Abstract
PurposeTo evaluate the safety and the efficacy of percutaneous pharmaco-mechanical thrombectomy (PPMT) of acute superior mesenteric vein (SMV) thrombosis.MethodsA database of patients treated between 2011 and 2018 with acute venous mesenteric ischemia (VMI) was reviewed. VMI was diagnosed in the presence of SMV thrombosis and CT evidence of jejunal thickening. All patients presented with mild to moderate peritonism, which allowed surgery to be postponed. Initial treatment consisted of heparinization. PPMT was indicated in case of worsening abdominal pain despite anticoagulation and was performed via a transjugular or transhepatic approach, using a rotational aspiration thrombectomy catheter, followed by transcatheter thrombolysis. Clinical success was defined as symptoms resolution. Technical success was defined as patency of > 50% of SMV at venography and resolution of jejunal thickening. Patients were discharged on lifelong oral anticoagulation (INR 2.5–3.5). Follow-ups were performed using CT and color Doppler ultrasound.ResultsPopulation consisted of eight males, aged 37–81 (mean 56.5 years). Causes for thrombosis were investigated. Urokinase infusion time ranged from 48 to 72 h (3,840,000–5,760,000 IU). Clinical and technical success was obtained in all cases. One patient experienced bleeding from the superior epigastric artery and was treated with embolization. One patient died of multi-organ failure after 35 days, despite resolution of SMV thrombosis. In no case was surgery required after PPMT; mean hospitalization was 14.1 days (9–24). Mean follow-up of remaining seven patients was 37.7 months (12–84 months).ConclusionPPMT of acute SMV thrombosis seems safe and effective, with an 87.5% long-term survival rate and a 12.5% major complication rate.
Highlights
Acute superior mesenteric vein (SMV) thrombosis is a rare disease that accounts for 5–15% of mesenteric thromboembolic events [1]
percutaneous pharmaco-mechanical thrombectomy (PPMT) was indicated in case of worsening abdominal pain despite anticoagulation and was performed via a transjugular or transhepatic approach, using a rotational aspiration thrombectomy catheter, followed by transcatheter thrombolysis
One patient died of multi-organ failure after 35 days, despite resolution of SMV thrombosis
Summary
Acute SMV thrombosis is a rare disease that accounts for 5–15% of mesenteric thromboembolic events [1]. Owing to a delay in diagnosis determined by its vague symptomatological profile, it is associated with high rates of mortality, up to 50% in the case of intestinal infarction [2]. The causes of acute SMV thrombosis include liver cirrhosis, a previous history of surgery, abdominal infection or inflammation, and hypercoagulable states (such as deficiencies of antithrombin III, protein C, protein S, and factor V Leiden) [3]. Systemic anticoagulation with heparin is the initial conventional therapy for acute SMV thrombosis. P. Rabuffi et al.: Percutaneous Pharmaco-Mechanical Thrombectomy of Acute Symptomatic
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