Published online Oct 21, 2018. doi: 10.3748/wjg.v24.i39.4482
Peer-review started: July 23, 2018
First decision: August 30, 2018
Revised: September 13, 2018
Accepted: October 5, 2018
Article in press: October 5, 2018
Published online: October 21, 2018
To evaluate the safety and efficacy of agitation thrombolysis (AT) combined with catheter-directed thrombolysis (CDT) for the treatment of non-cirrhotic acute portal vein thrombosis (PVT).
Nine patients with non-cirrhotic acute PVT who underwent AT combined with CDT were analyzed retrospectively. Portography was carried out via the transjugular intrahepatic portosystemic (commonly known as TIP) or percutaneous transhepatic (commonly known as PT) route, followed by AT combined with CDT. Complications of the procedure, and the changes in clinical symptoms, hemodynamics of the portal vein and liver function were recorded. Follow-up was scheduled at 1, 3 and 6 mo after treatment, and every 6 mo thereafter, or when the patients developed clinical symptoms related to PVT. Color Doppler ultrasound and contrast-enhanced computed tomography/magnetic resonance imaging were performed during the follow-up period to determine the condition of the portal vein.
AT combined with CDT was successfully performed. The portal vein was reached via the TIP route in 6 patients, and via the PT route in 3 patients. All clinical symptoms were relieved or disappeared, with the exception of 1 patient who died of intestinal necrosis 9 d after treatment. Significant differences in the changes in portal vein hemodynamics were observed, including the maximum lumen occupancy of PVT, portal vein pressure and flow velocity between pre- and post-treatment (P < 0.05). During the follow-up period, recurrence was observed in 1 patient at 19 mo after the procedure, and the portal vein was patent in the remaining patients.
AT combined with CDT is a safe and effective method for the treatment of non-cirrhotic acute PVT.
Core tip: Agitation is a common phenomenon in daily life, and can accelerate the rate of solute dissolution in a solvent. As the thrombus is porous in the acute stage, it can easily be broken into smaller fragments by agitation, which increases the contact area between the thrombus and thrombolytics, and increases the speed of thrombus dissolution. According to our research, agitation thrombolysis combined with catheter-directed thrombolysis is a safe and effective method for the treatment of non-cirrhotic acute portal vein thrombosis, with a good short- to middle-term efficacy. However, the long-term efficacy of agitation thrombolysis combined with catheter-directed thrombolysis in a large population requires further investigation.