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
Non-cirrhotic portal vein thrombosis (PVT) has a low incidence, with a prevalence of approximately 1%, and partial obstruction of the portal vein is often clinically imperceptible. However, complete obstruction due to acute thrombus can lead to a series of clinical symptoms, such as abdominal pain, ascites, and even intestinal necrosis. Common treatment opinions including anticoagulation or indirect thrombolysis are useful for relieving symptoms, but the outcome is unsatisfactory as most patients develop into cavernous transformation of the portal vein due to incomplete recanalization.
Catheter-directed thrombolysis (CDT) via the transjugular intrahepatic portosystemic (commonly known as TIP) or percutaneous transhepatic (PT) route is a minimally invasive method, which can dissolve the thrombus and relieve symptoms rapidly with a lower dose of thrombolytics. In addition, agitation thrombolysis (AT) can break the thrombus into smaller fragments and accelerate the speed of thrombolysis.
The objective of this study was to evaluate the safety and efficacy of AT combined with CDT for the treatment of non-cirrhotic acute PVT.
Nine patients with non-cirrhotic acute PVT who underwent AT combined with CDT via TIP or percutaneous transhepatic route were analyzed retrospectively. AT had not been reported for the treatment of PVT so far. The changes in clinical symptoms, hemodynamics of the portal vein and liver function were recorded and followed up to evaluate the safety and efficacy.
According to our research, AT combined with CDT is a safe and effective method for the treatment of non-cirrhotic acute PVT, with a good short- to middle-term efficacy. However, the long-term efficacy of AT combined with CDT in a large population requires further investigation.
Agitation is a common phenomenon in daily life, and can accelerate the rate of solute dissolution in a solvent. AT was first reported for the treatment of acute inferior vein thrombus in Budd-Chiari syndrome, which showed good long-term efficacy, but has not yet been reported in the treatment of PVT. 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. Compared with other methods, such as endovascular aspiration or mechanical thrombectomy, AT is simpler and safer, with less blood loss.
The shape of the catheter tip is important. In this study, the pigtail catheter was chosen as an agitator, as it did not injure the vessel wall and resulted in greater fragmentation of the thrombus during rotation. In addition, a guidewire with a helical tip can enhance the fracture resistance of the pigtail catheter, and increase the range of agitation. The future research we will focus on involves the long-term efficacy of AT combined with CDT in a large population.