scholarly journals Primary Catheter-Directed Thrombolysis For Porto-Mesenteric Venous Thrombosis (PMVT) In Non-Cirrhotic Patients.

2021 ◽  
Author(s):  
Chia-Ling Chiang ◽  
Huei-Lung Liang ◽  
Ming-Feng Li
Keyword(s):  
Venous Thrombosis ◽  
Intestinal Ischemia ◽  
Balloon Dilation ◽  
Secondary Patency ◽  
Mesenteric Venous Thrombosis ◽  
Technical Success ◽  
Catheter Directed Thrombolysis ◽  
Major Procedure ◽  
Cirrhotic Patients ◽  
Urokinase Infusion

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.

scholarly journals Diagnosis and management challenges of acute mesenteric venous thrombosis in patients with liver cirrhosis: a single institution's experience

2017 ◽  
Vol 4 (6) ◽  
pp. 1837
Author(s):  
Hazem M. Zakaria ◽  
Khaled G. Ammar ◽  
Sherif M. Saleh ◽  
Mohammed Abbas ◽  
Nahla M. Gaballa ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Venous Thrombosis ◽  
Diagnostic Tools ◽  
Mesenteric Venous Thrombosis ◽  
Low Protein ◽  
Cirrhotic Patients ◽  
Coagulation Status ◽  
Triphasic Ct ◽  
Primary Resection And Anastomosis ◽  
Resection And Anastomosis

Background: Acute mesenteric venous thrombosis (MVT) is a dreadful complication of liver cirrhosis that requires prompt diagnosis and aggressive management for better outcome. The aim of this work was to study the diagnostic tools and the optimal management of acute MVT in patients with liver cirrhosis.Methods: It was a retrospective study including 40 patients with liver cirrhosis who were admitted to the surgical emergency and were eventually diagnosed as acute MVT between May 2011 to September 2016. The preoperative clinicopathological data, operative data and postoperative follow up were recorded.Results: Forty patients had acute MVT. Twenty five patients (62.5%) had prolonged prothrombin time, 18 patients (45%) had thrombocytopenia and 22 patients (55%) had low protein C. triphasic CT scan was the main diagnostic image in 28 patients, with sensitivity 100% and accuracy 96.9% in detection of intestinal infarction. Ten patients (25%) underwent conservative treatment with anticoagulant, while 30 patients (75%) were surgically explored and 28 patients of them had gangrenous bowel loops and underwent primary resection and anastomosis. Three patients underwent second look operation. Three patients had recurrent symptoms after 1 month of the first presentation. The overall 30- and 90-day mortality was 27.5% and 37.5% respectively.Conclusions: Cirrhotic patients may have hypercoagulable state and the usual laboratory tests don’t accurately assess the coagulation status in these patient. Acute MVT in cirrhotic patients has a high early morbidity and mortality that needs early diagnosis and urgent management with selective surgical intervention and proper anticoagulant.

Portal and mesenteric venous thrombosis in cirrhotic patients

2002 ◽  
Vol 123 (4) ◽  
pp. 1409-1410 ◽  
Author(s):  
Lucio Amitrano ◽  
Maria Anna Guardascione ◽  
Vincenzo Brancaccio ◽  
Luigi Iannaccone ◽  
Paul R.J. Ames ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Mesenteric Venous Thrombosis ◽  
Cirrhotic Patients

scholarly journals Acute symptomatic mesenteric venous thrombosis: treatment by catheter-directed thrombolysis with transjugular intrahepatic route

2010 ◽  
Vol 36 (4) ◽  
pp. 390-398 ◽  
Author(s):  
Mao Qiang Wang ◽  
Feng Yong Liu ◽  
Feng Duan ◽  
Zhi Jun Wang ◽  
Peng Song ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Mesenteric Venous Thrombosis ◽  
Catheter Directed Thrombolysis

Aspiration thrombectomy for the management of acute deep venous thrombosis in the setting of venous thoracic outlet syndrome

Vascular ◽  
2019 ◽  
Vol 28 (2) ◽  
pp. 183-188
Author(s):  
Katherine Teter ◽  
Frank Arko ◽  
Patrick Muck ◽  
Patrick J Lamparello ◽  
Minhaj S Khaja ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Upper Extremity ◽  
Thoracic Outlet Syndrome ◽  
Technical Success ◽  
Aspiration Thrombectomy ◽  
Venous Involvement ◽  
Acute Thrombosis ◽  
Catheter Directed Thrombolysis

Objectives Venous thoracic outlet syndrome, known by the eponym Paget–Schroetter syndrome, is seen in healthy, young individuals with “effort-induced thrombosis.” Endovascular therapies, including catheter-directed thrombolysis, have been described in the acute management of the upper extremity deep venous thrombosis; however, we assessed the technical success of treating this entity using a mechanical aspiration thrombectomy system. Methods This was a multi-center retrospective review of patients with venous thoracic outlet syndrome with acute thrombosis treated with the Indigo continuous aspiration mechanical thrombectomy system. Charts from patients with venous thoracic outlet syndrome and acute deep venous thrombosis treated with this system at our institution along with three data sharing locations were reviewed for demographics, deep venous thrombosis risk factors, imaging modalities used for diagnosis, extent of axillosubclavian deep venous thrombosis, treatment details, adjunctive therapies, and complications. The primary outcome was technical success (resolution of >70% of thrombus). Results There were 16 patients (50% male) with a mean age of 33 years (range 17–69 years). Six patients had underlying venous thromboembolism risk factors including use of contraceptives ( n = 2), prior deep venous thrombosis ( n = 3), and known thrombophilia ( n = 1). Fifteen patients had complete venous occlusion, and the extent of venous involvement included subclavian ( n = 14), axillary ( n = 16), and brachial ( n = 7). The majority (81.25%) of patients were treated in a single setting, and technical success was achieved in all cases with the use of adjunctive therapies. Only three patients required additional overnight thrombolytic therapy. Conclusions The Penumbra Indigo system, often in combination with adjunctive catheter-directed thrombolysis and venoplasty, is a safe and effective device for the treatment of acute upper extremity deep venous thrombosis in the setting of Paget–Schroetter syndrome. No patients experienced central embolization or post-operative renal insufficiency. One-third of patients avoided any additional catheter-directed thrombolysis exposure, and technical success was achieved in all cases. A single bleeding complication was observed in a patient undergoing overnight adjunctive catheter-directed thrombolysis. All patients maintained patency until time of first rib resection.

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