Abstract No. 263 EE: Portomesenteric thrombosis: Multiple approaches to percutaneous access and techniques for transcatheter treatment

Abstract

Understand the disease entity portomesenteric thrombosis, its major underlying contributing factors, treatment options and interventional radiology's unique place within this spectrum. Understand specific techniques on how to successfully access the portomesenteric venous system for subsequent transcatheter therapy utilizing different approaches and imaging modalities through case examples. Understand the wide scope of specific percutaneous transcatheter treatment options through case examples. Portomesenteric venous thrombosis (PVT) is rare but potentially devastating condition accounting for 5% to 15% of all mesenteric ischemic events. This disease process includes a spectrum of clinical presentations ranging from incidental findings in an asymptomatic patient to fulminate liver failure and life-threatening bowel infarction with reported mortality rates of 13-50% for mesenteric thrombosis. Current therapy options for PVT involves a spectrum ranging from anticoagulation to invasive surgery including multivisceral transplantation in extreme cases. In recent years modern imaging guidance and catheter directed techniques have allowed percutaneous intervention to become an important treatment option for many patients. Cases will be highlighted demonstrating portomesenteric access from the transhepatic and bilateral transjugular routes as well as direct cannulation of the mesenteric vein during laparotomy. Examples of transhepatic access will be further divided by imaging modality including percutaneous puncture under fluoroscopy, ultrasound, and CT guidance. Examples of different transcatheter treatment options will include passive instillation of thrombolytics, pulse spray thrombolysis, use of pharmaco-mechanical combination as well as percutaneous mechanical thrombectomy devices such as Trellis-8 and AngioJet. Interventional radiology has a key role in administering effective, focused, minimally invasive treatment for the rare but potentially devastating disease entity of portomesenteric thrombosis by incorporating a spectrum of percutaneous options utilizing multiple approaches and treatment delivery techniques which can be tailored to specific patients needs.