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Abstract

Purpose:

To present the management of symptomatic acute mesenteric venous thrombosis using a percutaneous thrombectomy device followed by resection of necrotic intestine.

Case Report:

A 60-year-old woman developed acute abdomen and melena. Diffuse and extensive mesenteric and portal vein thromboses were diagnosed by computed tomography. Percutaneous transhepatic mechanical thrombectomy with an Oasis thrombectomy device removed ~80% of the thrombus in the portal and superior mesenteric veins. The patient underwent laparotomy immediately after thrombectomy, in which 100 cm of necrotic intestine was resected. Catheter-directed urokinase thrombolysis was performed for 3 days to address residual thrombi. The result was excellent, and the patient recovered without short bowel syndrome.

Conclusions:

The hydrodynamic thrombectomy system is a quick, reliable, efficient device that may offer an alternative to thrombolysis and surgical thrombectomy. Combining mechanical thrombectomy devices and surgery can be used to treat symptomatic acute mesenteric venous thrombosis.

Keywords

venous thrombosis mesenteric vein portal vein hydrodynamic thrombectomy percutaneous thrombectomy

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References

Kumar

Sarr

Kamath

. Mesenteric venous thrombosis. N Engl J Med. 2001; 345: 1683–1688.

Grendell

Ockner

. Mesenteric venous thrombosis. Gastroenterology. 1982; 82: 358–372.

Rhee

Gloviczki

Mendonca

. Mesenteric venous thrombosis: Still a lethal disease in the 1990s. J Vasc Surg. 1994; 20: 688–697.

Abdu

Zakhour

Dallis

. Mesenteric venous thrombosis—1911 to 1984. Surgery. 1987; 101: 383–388.

Yankes

Uglietta

Grant

. Percutaneous transhepatic recanalization and thrombolysis of the superior. AJR Am J Roentgenol. 1988; 151: 289–290.

Lopera

Correa

Brazzini

. Percutaneous transhepatic treatment of symptomatic mesenteric venous thrombosis. J Vasc Surg. 2002; 36: 1058–1061.

Rivitz

Geller

Hahn

. Treatment of acute mesenteric venous thrombosis with transjugular intramesenteric urokinase infusion. J Vasc Interv Radiol. 1995; 6: 219–223.

Poplausky

Kaufman

Geller

. Mesenteric venous thrombosis treated with urokinase via the superior mesenteric artery. Gastroenterology. 1996; 110: 1633–1635.

Ludwig

Hauptmann

Rosoff

. Mesenteric and portal vein thrombosis in a young patient with protein S deficiency treated with urokinase via the superior mesenteric artery. J Vasc Surg. 1999; 30: 551–554.

10.

Rosen

Sheiman

. Transhepatic mechanical thrombectomy followed by infusion of TPA into the superior mesenteric artery to treat acute mesenteric vein thrombosis. J Vasc Interv Radiol. 2000; 11: 195–198.

11.

Uflacker

. Applications of percutaneous mechanical thrombectomy in transjugular intrahepatic portosystemic shunt and portal vein thrombosis. Tech Vasc Interv Radiol. 2003; 6: 59–69.

12.

Morasch

Ebaugh

Chiou

. Mesenteric venous thrombosis: A changing clinical entity. J Vasc Surg. 2001; 34: 680–684.

13.

Brunaud

Antunes

Collinet-Adler

. Acute mesenteric venous thrombosis: Case for nonoperative management. J Vasc Surg. 2001; 34: 673–679.

14.

Klempnauer

Grothues

Bektas

. Results of portal thrombectomy and splanchnic thrombolysis for the surgical management of acute mesentericoportal thrombosis. Br J Surg. 1997; 84: 129–132.

15.

Ryu

Lin

Kumpe

. Percutaneous mesenteric venous thrombectomy and thrombolysis: Successful treatment followed by liver transplantation. Liver Transpl Surg. 1998; 4: 222–225.

Percutaneous Transhepatic Mechanical Thrombectomy for Acute Mesenteric Venous Thrombosis