Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis

• Published in: Journal of vascular and interventional radiology Vol. 16; no. 5; p. 651
• Main Authors: Hollingshead, Michael, Burke, Charles T, Mauro, Matthew A, Weeks, Susan M, Dixon, Robert G, Jaques, Paul F
• Format: Journal Article
• Language: English
• Published: United States 01-05-2005
• Subjects: Acute Disease; Adolescent; Adult; Aged; Child; Female; Humans; Male; Mesenteric Veins - diagnostic imaging; Middle Aged; Portal Vein - diagnostic imaging; Portography; Retrospective Studies; Thrombolytic Therapy - instrumentation; Thrombolytic Therapy - methods; Treatment Outcome; Venous Thrombosis - diagnostic imaging; Venous Thrombosis - drug therapy
• ISSN: 1051-0443
• DOI: 10.1097/01.RVI.0000156265.79960.86

The purpose of this study was to evaluate the utility of transcatheter thrombolytic therapy in 20 patients with acute or subacute (symptoms <40 days) portal and/or mesenteric vein thrombosis with severe symptoms, deteriorating clinical condition, and/or persistent symptoms despite anticoagulation.
This retrospective study examined 12 male patients and eight female patients seen over a period of 11 years. The average age was 37.6 years. Four of the patients had previously undergone liver transplantation. An anatomic classification system was established to describe the extent of thrombus at the time of diagnosis. Patients were treated with thrombolytic therapy via the transhepatic route, common femoral vein route, and/or superior mesenteric artery route. Improvement in symptoms, avoidance of bowel resection, complications, and radiographic evidence of clot resolution were the main clinical outcomes.
Fifteen of the 20 patients exhibited some degree of lysis of the thrombus. Three patients had complete resolution, 12 had partial resolution, and five had no resolution. Eighty-five percent of patients (n = 17) had resolution of symptoms. Sixty percent of patients (n = 12) developed a major complication. No patients required bowel resection after thrombolytic therapy. One patient died with gastrointestinal hemorrhage and septic shock 2 weeks after thrombolytic therapy. Other major complications included bleeding and conditions requiring transfusion. No patients developed new portal or mesenteric thromboses. Two of the patients who received transplants eventually required repeat transplantation.
Transcatheter thrombolysis was beneficial in avoiding patient death, resolving thrombus, improving symptoms, and avoiding bowel resection. However, there was a high complication rate, indicating that this therapy should be reserved for patients with severe disease. Further evaluation of these techniques and outcomes should continue to be pursued.