Acute symptomatic mesenteric venous thrombosis: treatment by catheter-directed thrombolysis with transjugular intrahepatic route

详细信息    查看全文

• 作者：1. Department of Interventional Radiology ; Chinese PLA General Hospital ; Beijing ; China
• 关键词：Superior mesenteric vein – Thrombosis – Thrombolysis – Mechanical thrombectomy – Interventional radiology
• 刊名：Abdominal Imaging
• 出版年：2011
• 出版时间：August 2011
• 年：2011
• 卷：36
• 期：4
• 页码：390-398
• 全文大小：777.1 KB
• 参考文献：1. Kumar S, Sarr MG, Kamath PS (2001) Mesenteric venous thrombosis. N Engl J Med 345:1683–1688
  2. Brunaud L, Antunes L, Collinet-Adler S, et al. (2001) Acute mesenteric venous thrombosis: case for nonoperative management. J Vasc Surg 34:673–679
  3. Amitrano L, Guardascione MA, Scaglione M, et al. (2007) Prognostic factors in noncirrhotic patients with splanchnic vein thromboses. Am J Gastroenterol 102:2464–2470
  4. Acosta S, Alhadad A, Svensson P, Ekberg O (2008) Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg 95:1245–1251
  5. Hedayati N, Riha GM, Kougias P, et al. (2008) Prognostic factors and treatment outcome in mesenteric vein thrombosis. Vasc Endovascular Surg 42:217–224
  6. Cenedese A, Monneuse O, Gruner L, et al. (2009) Initial management of extensive mesenteric venous thrombosis: retrospective study of nine cases. World J Surg 33:2203–2208
  7. Stambo GW, Grauer L (2005) Transhepatic portal venous power-pulse spray rheolytic thrombectomy for acute portal thrombosis after CT-guided pancreas biopsy. Am J Roentgenol 184(3 suppl):S118–S119
  8. Kim HS, Patra A, Khan J, Arepally A, Streiff MB (2005) Transhepatic catheter-directed thrombectomy and thrombolysis of acute superior mesenteric venous thrombosis. J Vasc Interv Radiol 16:1685–1691
  9. Hollingshead M, Burke CT, Mauro MA, et al. (2005) Transcatheter thrombolytic for acute mesenteric and portal vein thrombosis. J Vasc Interv Radiol 16:651–661
  10. Sze DY, O’Sullivan GJ, Johnson DL, Dake MD (2000) Mesenteric and portal venous thrombosis treated by transjugular mechanical thrombolysis. Am J Roentgenol 175:732–734
  11. Bilbao JI, Elorz M, Vivas I, et al. (2004) Transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of venous symptomatic chronic portal thrombosis in non-cirrhotic patients. Cardiovasc Intervent Radiol 27:474–480
  12. Ferro C, Rossi UG, Bovio G, Dahamane M, Centanaro M (2007) Transjugular intrahepatic portosystemic shunt, mechanical aspiration thrombectomy, and direct thrombolysis in the treatment of acute portal and superior mesenteric vein thrombosis. Cardiovasc Intervent Radiol 30:1070–1074
  13. Nakayama S, Murashima N, Isobe Y (2008) Superior mesenteric venous thrombosis treated by direct aspiration thrombectomy. Hepatogastroenterology 55:367–370
  14. Rosen MP, Sheiman R (2000) Transhepatic mechannical thrombectomy followed by infusion of TPA into the superior mesenteric artery to treat acute mesenteric vein thrombosis. J Vasc Interv Radiol 11:195–198
  15. Hechelhammer L, Crook DW, Widmer U, Wildermuth S, Pfammatter T (2004) Thrombosis of a superior mesenteric vein aneurysm: transarterial thrombolysis and transhepatic aspiration thrombectomy. Cardiovasc Intervent Radiol 27:551–555
  16. Safieddine N, Mamazza J, Common A, Prabhudesai V (2007) Splenic and superior mesenteric artery thrombolytic infusion therapy for acute portal and mesenteric vein thrombosis. Can J Surg 50:68–69
  17. Ozkan U, Oguzkurt L, Tercan F, Tokmak N (2006) Percutaneous transhepatic thrombolysis in the treatment of acute portal venous thrombosis. Diagn Interv Radiol 12:105–107
  18. Bradbury MS, Kavanagh PV, Bechtold RE, et al. (2002) Mesenteric venous thrombosis: diagnosis and noninvasive imaging. Radiographics 22:527–541
  19. Goldberg MF, Kim HS (2003) Treatment of acute superior mesenteric vein thrombosis with percutaneous techniques. Am J Roentgenol 181:1305–1307
  20. Lopera JE, Correa G, Brazzini A, et al. (2002) Percutaneous transhepatic treatment of symptomatic mesenteric venous thrombosis. J Vasc Surg 36:1058–1061
  21. Zhou W, Choi L, Lin PH, et al. (2007) Percutaneous transhepatic thrombectomy and pharmacologic thrombolysis of mesenteric venous thrombosis. Vascular 15:41–45
  22. McManimon S, Ryu RK, Durham JD (1998) Mesenteric venous thrombosis. Tech Vasc Interv Radiol 1:209–215
  23. Brountzos EN, Alexopoulou E, Koskinas I, et al. (2000) Intraperitoneal portal vein bleeding during transjugular intrahepatic portosystemic shunt: treatment with stent-graft placement. Am J Roentgenol 174:132–134
  24. Owen AR, Stanley AJ, Vijayananthan A, Moss JG (2009) The transjugular intrahepatic portosystemic shunt (TIPS). Clin Radiol 64:664–674
  25. Ouriel K, Gray B, Clair DG, Olin J (2000) Complications associated with the use of urokinase and recombinant tissue plasminogen activator for catheter-directed peripheral arterial and venous thrombolysis. J Vasc Interv Radiol 11:295–298
  26. Sch?fer C, Zundler J, Bode JC (2000) Thrombolytic therapy in patients with portal vein thrombosis: case report and review of the literature. Eur J Gastroenterol Hepatol 12:1141–1145
• 作者单位：http://www.springerlink.com/content/g868157066217617/
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Imaging and Radiology
  Gastroenterology
  Hepatology
  
• 出版者：Springer New York
• ISSN：1432-0509

文摘

Objective: To assess the feasibility and effectiveness of transjugular intrahepatic route aspiration thrombectomy and catheter-directed thrombolytic therapy in patients with acute superior mesenteric venous thrombosis. Materials and methods: During a period of 8 years, 12 patients with acute thrombosis of the superior mesenteric vein (SMV) were treated by transjugular intrahepatic approach. The mean age was 41.2 years. After access to the portal system via the transjugular approach, the pigtail catheter fragmentation of the thrombus, local urokinase injection, and manual aspiration thrombectomy were used for treatment of the SMV thrombosis initially, followed by continuous thrombolytic therapy via an indwelling infusion catheter in the SMV, which was performed for 2 to 6 days (4.2 ± 1.8 days). The adequacy of anticoagulation was performed during treatment, throughout hospitalization, and after discharge. Results: Technical success was achieved in all 12 patients. Substantial clinical improvement was seen in these patients after the procedure. Minor complications at the jugular puncture site were observed in 4 patients, but the thrombolytic therapy was not interrupted. Contrast-enhanced computed tomography (CT) scan before discharge demonstrated nearly complete disappearance of SMV thrombosis in all patients. The 12 patients were discharged 5–10 days (7.6 ± 2.0) after admission. Mean duration of follow-up after hospital discharge was 37.7 months, and no recurrent episodes of SMV thrombosis developed during that time period. Conclusion: Catheter-directed thrombus aspiration, mechanical fragmentation, and local thrombolytic infusion via the transjugular intrahepatic route is a safe and effective therapy for the management of patients with acute symptomatic SMV thrombosis.