Acute Portomesenteric Venous Thrombosis: Diagnosis and Treatment

Guy E. Johnson; Stephen K. Allison; David S. Shin

doi:10.1055/s-0038-1668096

Digestive Disease Interventions, Table of Contents

Digestive Disease Interventions 2018; 02(03): 249-255
DOI: 10.1055/s-0038-1668096

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Acute Portomesenteric Venous Thrombosis: Diagnosis and Treatment

Guy E. Johnson

¹Department of Radiology, Section of Interventional Radiology, University of Washington, Seattle, Washington

,

Stephen K. Allison

¹Department of Radiology, Section of Interventional Radiology, University of Washington, Seattle, Washington

,

David S. Shin

¹Department of Radiology, Section of Interventional Radiology, University of Washington, Seattle, Washington

› Author Affiliations

Abstract

Acute portomesenteric venous thrombosis (PMVT) is an unusual cause of acute mesenteric ischemia. Because of its rarity and nonspecific presentation, radiologic imaging plays a key role in the diagnosis of acute PMVT. Medical management with anticoagulation is the mainstay of therapy, with surgery reserved for patients suspected of having peritonitis or bowel infarction. However, endovascular therapy has an evolving role and may serve as an important adjunct to anticoagulation in selected patients with acute PMVT.

Keywords

portal vein thrombosis - mesenteric vein thrombosis - portomesenteric thrombosis - splanchnic vein thrombosis - mesenteric ischemia - portal vein - superior mesenteric vein - venous thrombolysis

Full Text

References

References
1 Acosta S, Alhadad A, Svensson P, Ekberg O. Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg 2008; 95 (10) 1245-1251
2 Acosta S, Ogren M, Sternby NH, Bergqvist D, Björck M. Mesenteric venous thrombosis with transmural intestinal infarction: a population-based study. J Vasc Surg 2005; 41 (01) 59-63
3 Rhee RY, Gloviczki P. Mesenteric venous thrombosis. Surg Clin North Am 1997; 77 (02) 327-338
4 Salim S, Ekberg O, Elf J, Zarrouk M, Gottsäter A, Acosta S. Clinical implications of CT findings in mesenteric venous thrombosis at admission. Emerg Radiol 2018; 25 (04) 407-413
5 Schoots IG, Koffeman GI, Legemate DA, Levi M, van Gulik TM. Systematic review of survival after acute mesenteric ischaemia according to disease aetiology. Br J Surg 2004; 91 (01) 17-27
6 Malkowski P, Pawlak J, Michalowicz B. , et al. Thrombolytic treatment of portal thrombosis. Hepatogastroenterology 2003; 50 (54) 2098-2100
7 Chawla YK, Bodh V. Portal vein thrombosis. J Clin Exp Hepatol 2015; 5 (01) 22-40
8 Amitrano L, Guardascione MA, Scaglione M. , et al. Prognostic factors in noncirrhotic patients with splanchnic vein thromboses. Am J Gastroenterol 2007; 102 (11) 2464-2470
9 Harnik IG, Brandt LJ. Mesenteric venous thrombosis. Vasc Med 2010; 15 (05) 407-418
10 Kumar S, Sarr MG, Kamath PS. Mesenteric venous thrombosis. N Engl J Med 2001; 345 (23) 1683-1688
11 Zarrouk M, Salim S, Elf J, Gottsäter A, Acosta S. Testing for thrombophilia in mesenteric venous thrombosis - Retrospective original study and systematic review. Best Pract Res Clin Gastroenterol 2017; 31 (01) 39-48
12 Clavien PA, Dürig M, Harder F. Venous mesenteric infarction: a particular entity. Br J Surg 1988; 75 (03) 252-255
13 Rhee RY, Gloviczki P, Mendonca CT. , et al. Mesenteric venous thrombosis: still a lethal disease in the 1990s. J Vasc Surg 1994; 20 (05) 688-697
14 Martinez JP, Hogan GJ. Mesenteric ischemia. Emerg Med Clin North Am 2004; 22 (04) 909-928
15 Leone M, Bechis C, Baumstarck K. , et al. Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases. Intensive Care Med 2015; 41 (04) 667-676
16 Acosta S, Block T, Björnsson S, Resch T, Björck M, Nilsson T. Diagnostic pitfalls at admission in patients with acute superior mesenteric artery occlusion. J Emerg Med 2012; 42 (06) 635-641
17 Brunaud L, Antunes L, Collinet-Adler S. , et al. Acute mesenteric venous thrombosis: case for nonoperative management. J Vasc Surg 2001; 34 (04) 673-679
18 Kanasaki S, Furukawa A, Fumoto K. , et al. Acute Mesenteric Ischemia: Multidetector CT Findings and Endovascular Management. Radiographics 2018; 38 (03) 945-961
19 Kim HK, Hwang D, Park S, Lee JM, Huh S. Treatment outcomes and risk factors for bowel infarction in patients with acute superior mesenteric venous thrombosis. J Vasc Surg Venous Lymphat Disord 2017; 5 (05) 638-646
20 European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu. Electronic address eee. EASL Clinical Practice Guidelines: vascular diseases of the liver. J Hepatol 2016; 64 (01) 179-202
21 DeLeve LD, Valla DC, Garcia-Tsao G. ; American Association for the Study Liver Diseases. Vascular disorders of the liver. Hepatology 2009; 49 (05) 1729-1764
22 Turnes J, García-Pagán JC, González M. , et al. Portal hypertension-related complications after acute portal vein thrombosis: impact of early anticoagulation. Clin Gastroenterol Hepatol 2008; 6 (12) 1412-1417
23 Condat B, Pessione F, Helene Denninger M, Hillaire S, Valla D. Recent portal or mesenteric venous thrombosis: increased recognition and frequent recanalization on anticoagulant therapy. Hepatology 2000; 32 (03) 466-470
24 Plessier A, Darwish-Murad S, Hernandez-Guerra M. , et al; European Network for Vascular Disorders of the Liver (EN-Vie). Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology 2010; 51 (01) 210-218
25 Maldonado TS, Blumberg SN, Sheth SU. , et al. Mesenteric vein thrombosis can be safely treated with anticoagulation but is associated with significant sequelae of portal hypertension. J Vasc Surg Venous Lymphat Disord 2016; 4 (04) 400-406
26 Di Minno MN, Milone F, Milone M. , et al. Endovascular thrombolysis in acute mesenteric vein thrombosis: a 3-year follow-up with the rate of short and long-term sequaelae in 32 patients. Thromb Res 2010; 126 (04) 295-298
27 Hollingshead M, Burke CT, Mauro MA, Weeks SM, Dixon RG, Jaques PF. Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis. J Vasc Interv Radiol 2005; 16 (05) 651-661
28 Kim HS, Patra A, Khan J, Arepally A, Streiff MB. Transhepatic catheter-directed thrombectomy and thrombolysis of acute superior mesenteric venous thrombosis. J Vasc Interv Radiol 2005; 16 (12) 1685-1691
29 Wang MQ, Liu FY, Duan F, Wang ZJ, Song P, Fan QS. Acute symptomatic mesenteric venous thrombosis: treatment by catheter-directed thrombolysis with transjugular intrahepatic route. Abdom Imaging 2011; 36 (04) 390-398
30 Wang M-Q, Lin H-Y, Guo L-P, Liu F-Y, Duan F, Wang Z-J. Acute extensive portal and mesenteric venous thrombosis after splenectomy: treated by interventional thrombolysis with transjugular approach. World J Gastroenterol 2009; 15 (24) 3038-3045
31 Yang S, Liu B, Ding W, He C, Wu X, Li J. Acute superior mesenteric venous thrombosis: transcatheter thrombolysis and aspiration thrombectomy therapy by combined route of superior mesenteric vein and artery in eight patients. Cardiovasc Intervent Radiol 2015; 38 (01) 88-99
32 Liu F-Y, Wang M-Q, Fan Q-S, Duan F, Wang Z-J, Song P. Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis. World J Gastroenterol 2009; 15 (40) 5028-5034
33 Klinger C, Riecken B, Schmidt A. , et al. Transjugular local thrombolysis with/without TIPS in patients with acute non-cirrhotic, non-malignant portal vein thrombosis. Dig Liver Dis 2017; 49 (12) 1345-1352
34 Kercher KW, Sing RF, Watson KW, Matthews BD, LeQuire MH, Heniford BT. Transhepatic thrombolysis in acute portal vein thrombosis after laparoscopic splenectomy. Surg Laparosc Endosc Percutan Tech 2002; 12 (02) 131-136
35 Ozkan U, Oğuzkurt L, Tercan F, Tokmak N. Percutaneous transhepatic thrombolysis in the treatment of acute portal venous thrombosis. Diagn Interv Radiol 2006; 12 (02) 105-107
36 Rosenqvist K, Ebeling Barbier C, Rorsman F, Sangfelt P, Nyman R. Treatment of acute portomesenteric venous thrombosis with thrombectomy through a transjugular intrahepatic portosystemic shunt: a single-center experience. Acta Radiol 2018; 59 (08) 953-958
37 Farsad K, Fuss C, Kolbeck KJ. , et al. Transjugular intrahepatic portosystemic shunt creation using intravascular ultrasound guidance. J Vasc Interv Radiol 2012; 23 (12) 1594-1602
38 Hechelhammer L, Crook DW, Widmer U, Wildermuth S, Pfammatter T. Thrombosis of a superior mesenteric vein aneurysm: transarterial thrombolysis and transhepatic aspiration thrombectomy. Cardiovasc Intervent Radiol 2004; 27 (05) 551-555