Postoperative Catheter-Directed Thrombolysis Versus Systemic Anticoagulation for Acute Superior Mesenteric Venous Thrombosis

Abstract Purpose: To report our technique, treatment strategy and clinical outcomes for porto-mesenteric venous thrombosis (PMVT) in non-cirrhotic patients.Methods: 16 non-cirrhotic PMVT patients (mean age: 48.6 years) with imminent intestinal ischemia were enrolled from 2004-2020. 8 patients presented thrombus extension into the peripheral mesenteric vein, close to the venous arcade. Transhepatic catheter-directed thrombolysis (CDT) was performed by urokinase infusion (60,000-30,000 IU/hour concomitant with heparin 300-400 IU/hour), catheter aspiration and/or balloon dilation/stent placement. Additional intra-arterial mesenteric infusion of urokinase (30,000 IU/hour) was given in patients with the peripheral mesenteric venules involved. Transjugular intrahepatic porto-systemic shunt (TIPS) was created in patients with poor recanalization of the intrahepatic portal flow (PV). Results: The transhepatic route was adopted in all patients, with adjunct indirect mesenteric arterial thrombolytic infusion in 8 patients. A total of up to 20.4 million IU urokinase was infused for 1-30 days’ treatment duration. TIPS was created in 3 patients with recanalization failure of the intrahepatic PV. Technical success was achieved in 100% of patients with complete recanalization of 80% and partial recanalization of 20%. No major procedure-related complications were encountered. The 30-day mortality rate was 6.7%. The overall 1- and 2-year primary and secondary patency were both 74.0% and 84.6% respectively. Conclusions: CDT can be performed as a primary salvage treatment once the diagnosis is made. CDT via the transhepatic route with tailored thrombolytic regimen is safe and effective for both acute and chronic PMVT . TIPS creation can be preserved in non-cirrhotic PMVT patients if intrahepatic PV recanalization fails.

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Acute Mesenteric Venous Thrombosis: A Better Outcome Achieved Through Improved Imaging Techniques and a Changed Policy of Clinical Management

Yearbook of Vascular Surgery ◽

10.1016/s0749-4041(08)70269-0 ◽

2006 ◽

Vol 2006 ◽

pp. 350-351

Author(s):

G.L. Moneta

Keyword(s):

Venous Thrombosis ◽

Clinical Management ◽

Imaging Techniques ◽

Mesenteric Venous Thrombosis

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CT diagnosis of traumatic mesenteric venous thrombosis.

American Journal of Roentgenology ◽

10.2214/ajr.154.2.2105044 ◽

1990 ◽

Vol 154 (2) ◽

pp. 425-425 ◽

Cited By ~ 1

Author(s):

M D Salerno ◽

B S Rose

Keyword(s):

Venous Thrombosis ◽

Mesenteric Venous Thrombosis ◽

Ct Diagnosis

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Catheter directed thrombolysis and mechanical intervention in deep venous thrombosis: What is the status after the ATTRACT Trial?

Postgraduate Medicine ◽

10.1080/00325481.2021.1919435 ◽

2021 ◽

Author(s):

Savannah E. Fletcher ◽

Sonia Jasuja ◽

Leo P. Lawler ◽

John M. Moriarty

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Catheter Directed Thrombolysis ◽

The Status ◽

Mechanical Intervention

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A systematic review and meta-analysis on endovascular treatment as an attractive alternative for acute superior mesenteric venous thrombosis

Vascular ◽

10.1177/1708538121991270 ◽

2021 ◽

pp. 170853812199127

Author(s):

Lixin Wang ◽

Enci Wang ◽

Fei Liu ◽

Wei Zhang ◽

Xiaolong Shu ◽

...

Keyword(s):

Systematic Review ◽

Treatment Group ◽

Conservative Treatment ◽

Venous Thrombosis ◽

Endovascular Treatment ◽

Meta Analysis ◽

Statistical Significance ◽

Published Data ◽

Mesenteric Venous Thrombosis ◽

Surgery Group

Objective This systematic review and meta-analysis evaluated the published data on the efficacy and safety of therapies for superior mesenteric venous thrombosis (SMVT), aiming to provide a reference and set of recommendations for clinical treatment. Methods Relevant databases were searched for studies published from 2000 to June 2020 on SMVT treated with conservative treatment, surgical treatment, or endovascular approach. Different treatment types were grouped for analysis and comparison, and odds ratios with corresponding 95% confidence intervals were calculated. The outcomes were pooled using meta-analytic methods and presented by forest plots. Results Eighteen articles, including eight on SMVT patients treated with endovascular therapies, were enrolled. The treatment effectiveness was compared between different groups according to the change of symptoms, the occurrence of complications, and mortality as well. The conservative treatment group had better efficacy compared to the surgery group (89.0% vs. 78.6%, P <0.05), and the one-year survival rate was also higher (94.4% vs. 80.0%, P >0.05), but without statistical significance. As for endovascular treatment, the effectiveness was significantly higher than the surgery group (94.8% vs. 75.2%, P <0.05), and the conservative treatment group as well (93.3% vs. 86.3%, P >0.05), which still requires further research for the lack of statistical significance. Conclusions Present findings indicate that anticoagulation, as conservative treatment should be the preferred clinical option in the clinic for SMVT, due to its better curative effect compared to other treatment options, including lower mortality, fewer complications, and better prognosis. Moreover, endovascular treatment is a feasible and promising approach that is worth in-depth research, for it is less invasive than surgery and has relatively better effectiveness, thus can provide an alternative option for SMVT treatment and may be considered as a reliable method in clinical.

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