Comparison of Systemic Thrombolysis Versus Indirect Thrombolysis via the Superior Mesenteric Artery in Patients with Acute Portal Vein Thrombosis.
BACKGROUND
The aim of this study was to evaluate the safety and efficacy of indirect thrombolysis via the superior mesenteric artery (SMA) in patients with acute portal vein thrombosis.


METHODS
Over 10 years, we studied the safety and efficacy of indirect thrombolysis via the SMA in 34 patients with acute portal vein thrombosis. Eighteen patients were categorized as the systemic thrombolysis (ST) group and 16 as the catheter thrombolysis (CT) group. The ST group was administered low-molecular-weight heparin, and patients in the CT group received catheter thrombolysis. Clinical data, such as comorbidities, laboratory test results, therapeutic methods, and prognosis, were recorded. All the patients underwent a routine clinical follow-up that was performed by inpatient examinations or outpatient visits at a mean follow-up time of 34 months.


RESULTS
The thrombus score was significantly higher in the ST group (3.67 ± 1.19) than in the CT group (2.38 ± 0.62) after 2 weeks of treatment (P < 0.05). The average period of symptom alleviated was longer in the ST group (3.29 ± 1.59 days) than in the CT group (2.07 ± 0.73 days, P < 0.05). Five patients (4 in the ST group and 1 in the CT group) underwent a laparotomy because of peritonitis after thrombolysis for 24 hr. One patient died of a malignant tumor after 18 months.


CONCLUSIONS
Indirect thrombolysis via the SMA is safer and more effective for patients with portal vein thrombosis compared with systemic thrombolysis.
Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Jiangsu, China; Department of Vascular Surgery, The Suqian People's Hospital affiliated to Nanjing Drama Tower Hospital Group, Jiangsu, China.
Kun
K
Liu
Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Jiangsu, China.
Wen-Dong
WD
Li
Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Jiangsu, China.
Xiao-Long
XL
Du
Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Jiangsu, China. Electronic address: lcljm11@163.com.
Cheng-Long
CL
Li
Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Jiangsu, China. Electronic address: flytsg@126.com.
Xiao-Qiang
XQ
Li
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D008297:Male; D017538:Mesenteric Artery, Superior; D008875:Middle Aged; D061214:Patient Safety; D018579:Patient Selection; D011169:Portal Vein / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D014568:Urokinase-Type Plasminogen Activator