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Acute and Subacute Portomesenteric Venous Thrombosis: Treated by Interventional Radiological Techniques<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
王茂强* 王志强# 刘迎娣#
刘凤永* 王仲朴* 程留芳#
* 中国人民解放军总医院介入医学科， 北京 100853
#中国人民解放军总医院介入消化科
Mao-qiang Wang, Zhi-qiang Wang, Ying-di Liu, et. al
Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853.
ABSTRACT
Objective: To assess the efficacy of the interventional techniques for management of acute and subacute portomesenteric thrombosis.
Methods: Ten patients with thrombosis of the PV and SMV were treated by interventional procedures, including transcatheter superior mensenteric arterial (SMA) thrombolysis with urokinase in 4 and transjugular intrahepatic portosystemic shunt (TIPS) approach in 6 cases. From the TIPS approach, catheter-directed thrombus suction, mechanical fragmentation, and local thrombolysis were performed. The patients consisted of 6 men and 4 women with age range of 28-68 years. All patients presented with abdominal pain and distention, associated with diarrhea in 6 and a small amount of ascites in 2 cases. No clinical signs of peritonitis were seen. The diagnosis was established by Doppler ultrasound scan and contrast enhanced CT.
Results: The technical success was achieved in all cases. No complications related to the procedure occurred. Clinical improvement was seen in 3 of 4 patients whom underwent transcatheter intra-SMA thrombolysis. With TIPS approach, the majority of the thrombus in PV and SMV was cleared with flow restoration in the 6 patients on the completion angiograms. Clinical improvement was seen in 5 patients, characterized by progressive reduction of abdominal pain, distention, and diarrhea. One patient died of intra-abdominal sepsis and multiple organs failure 12 days after the procedure even though the antegrade flow was re-established in the main trunk of the PV.
Conclusions: The minimally invasive interventional techniques, including transcatheter intra-SMA local thrombolysis and TIPS approach catheter-directed thrombolysis, are effective in the treatment of acute and subacute portomesenteric thrombosis.
Key words: Portal vein; Thrombosis Mesenteric venous thrombosis; Thrombolysis; Interventional procedures |
