Postoperative Catheter-Directed Thrombolysis Versus Systemic Anticoagulation for Acute Superior Mesenteric Venous Thrombosis.
BACKGROUND
Little data evaluate catheter-directed thrombolysis (CDT) therapy as a sequential treatment of emergent surgery for patients with acute superior mesenteric venous thrombosis (ASMVT). We compared the outcomes of ASMVT patients receiving CDT via superior mesenteric artery (SMA) with those who had systemic anticoagulation after emergent laparotomy.


METHODS
A single-center retrospective study of ASMVT patients receiving emergent laparotomy from May 2012 to April 2014 was performed. Patients in group I had postoperative systemic anticoagulation and patients in group II underwent postoperative CDT. The demography, etiology, imaging features, clinical outcomes, and complications were compared. Moreover, univariate analysis was performed to identify confounding variables of 30-day mortality.


RESULTS
Thirty-two patients (20 males, mean age of 44.9 ± 10.6 years) were included, 17 in group I and 15 in group II. No significant differences of demographic data, etiology, baseline value, and perioperative comorbidity were found. The rate of complete thrombus removal was significantly higher in group II than group I (29.4% vs. 80.0%, P = 0.001). The second-look laparotomy and repeat bowel resection (58.8% vs. 13.3%, P = 0.002) were required in fewer patients in group II (20.0% vs. 70.6%, P = 0.001). The incidence of short-bowel syndrome (SBS; 41.2% vs. 6.7%, P = 0.001) and 30-day mortality (41.2% vs. 6.7%, P = 0.001) were lower in group II. The 1-year survival was also better in group II (52.9% vs. 93.3%, P = 0.014). The incidence of massive abdominal hemorrhage requiring blood transfusion and surgical intervention was 11.8% in group I and 20.0% in group II (P = 0.645). The age, serum D-dimer level, SBS, and postoperative CDT were significant risk factors of 30-day mortality in this study.


CONCLUSIONS
For ASMVT patients receiving emergent surgery and intraoperative thrombectomy, the algorithm with postoperative CDT via SMA is associated with more favorable clinical outcome compared with systemic anticoagulation.
Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China; Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, P. R. China.
Shuofei
S
Yang
Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China.
Lan
L
Zhang
Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu Province, P. R. China.
Kai
K
Liu
Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu Province, P. R. China.
Xinxin
X
Fan
Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, P. R. China.
Weiwei
W
Ding
Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu Province, P. R. China.
Changsheng
C
He
Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, P. R. China. Electronic address: xingjiangwu@gmail.com.
Xingjiang
X
Wu
Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, P. R. China.
Jieshou
J
Li
D000208:Acute Disease; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D002681:China; D000072226:Computed Tomography Angiography; D004630:Emergencies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007261:Infusions, Intra-Arterial; D007279:Injections, Subcutaneous; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000601:surgery*; D065666:Mesenteric Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000628:therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017131:Thrombectomy / Q000009:adverse effects; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*
D000925:Anticoagulants; D005343:Fibrinolytic Agents