Acute Portomesenteric Venous Thrombosis: Diagnosis and Treatment

2018 ◽  
Vol 02 (03) ◽  
pp. 249-255
Author(s):  
Stephen Allison ◽  
David Shin ◽  
Guy Johnson
Keyword(s):  
Venous Thrombosis ◽  
Endovascular Therapy ◽  
Medical Management ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Diagnosis And Treatment ◽  
Bowel Infarction ◽  
Radiologic Imaging ◽  
Portomesenteric Venous Thrombosis

AbstractAcute portomesenteric venous thrombosis (PMVT) is an unusual cause of acute mesenteric ischemia. Because of its rarity and nonspecific presentation, radiologic imaging plays a key role in the diagnosis of acute PMVT. Medical management with anticoagulation is the mainstay of therapy, with surgery reserved for patients suspected of having peritonitis or bowel infarction. However, endovascular therapy has an evolving role and may serve as an important adjunct to anticoagulation in selected patients with acute PMVT.

Endovascular Therapy for Acute Mesenteric Ischemia: An NSQIP Analysis

2015 ◽  
Vol 81 (11) ◽  
pp. 1170-1176 ◽  
Author(s):  
Bernardino C. Branco ◽  
Miguel F. Montero-Baker ◽  
Hassan Aziz ◽  
Zachary Taylor ◽  
Joseph L. Mills
Keyword(s):  
Endovascular Therapy ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Improvement Program ◽  
Risk Of Death ◽  
Transfusion Requirements ◽  
Emergency Surgical Intervention ◽  
The Impact

Acute mesenteric ischemia (AMI) continues to carry high morbidity and mortality. Endovascular strategies have been increasingly used in the management of AMI. The purpose of this study was to evaluate the impact of endovascular therapy on outcomes of patients with AMI. The National Surgical Quality Improvement Program database was queried to identify all patients requiring emergency surgical intervention for AMI. Demographics, clinical data, interventions, and outcomes were extracted. Patients were compared according to treatment (endovascular versus hybrid versus open revascularization). Over the six-year study period, a total of 439 patients were found to have AMI [27 (6.2%) endovascular, 23 (5.2%) hybrid, and 389 (88.6%) open revascularization]. A total of 16 (59.3%) patients in the endovascular group avoided laparotomy. There was a trend toward lower transfusion requirements (intraoperative transfusion: 3.7% for endovascular vs 17.4% for hybrid vs 19.3% for open, adjusted. P = 0.127) and complications in particular pneumonia (22.2% vs 39.1% vs 27.8%, respectively, Adj. P = 0.392) and sepsis (25.9% vs 21.7% vs 35.5%, adjusted P = 0.260). Endovascular therapy was associated with a 2.5-fold decrease in the risk of death [odds ratio, 95% confidence interval: 0.4 (0.2, 0.9), adjusted P = 0.018]. In this analysis of morbidity and mortality, endovascular therapy was associated with decreased need for laparotomy and a trend toward lower transfusion requirements and complications, in particular pneumonia and sepsis. Endovascular first therapy was associated with a 2.5-fold decrease in the risk of death. Further prospective evaluation of these results is warranted.

scholarly journals Problems of the Diagnosis and Treatment of Acute Mesenteric Ischemia: a SingleCenter Experience

2018 ◽  
Vol 3 (4) ◽  
Keyword(s):  
Blood Flow ◽  
Mortality Rate ◽  
Early Diagnosis ◽  
High Mortality ◽  
Mesenteric Ischemia ◽  
Intestinal Resection ◽  
Acute Mesenteric Ischemia ◽  
Mesenteric Arteries ◽  
Diagnosis And Treatment ◽  
Number Of Patients

Objective: To improve the diagnosis and treatment of acute mesenteric ischemia by using available methods of early diagnosis and modern methods of treatment. Summary Background Data: The number of patients with disorders of the mesenteric circulation is increasing all over the world. In comparison with the occlusion of the coronary, cerebral arteries and peripheral veins, acute obstruction of the mesenteric arteries and veins is diagnosed much later, which causes a high mortality rate from 53 to 100%. Methods: In this study the experience of treatment of 162 patients with acute mesenteric ischemia was analyzed. All patients underwent treatment in Institute of Urgent and Recovery Surgery (IURS NAMS, Donetsk, Ukraine) from 2002 to 2017. Results: From 162 patients: 112 patients were with acute occlusive and 50 patients with acute nonocclusive mesenteric ischemia. The intravital diagnosis was not confirmed in 26 patients (16 %). 119 of patients died, the level of mortality was 73, 5%. 104 patients were operated, 32 patients were discharged (30,8 %), 72 patients died, a mortality rate was 69,2 %. Operations with restore of blood flow were performed in 14 patients, 5 patients died, 9 patients left the hospital. Conservative therapy was performed in 22 patients, in 11 patients with good results (50 %). Conclusions: The early diagnosis of this pathology is crucial and it can reduce the high mortality rate of patients with AMI. Treatment of OAMI should be carried out in a community of general, vascular and endovascular surgeons. Restoration of blood flow through mesenteric vessels with the help of endovascular technology and implementation of thrombembolectomy during open surgical intervention in a number of cases allows to avoid intestinal resection.

Acute mesenteric ischemia: endovascular therapy

2006 ◽  
Vol 32 (3) ◽  
pp. 299-303 ◽  
Author(s):  
Gulen Demirpolat ◽  
Ismail Oran ◽  
Sadik Tamsel ◽  
Mustafa Parildar ◽  
Ahmet Memis
Keyword(s):  
Endovascular Therapy ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia

Mesenteric Ischemia

2016 ◽  
Author(s):  
Ugo A. Ezenkwele
Keyword(s):  
Abdominal Pain ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Computed Tomographic Angiography ◽  
Low Flow ◽  
Chronic Mesenteric Ischemia ◽  
Flow State ◽  
Nonocclusive Mesenteric Ischemia ◽  
Vasodilator Therapy ◽  
Bowel Infarction

Acute mesenteric ischemia is interruption of intestinal blood flow by embolism, thrombosis, or a low-flow state. Bowel infarction is the end result of a process initiated by mediator release and inflammation. On clinical assessment, the early hallmark is severe abdominal pain but minimal physical findings. The abdomen remains soft, with little or no tenderness. Mild tachycardia may be present. Early diagnosis is difficult, but selective mesenteric angiography and computed tomographic angiography have the most sensitivity; other imaging studies and serum markers can show abnormalities but lack sensitivity and specificity early in the course of the disease, when diagnosis is most critical. Treatment is by embolectomy, anticoagulation, revascularization of viable segments, or resection; sometimes vasodilator therapy is successful. If diagnosis and treatment take place before infarction occurs, mortality is low; after intestinal infarction, mortality approaches 30 to 70%. For this reason, in the emergency department, clinical diagnosis should supersede diagnostic tests, which may delay treatment. This review contains 6 highly rendered figures, 4 tables, and 33 references. Key words: acute mesenteric ischemia; bowel necrosis; chronic mesenteric ischemia; mesenteric occlusive disease; mesenteric venous thrombosis; nonocclusive mesenteric ischemia; postprandial abdominal pain; superior mesenteric artery thromboembolism

A case of acute mesenteric ischemia caused by mesenteric venous thrombosis

2018 ◽  
Vol 85 (6) ◽  
pp. 1127-1129
Author(s):  
Dario Tartaglia ◽  
Rita Fantacci ◽  
Caterina Corsini ◽  
Luigi Cobuccio ◽  
Giuseppe Zocco ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Mesenteric Venous Thrombosis

scholarly journals Nonoсclusive mesenteric ischemia (literature review)

2021 ◽  
pp. 76-83
Author(s):  
V.S. Khomenko ◽  
◽  
V.P. Perepelitsіa ◽  
I.O. Kuchynskyi ◽  
A.V. Sirotkin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Literature Review ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Care Physician ◽  
Diagnosis And Treatment ◽  
Diagnostic Tools ◽  
Mesenteric Blood Flow ◽  
Wide Range ◽  
Occlusive Mesenteric Ischemia

Non-occlusive mesenteric ischemia is a relatively rare but extremely complex pathology in terms of diagnosis. A wide range of reasons for the development of non-occlusive impression dramatically complicates the diagnosis and differentiation with other abdominal pathology. The vast majority of publications in the domestic literature on acute disorders of mesenteric blood flow, mostly address the problems of diagnosis and treatment of occlusive types of mesenteric ischemia, while the topic of non-occlusive ischemia remains insufficiently covered. Given that in half of the cases NOMI is diagnosed at the stage of irreversible necrotic changes of the intestine – there is a real need to generalize the root causes and mechanisms of neoclustive mesenteric ischemia, modern methods of diagnosis and treatment. Purpose – to analyze of the causes, prevalence, classification, diagnosis and treatment of non-occlusive disorders of mesenteric blood flow. This research, based on literature review, showed that acute non-occlusive mesenteric ischemia (NOMI) is associated with poor prognosis due to the lack of accurate diagnostic measures. First of all, clarity regarding biochemical markers. Therefore, the research and development of the latter is seen as a priority. Contrast methods of examination (computed tomography, angiography) are the only possible diagnostic tools. Pharmacological correction is fundamental and presupposes the use of drugs with a vasodilating effect systemically or locally (catheter-associated). An important issue is the development of pharmacological agents that allow targeted action on the pathogenetic mechanisms of the development of NOMI. A multidisciplinary approach involving a specialized doctor, a surgeon, an X-ray endovascular surgeon and an intensive care physician in the treatment of a patient with suspected NOMI is the foundation for the success of therapy. The question of the use of laparoscopy remains controversial, given the invasiveness of the method and the difficulty of interpreting the changes detected in the early phase of the disease. No conflict of interests was declared by the authors. Key words: acute mesenteric ischemia, non-occlusive disorders of mesenteric blood flow.

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