Original Article
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Oct 28, 2009; 15(40): 5028-5034
Published online Oct 28, 2009. doi: 10.3748/wjg.15.5028
Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis
Feng-Yong Liu, Mao-Qiang Wang, Qing-Sheng Fan, Feng Duan, Zhi-Jun Wang, Peng Song
Feng-Yong Liu, Mao-Qiang Wang, Qing-Sheng Fan, Feng Duan, Zhi-Jun Wang, Peng Song, Department of Interventional Radiology, Clinical Division of Internal Medicine, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
Author contributions: Liu FY and Wang MQ designed the research; Liu FY, Wang MQ and Duan F wrote the manuscript; Liu FY, Wang MQ, Duan F and Fan QS performed the research; Liu FY, Wang ZJ and Fan QS analyzed data; Liu FY, and Song P were responsible for the literature search; all of the authors read and approved the final version.
Supported by The National Natural Science Foundation, Project No. 30670606; Chinese army “Eleventh Five-Year Plan” Research Fund, Project No. 06MA263
Correspondence to: Dr. Mao-Qiang Wang, Department of Interventional Radiology, Clinical Division of Internal Medicine, Chinese People’s Liberation Army General Hospital, Beijing 100853, China. wangmq@vip.sina.com
Telephone: +86-10-66936746 Fax: +86-10-66936327
Received: May 5, 2009
Revised: August 13, 2009
Accepted: August 20, 2009
Published online: October 28, 2009
Abstract

AIM: To summarize our methods and experience with interventional treatment for symptomatic acute-subacute portal vein and superior mesenteric vein thrombosis (PV-SMV) thrombosis.

METHODS: Forty-six patients (30 males, 16 females, aged 17-68 years) with symptomatic acute-subacute portal and superior mesenteric vein thrombosis were accurately diagnosed with Doppler ultrasound scans, computed tomography and magnetic resonance imaging. They were treated with interventional therapy, including direct thrombolysis (26 cases through a transjugular intrahepatic portosystemic shunt; 6 through percutaneous transhepatic portal vein cannulation) and indirect thrombolysis (10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization).

RESULTS: The blood reperfusion of PV-SMV was achieved completely or partially in 34 patients 3-13 d after thrombolysis. In 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased significantly. Symptoms in these 45 patients were improved dramatically without severe operational complications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment. In 3 patients with interventional treatment, thrombi re-formed 1, 3 and 4 mo after treatment. In these 3 patients, indirect PV-SMV thrombolysis was performed again and was successful.

CONCLUSION: Interventional treatment, including direct or indirect PV-SMV thrombolysis, is a safe and effective method for patients with symptomatic acute-subacute PV-SMV thrombosis.

Keywords: Portal thrombosis; Superior mesenteric vein thrombosis; Thrombolysis; Interventional treatment