3:09 PM Abstract No. 362 Percutaneous transhepatic catheter-directed thrombolysis for the treatment of acute portal and mesenteric vein thrombosis

Abstract

To evaluate our institutional outcomes following catheter-directed thrombolysis (CDT) for the treatment of acute portal and mesenteric vein thrombosis (PVT). A retrospective chart review of all patients with PVT treated with CDT over a ten-year period was performed. Thrombus was quantified using the Yerdel Classification pre- and post-thrombolysis. Demographics, risk factors for PVT, symptoms, clinical and technical success rates, and complications were analyzed. Subgroup analyses were performed comparing cirrhotic and non-cirrhotic patients. Twenty-eight patients (mean age 50.6 years) were treated with CDT, including 8 cirrhotic patients. Major risk factors included recent surgery, cirrhosis, and malignancy. Presenting symptoms were abdominal pain and nausea. Immediate clinical and technical success rates were 82.1% and 89.3%, respectively. Median Yerdel score significantly decreased in all groups, but more dramatically in the non-cirrhotic population (3.5 vs. 1, p = 0.034). Pain significantly decreased from a median score of 7 (IQR 4-9.5) pretreatment to 0 (IQR 0-3.25) posttreatment. Two procedure related patient deaths occurred, 1 bleed in a heparinized patient (aPTT >200) 5 days postprocedure, and multi-organ failure in a patient with a thrombosed SMV stent placed post Whipple. Additional complications included self-limited SMV extravasation post angioplasty, rapid ventricular response requiring antiarrhythmic medications, blood loss requiring transfusion, and vomiting requiring a nasogastric tube. There was a trend towards a lower complication rate in the cirrhotic population (25% vs. 55%). Nineteen patients had long-term follow-up (median 10.8 mo IQR: 4.9-18.7 mo) with 78.9% stable or decreased thrombus and 21.1% re-thrombosis. CDT for acute portal and mesenteric vein thrombosis has a good success rate with long-term partial and complete patency up to 79%, however continues to have a modest rate of significant complications. Given these findings, further investigation with a medically managed control group is warranted.