Mechanical thrombectomy-assisted thrombolysis for acute symptomatic portal and superior mesenteric venous thrombosis

Abstract

Acute portal vein and mesenteric vein thrombosis (PVMVT) can cause acute mesenteric ischemia and be fatal with mortality rate of 37%-76%. Therefore, early diagnosis and prompt venous revascularization are warranted in patients with acute symptomatic PVMVT. Due to advances in catheter-directed treatment, endovascular treatment has been used for revascularization of affected vessels in PVMVT. We report two cases of symptomatic PVMVT treated successfully by transhepatic percutaneous mechanical thrombectomy-assisted thrombolysis.

Keywords: Endovascular procedures; Ischemia; Mesenteric veins; Portal vein; Venous thrombosis.

Fig. 1

Initial CT scan. Intraluminal thrombosis in the portal vein (A, arrow), splenic vein (B, arrows), and superior mesenteric vein (C, arrow) is evident. (D) Jejunal loop dilation and diffuse wall thickening (arrows) with a small amount of ascites are evident (dotted arrows; A, D).

Fig. 2

(A) Portogram and mesenteric venogram showed extensive thrombosis in the portal vein and mesenteric vein. (B) AngioJet Spiroflex thrombectomy catheter in SMV (arrow). (C) The completion venogram demonstrated partial recanalization of venous flow in the portal vein and SMV and splenic vein. (D, E) Follow-up abdominal CT scan at the 16th hospital day. Improved blood flow with a small amount of residual intraluminal thrombus in the PV and SMV compared to the initial CT. (D) The puncture site of the liver was coil embolized (arrow). (E) Bowel loop dilatation and wall thickening also improved significantly.

Fig. 3

Initial CT scan showed intraluminal thrombosis in the portal vein (A, arrow), splenic vein (B, arrows), and superior mesenteric vein (C, arrow). (C, D) Streaky infiltrations in the mesentery raised the suspicion of mesenteric edema (dotted arrows).

Fig. 4

(A) Venogram demonstrated extensive thrombosis in the portal vein (PV), superior mesenteric vein (SMV), and splenic vein (SV). (B) Using AngioJet catheter (arrow), mechanical thrombectomy was performed in the thrombosed segments of superior mesenteric vein. (C) Two days after the procedure, venography of superior mesenteric and portal veins demonstrated partial recanalization of these vessels. (D, E) Postprocedure 8th day abdominal CT scan. The volume of thrombi in the portal vein (D, arrow) and superior mesenteric vein (E, arrow) was decreased, and mesenteric edema had improved.

Fig. 5

Removed thrombi.