Clinical Studies
Transcatheter Thrombolytic Therapy for Acute Mesenteric and Portal Vein Thrombosis

https://doi.org/10.1097/01.RVI.0000156265.79960.86Get rights and content

PURPOSE

The purpose of this study was to evaluate the utility of transcatheter thrombolytic therapy in 20 patients with acute or subacute (symptoms <40 days) portal and/or mesenteric vein thrombosis with severe symptoms, deteriorating clinical condition, and/or persistent symptoms despite anticoagulation.

MATERIALS AND METHODS

This retrospective study examined 12 male patients and eight female patients seen over a period of 11 years. The average age was 37.6 years. Four of the patients had previously undergone liver transplantation. An anatomic classification system was established to describe the extent of thrombus at the time of diagnosis. Patients were treated with thrombolytic therapy via the transhepatic route, common femoral vein route, and/or superior mesenteric artery route. Improvement in symptoms, avoidance of bowel resection, complications, and radiographic evidence of clot resolution were the main clinical outcomes.

RESULTS

Fifteen of the 20 patients exhibited some degree of lysis of the thrombus. Three patients had complete resolution, 12 had partial resolution, and five had no resolution. Eighty-five percent of patients (n = 17) had resolution of symptoms. Sixty percent of patients (n = 12) developed a major complication. No patients required bowel resection after thrombolytic therapy. One patient died with gastrointestinal hemorrhage and septic shock 2 weeks after thrombolytic therapy. Other major complications included bleeding and conditions requiring transfusion. No patients developed new portal or mesenteric thromboses. Two of the patients who received transplants eventually required repeat transplantation.

CONCLUSIONS

Transcatheter thrombolysis was beneficial in avoiding patient death, resolving thrombus, improving symptoms, and avoiding bowel resection. However, there was a high complication rate, indicating that this therapy should be reserved for patients with severe disease. Further evaluation of these techniques and outcomes should continue to be pursued.

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MATERIALS AND METHODS

In this retrospective study, billing records were searched to identify patients with Current Procedural Terminology codes corresponding to PV access, thrombolytic drug infusion, selective catheterization, and/or visceral angiography. The study was approved by the institutional review board, which determined the study was exempted from obtaining patient consent.

Radiographic Evidence of Success

The procedure resulted in lysis of thrombus in the majority of patients (Table 1, Table 2, Table 3). Overall, 15 of 20 patients (75%) experienced some degree of lysis. Three patients experienced complete lysis and 12 patients experienced partial lysis. Of patients with class 6 disease, three had no lysis, nine had partial lysis, and one had complete lysis (Table 1).

There were four patients who had not received transplants who did not exhibit any lysis. Two of these four patients developed major

DISCUSSION

Mesenteric vein thrombosis can lead to bowel infarction and death, with reported mortality rates of 13%–50% (8). A study on mesenteric vein thrombosis with a variety of treatments reported that eight of 23 patients with acute thrombus required bowel resection and there was a 30day mortality rate of 30% (14). As part of a retrospective study, Rhee et al (15) examined 53 patients with acute mesenteric vein thrombosis treated at their institution over a period of 21 years. Thirty patients required

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None of the authors have identified a conflict of interest.

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