Agitation thrombolysis combined with catheter-directed thrombolysis for the treatment of non-cirrhotic acute portal vein thrombosis

Abstract

Aim: To evaluate the safety and efficacy of agitation thrombolysis (AT) combined with catheter-directed thrombolysis (CDT) for the treatment of non-cirrhotic acute portal vein thrombosis (PVT).

Methods: Nine patients with non-cirrhotic acute PVT who underwent AT combined with CDT were analyzed retrospectively. Portography was carried out via the transjugular intrahepatic portosystemic (commonly known as TIP) or percutaneous transhepatic (commonly known as PT) route, followed by AT combined with CDT. Complications of the procedure, and the changes in clinical symptoms, hemodynamics of the portal vein and liver function were recorded. Follow-up was scheduled at 1, 3 and 6 mo after treatment, and every 6 mo thereafter, or when the patients developed clinical symptoms related to PVT. Color Doppler ultrasound and contrast-enhanced computed tomography/magnetic resonance imaging were performed during the follow-up period to determine the condition of the portal vein.

Results: AT combined with CDT was successfully performed. The portal vein was reached via the TIP route in 6 patients, and via the PT route in 3 patients. All clinical symptoms were relieved or disappeared, with the exception of 1 patient who died of intestinal necrosis 9 d after treatment. Significant differences in the changes in portal vein hemodynamics were observed, including the maximum lumen occupancy of PVT, portal vein pressure and flow velocity between pre- and post-treatment (P < 0.05). During the follow-up period, recurrence was observed in 1 patient at 19 mo after the procedure, and the portal vein was patent in the remaining patients.

Conclusion: AT combined with CDT is a safe and effective method for the treatment of non-cirrhotic acute PVT.

Keywords: Agitation thrombolysis; Catheter-directed thrombolysis; Portal vein thrombosis.

Figure 1

A 29-year-old man had acute abdominal pain and distension for 4 d. A and B: Contrast-enhanced computed tomography (CT) and portography via the transjugular intrahepatic portosystemic route showed thrombus formation in the portal vein and superior mesenteric vein (arrow) with massive ascites; C: Portography after agitation thrombolysis and catheter-directed thrombolysis showed that the filling defect in the portal vein had decreased; D: Contrast-enhanced CT after surgery showed that the thrombus had disappeared completely; E: At 6 mo after treatment, color Doppler ultrasound showed smooth blood flow in the portal vein (arrow).

Figure 2

A 57-year-old woman had acute abdominal pain for 16 d. A and B: Contrast-enhanced computed tomography (CT) and portography via the percutaneous transhepatic route showed thrombus formation in the portal vein and superior mesenteric vein (arrow); C: Portography after agitation thrombolysis and catheter-directed thrombolysis showed that the filling defect in the portal vein had decreased; D: Contrast-enhanced CT after treatment showed that the thrombus had disappeared completely; E: At 12 mo after treatment, color Doppler ultrasound showed smooth blood flow in the portal vein (arrow).

Figure 3

Pigtail catheter was inserted into the thrombus through the sheath, and a guidewire with a helical tip molded in vitro was advanced through the catheter. A: A pigtail catheter, and a guidewire with a helical tip (arrow) through the catheter in vitro; B: The catheter and guidewire in the portal vein (arrow) during agitation thrombolysis via the transjugular intrahepatic portosystemic route.