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Treatment of acute portomesenteric venous thrombosis with thrombectomy through a transjugular intrahepatic portosystemic shunt: a single-center experience.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Gastroenterology/Hepatology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Gastroenterology/Hepatology.
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2018 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 59, no 8, p. 953-958Article in journal (Refereed) Published
Abstract [en]

Background: Acute portomesenteric venous thrombosis (PMVT) is a potentially life-threatening condition and urgent treatment is required.

Purpose: To retrospectively evaluate the efficacy and safety of treating acute PMVT by the creation of a transjugular intrahepatic portosystemic shunt (TIPS) followed by thrombectomy.

Material and Methods: Six patients (all men, age range = 39-51 years) presenting with acute PMVT were treated with transjugular thrombectomy (TT) through a TIPS created in the same session. The intervention included iterated venography through the TIPS one to three times within the first week after diagnosis and repeated thrombectomy if needed (n = 5).

Results: Recanalization was successful with persistent blood flow through the main superior mesenteric vein, portal vein, and TIPS in all six patients. Five patients were treated primarily with thrombectomy through a TIPS with clinical improvement. The final patient was initially treated with surgical thrombectomy and bowel resection. TIPS and TT was performed two days after surgery due to re-thrombosis but the patient deteriorated and died of multi-organ failure. Procedure-related complications were transient hematuria (n = 3) and transient encephalopathy (n = 2). In-hospital time was <14 days in four of the five patients with primary TIPS and TT. No sign of re-thrombosis was noted during follow-up (mean = 18 months, range = 8-28 months).

Conclusion: Thrombectomy through a TIPS is feasible and can be effective in recanalization and symptom-relief in acute PMVT.

Place, publisher, year, edition, pages
2018. Vol. 59, no 8, p. 953-958
Keywords [en]
Portal vein, mesenteric vein, thrombectomy, thrombosis, transjugular, transjugular intrahepatic portosystemic shunt (TIPS)
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:uu:diva-335506DOI: 10.1177/0284185117742683ISI: 000436017600009PubMedID: 29202584OAI: oai:DiVA.org:uu-335506DiVA, id: diva2:1163256
Available from: 2017-12-06 Created: 2017-12-06 Last updated: 2018-08-29Bibliographically approved

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Rosenqvist, KerstinEbeling Barbier, CharlotteRorsman, FredrikSangfelt, PerNyman, Rickard

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RadiologyCentre for Clinical Research, County of VästmanlandGastroenterology/Hepatology
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