acute portal vein thrombosis (PVT) presenting with severe diffuse abdominal pain and impending small bowel infarction. The patient was successfully treated with ultrasound-accelerated catheter-directed thrombolysis (EKOS endowave system; Covidien, Mansfield, Massachusetts), which resulted in prompt recanalization of his portal vein (PV) and its tributaries. The patient eventually had ischemic stricture that necessitated bowel resection. However, we believe that our technique was successful in rapidly restoring the patency of the PV and its tributaries, and therefore, avoiding a life-threatening complication of more extensive bowel infarction. To our knowledge, the use of ultrasound-accelerated thrombolysis in treatment of PVT has not been previously described in the literature.
authors.affiliation: Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA akamel@uabmc.edu.
authors.forename: Ahmed Kamel
authors.initials: AK
authors.lastname: Abdel-Aal
authors.affiliation: Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Islam B
authors.initials: IB
authors.lastname: Ezzeldin
authors.affiliation: Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Maysoon Farouk
authors.initials: MF
authors.lastname: Hamed
authors.affiliation: Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Rafik Mohamed
authors.initials: RM
authors.lastname: Ibrahim
authors.affiliation: Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Max
authors.initials: M
authors.lastname: Berry
authors.affiliation: Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Edgar S
authors.initials: ES
authors.lastname: Underwood
authors.affiliation: Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Souheil
authors.initials: S
authors.lastname: Saddekni
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D002406:Catheterization, Peripheral; D057510:Endovascular Procedures; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014654:Vascular Patency / Q000187:drug effects; D020246:Venous Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D005343:Fibrinolytic Agents
keywords: catheter directed; mesenteric venous thrombosis; portal vein thrombosis; thrombolysis; ultrasound accelerated