Endovascular Treatment for Nonacute Symptomatic Portal Venous Thrombosis through Intrahepatic Portosystemic Shunt Approach

Abstract

Purpose To study the safety and efficacy of nonacute symptomatic portal vein thrombosis (PVT) treated by mechanical thrombectomy combined with pharmacologic thrombolysis through an intrahepatic portosystemic shunt (IPS) approach. Materials and Methods Thirteen patients with nonacute symptomatic PVT were included in this study: five women and eight men, with a mean age of 48.9 y. Indications for therapy were variceal bleeding ( n = 7) and abdominal pain, distension, or intermittent melena ( n = 6). Through an IPS approach, balloon angioplasty, sheath-directed thrombus aspiration, and continuous infusion of urokinase were performed. Clinical follow-up was performed in all patients. Results An IPS was successfully created in all patients. After therapy, recanalization of all thrombosed main PVs was achieved. A majority of thrombus was removed and lysed. The overall rate of clinical improvement was 92.3%. One patient died of intraperitoneal bleeding the second day after the procedure, and another two patients experienced minor complications after therapy and recovered completely after conservative medical management. During a mean of 14.9 months of follow-up, two patients experienced recurrent variceal bleeding as a result of shunt dysfunction. Hemostasis was achieved after shunt revision. No other complications occurred. Conclusions Through an IPS approach, mechanical thrombectomy combined with pharmacologic thrombolysis was possible as a therapeutic option for patients with nonacute symptomatic PVT.