Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jun 28, 2009; 15(24): 3038-3045
Published online Jun 28, 2009. doi: 10.3748/wjg.15.3038
Acute extensive portal and mesenteric venous thrombosis after splenectomy: Treated by interventional thrombolysis with transjugular approach
Mao-Qiang Wang, Han-Ying Lin, Li-Ping Guo, Feng-Yong Liu, Feng Duan, Zhi-Jun Wang
Mao-Qiang Wang, Han-Ying Lin, Li-Ping Guo, Feng-Yong Liu, Feng Duan, Zhi-Jun Wang, Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Wang MQ designed the study; Wang MQ and Duan F wrote the manuscript; Wang MQ, Lin HY, Liu FY, Wang ZJ and Duan F treated the patients; Wang MQ, Liu FY, and Guo LP were responsible for analysis and interpretation of the data; Wang MQ, Liu FY, and Lin HY were responsible for the literature search; all of the authors read and approved the final version.
Correspondence to: Dr. Mao-Qiang Wang, Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, China. wangmq@vip.sina.com
Telephone: +86-10-66936746
Fax: +86-10-66936327
Received: April 1, 2009
Revised: May 19, 2009
Accepted: May 26, 2009
Published online: June 28, 2009
Abstract

AIM: To present a series of cases with symptomatic acute extensive portal vein (PV) and superior mesenteric vein (SMV) thrombosis after splenectomy treated by transjugular intrahepatic approach catheter-directed thrombolysis.

METHODS: A total of 6 patients with acute extensive PV-SMV thrombosis after splenectomy were treated by transjugular approach catheter-directed thrombolysis. The mean age of the patients was 41.2 years. After access to the portal system via the transjugular approach, pigtail catheter fragmentation of clots, local urokinase injection, and manual aspiration thrombectomy were used for the initial treatment of PV-SMV thrombosis, followed by continuous thrombolytic therapy via an indwelling infusion catheter in the SMV, which was performed for three to six days. Adequate anticoagulation was given during treatment, throughout hospitalization, and after discharge.

RESULTS: Technical success was achieved in all 6 patients. Clinical improvement was seen in these patients within 12-24 h of the procedure. No complications were observed. The 6 patients were discharged 6-14 d (8 ± 2.5 d) after admission. The mean duration of follow-up after hospital discharge was 40 ± 16.5 mo. Ultrasound and contrast-enhanced computed tomography confirmed patency of the PV and SMV, and no recurrent episodes of PV-SMV thrombosis developed during the follow-up period.

CONCLUSION: Catheter-directed thrombolysis via transjugular intrahepatic access is a safe and effective therapy for the management of patients with symptomatic acute extensive PV-SMV thrombosis.

Keywords: Mechanical thrombectomy; Portal vein; Splenectomy; Superior mesenteric vein; Thrombolysis; Thrombosis