Efficacy of endovascular treatment for completely occlusive acute–subacute portal and mesenteric vein thrombosis with severe complications in patients without cirrhosis
Purpose Completely occlusive acute–subacute portal and mesenteric vein thrombosis (PVMVT) with severe complications is fatal. Endovascular treatments (EVTs) of acute–subacute PVMVT are not standardized. Thrombectomy combined with continuous catheter-directed thrombolysis is considered an effective t...
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| Veröffentlicht in: | Japanese journal of radiology 2023-05, Vol.41 (5), p.541-550 |
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| creator | Saito, Hidemasa Sugihara, Fumie Ueda, Tatsuo Hayashi, Hiromitsu Shirai, Sayaka Matsumoto, Taiga Fujitsuna, Ryutaro Kumita, Shin-ichiro |
| description | Purpose
Completely occlusive acute–subacute portal and mesenteric vein thrombosis (PVMVT) with severe complications is fatal. Endovascular treatments (EVTs) of acute–subacute PVMVT are not standardized. Thrombectomy combined with continuous catheter-directed thrombolysis is considered an effective treatment. Here, we aimed to evaluate the outcome of EVTs of completely occlusive acute–subacute PVMVT with severe complications in patients without cirrhosis.
Materials and methods
Nineteen patients (nine men and 10 women; age, 60.1 ± 16.8 years) with completely occlusive acute–subacute PVMVT were retrospectively assessed. Acute–subacute PVMVT was defined as symptom onset within 40 days, with no cavernous transformation observed on contrast-enhanced computed tomography. The patients were treated with EVTs, a combination of thrombectomy (including aspiration thrombectomy, plain old balloon angioplasty, single injection of thrombolytic agents, and stent placement) and continuous catheter-directed thrombolysis. Kaplan–Meier analyses were performed to assess all-cause mortality, acute–subacute PVMVT-related mortality, and portal vein (PV) patency. The degree of recanalization and patency of PV, complications, factors related to acute–subacute PVMVT-related mortality, and factors related to patency of PV were also evaluated.
Results
The all-cause and acute–subacute PVMVT-related mortality rates were 36.8% (7/19) and 31.6% (6/19), respectively. Seven (36.8%) and 11 (57.9%) patients achieved complete and partial recanalization, respectively. Among the 18 patients who achieved recanalization, follow-up images after 608.7 ± 889.5 days confirmed recanalization in 83.3% (15/18) patients, and 53.3% (8/15) of these patients achieved patency of PV. Seven patients (36.8%) developed complications, and two (10.5%) required interventional treatment for complications. Deterioration of liver function significantly worsened the prognosis (
P
= 0.046), while anticoagulation therapy significantly maintained portal patency (
P
= 0.03).
Conclusion
This endovascular method for acute–subacute PVMVT, which combines thrombectomy and continuous catheter-directed thrombolysis EVT approach was effective for thrombus resolution. However, further studies must define conditions that improve patient prognosis. |
| doi_str_mv | 10.1007/s11604-022-01377-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10147747</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2890338481</sourcerecordid><originalsourceid>FETCH-LOGICAL-c499t-9d89aee7d82a6e186645e31ac51b478385b3c720c81ee3e20d726213f6037f03</originalsourceid><addsrcrecordid>eNp9kstu1TAQhi0EoqXwAiyQJTZsAr4d21khVJWLVIlNF-wsx5n0uEri4EtQd7wDb8Fj8SS4TTlcFqw80nz_7xn7R-gpJS8pIepVolQS0RDGGkK5Uk17Dx1TLVVDif50_1AreoQepXRFiBRciIfoiEupiSL8GH0_GwbvrLvGYcAw92G1yZXRRpwj2DzBnPEQInZhWkbIMFbQubEkvwK2rmT48fVbKt1tiZcQsx2xnXs8QapaiN7hFfyM8z6GqQvJJ_zF5z1OsEKEzbcOkH2YE67cUssq3KhQMnY-xv2N7jF6MNgxwZO78wRdvD27OH3fnH989-H0zXnjRNvmpu11awFUr5mVUJ9Aih1wat2OdkJprncdd4oRpykAB0Z6xSSjfJCEq4HwE_R6s11KN0Hv6jDRjmaJfrLx2gTrzd-d2e_NZVgNJVQoJVR1eHHnEMPnAimbyScH42hnCCUZpqRmnDPJK_r8H_QqlDjX9QzTLeFcC00rxTbKxZBShOEwDSXmJgpmi4KpUTC3UTBtFT37c4-D5NffV4BvQKqt-RLi77v_Y_sT9XvF_A</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2890338481</pqid></control><display><type>article</type><title>Efficacy of endovascular treatment for completely occlusive acute–subacute portal and mesenteric vein thrombosis with severe complications in patients without cirrhosis</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Saito, Hidemasa ; Sugihara, Fumie ; Ueda, Tatsuo ; Hayashi, Hiromitsu ; Shirai, Sayaka ; Matsumoto, Taiga ; Fujitsuna, Ryutaro ; Kumita, Shin-ichiro</creator><creatorcontrib>Saito, Hidemasa ; Sugihara, Fumie ; Ueda, Tatsuo ; Hayashi, Hiromitsu ; Shirai, Sayaka ; Matsumoto, Taiga ; Fujitsuna, Ryutaro ; Kumita, Shin-ichiro</creatorcontrib><description>Purpose
Completely occlusive acute–subacute portal and mesenteric vein thrombosis (PVMVT) with severe complications is fatal. Endovascular treatments (EVTs) of acute–subacute PVMVT are not standardized. Thrombectomy combined with continuous catheter-directed thrombolysis is considered an effective treatment. Here, we aimed to evaluate the outcome of EVTs of completely occlusive acute–subacute PVMVT with severe complications in patients without cirrhosis.
Materials and methods
Nineteen patients (nine men and 10 women; age, 60.1 ± 16.8 years) with completely occlusive acute–subacute PVMVT were retrospectively assessed. Acute–subacute PVMVT was defined as symptom onset within 40 days, with no cavernous transformation observed on contrast-enhanced computed tomography. The patients were treated with EVTs, a combination of thrombectomy (including aspiration thrombectomy, plain old balloon angioplasty, single injection of thrombolytic agents, and stent placement) and continuous catheter-directed thrombolysis. Kaplan–Meier analyses were performed to assess all-cause mortality, acute–subacute PVMVT-related mortality, and portal vein (PV) patency. The degree of recanalization and patency of PV, complications, factors related to acute–subacute PVMVT-related mortality, and factors related to patency of PV were also evaluated.
Results
The all-cause and acute–subacute PVMVT-related mortality rates were 36.8% (7/19) and 31.6% (6/19), respectively. Seven (36.8%) and 11 (57.9%) patients achieved complete and partial recanalization, respectively. Among the 18 patients who achieved recanalization, follow-up images after 608.7 ± 889.5 days confirmed recanalization in 83.3% (15/18) patients, and 53.3% (8/15) of these patients achieved patency of PV. Seven patients (36.8%) developed complications, and two (10.5%) required interventional treatment for complications. Deterioration of liver function significantly worsened the prognosis (
P
= 0.046), while anticoagulation therapy significantly maintained portal patency (
P
= 0.03).
Conclusion
This endovascular method for acute–subacute PVMVT, which combines thrombectomy and continuous catheter-directed thrombolysis EVT approach was effective for thrombus resolution. However, further studies must define conditions that improve patient prognosis.</description><identifier>ISSN: 1867-1071</identifier><identifier>ISSN: 1867-108X</identifier><identifier>EISSN: 1867-108X</identifier><identifier>DOI: 10.1007/s11604-022-01377-9</identifier><identifier>PMID: 36680703</identifier><language>eng</language><publisher>Singapore: Springer Nature Singapore</publisher><subject>Adult ; Aged ; Angioplasty ; Anticoagulants ; Balloon treatment ; Cardiovascular system ; Catheters ; Cirrhosis ; Complications ; Computed tomography ; Female ; Humans ; Imaging ; Implants ; Liver cirrhosis ; Liver Cirrhosis - complications ; Liver Cirrhosis - therapy ; Male ; Medical instruments ; Medicine ; Medicine & Public Health ; Mesenteric Veins - diagnostic imaging ; Middle Aged ; Mortality ; Nuclear Medicine ; Original ; Original Article ; Portal vein ; Portal Vein - diagnostic imaging ; Prognosis ; Radiology ; Radiotherapy ; Retrospective Studies ; Thrombectomy - methods ; Thromboembolism ; Thrombolysis ; Thrombolytic Therapy - adverse effects ; Thrombolytic Therapy - methods ; Thrombosis ; Thrombosis - etiology ; Treatment Outcome ; Veins ; Venous Thrombosis - complications ; Venous Thrombosis - diagnostic imaging ; Venous Thrombosis - therapy</subject><ispartof>Japanese journal of radiology, 2023-05, Vol.41 (5), p.541-550</ispartof><rights>The Author(s) 2023</rights><rights>2023. The Author(s).</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c499t-9d89aee7d82a6e186645e31ac51b478385b3c720c81ee3e20d726213f6037f03</citedby><cites>FETCH-LOGICAL-c499t-9d89aee7d82a6e186645e31ac51b478385b3c720c81ee3e20d726213f6037f03</cites><orcidid>0000-0001-7270-7126</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11604-022-01377-9$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11604-022-01377-9$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36680703$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Saito, Hidemasa</creatorcontrib><creatorcontrib>Sugihara, Fumie</creatorcontrib><creatorcontrib>Ueda, Tatsuo</creatorcontrib><creatorcontrib>Hayashi, Hiromitsu</creatorcontrib><creatorcontrib>Shirai, Sayaka</creatorcontrib><creatorcontrib>Matsumoto, Taiga</creatorcontrib><creatorcontrib>Fujitsuna, Ryutaro</creatorcontrib><creatorcontrib>Kumita, Shin-ichiro</creatorcontrib><title>Efficacy of endovascular treatment for completely occlusive acute–subacute portal and mesenteric vein thrombosis with severe complications in patients without cirrhosis</title><title>Japanese journal of radiology</title><addtitle>Jpn J Radiol</addtitle><addtitle>Jpn J Radiol</addtitle><description>Purpose
Completely occlusive acute–subacute portal and mesenteric vein thrombosis (PVMVT) with severe complications is fatal. Endovascular treatments (EVTs) of acute–subacute PVMVT are not standardized. Thrombectomy combined with continuous catheter-directed thrombolysis is considered an effective treatment. Here, we aimed to evaluate the outcome of EVTs of completely occlusive acute–subacute PVMVT with severe complications in patients without cirrhosis.
Materials and methods
Nineteen patients (nine men and 10 women; age, 60.1 ± 16.8 years) with completely occlusive acute–subacute PVMVT were retrospectively assessed. Acute–subacute PVMVT was defined as symptom onset within 40 days, with no cavernous transformation observed on contrast-enhanced computed tomography. The patients were treated with EVTs, a combination of thrombectomy (including aspiration thrombectomy, plain old balloon angioplasty, single injection of thrombolytic agents, and stent placement) and continuous catheter-directed thrombolysis. Kaplan–Meier analyses were performed to assess all-cause mortality, acute–subacute PVMVT-related mortality, and portal vein (PV) patency. The degree of recanalization and patency of PV, complications, factors related to acute–subacute PVMVT-related mortality, and factors related to patency of PV were also evaluated.
Results
The all-cause and acute–subacute PVMVT-related mortality rates were 36.8% (7/19) and 31.6% (6/19), respectively. Seven (36.8%) and 11 (57.9%) patients achieved complete and partial recanalization, respectively. Among the 18 patients who achieved recanalization, follow-up images after 608.7 ± 889.5 days confirmed recanalization in 83.3% (15/18) patients, and 53.3% (8/15) of these patients achieved patency of PV. Seven patients (36.8%) developed complications, and two (10.5%) required interventional treatment for complications. Deterioration of liver function significantly worsened the prognosis (
P
= 0.046), while anticoagulation therapy significantly maintained portal patency (
P
= 0.03).
Conclusion
This endovascular method for acute–subacute PVMVT, which combines thrombectomy and continuous catheter-directed thrombolysis EVT approach was effective for thrombus resolution. However, further studies must define conditions that improve patient prognosis.</description><subject>Adult</subject><subject>Aged</subject><subject>Angioplasty</subject><subject>Anticoagulants</subject><subject>Balloon treatment</subject><subject>Cardiovascular system</subject><subject>Catheters</subject><subject>Cirrhosis</subject><subject>Complications</subject><subject>Computed tomography</subject><subject>Female</subject><subject>Humans</subject><subject>Imaging</subject><subject>Implants</subject><subject>Liver cirrhosis</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver Cirrhosis - therapy</subject><subject>Male</subject><subject>Medical instruments</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mesenteric Veins - diagnostic imaging</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Nuclear Medicine</subject><subject>Original</subject><subject>Original Article</subject><subject>Portal vein</subject><subject>Portal Vein - diagnostic imaging</subject><subject>Prognosis</subject><subject>Radiology</subject><subject>Radiotherapy</subject><subject>Retrospective Studies</subject><subject>Thrombectomy - methods</subject><subject>Thromboembolism</subject><subject>Thrombolysis</subject><subject>Thrombolytic Therapy - adverse effects</subject><subject>Thrombolytic Therapy - methods</subject><subject>Thrombosis</subject><subject>Thrombosis - etiology</subject><subject>Treatment Outcome</subject><subject>Veins</subject><subject>Venous Thrombosis - complications</subject><subject>Venous Thrombosis - diagnostic imaging</subject><subject>Venous Thrombosis - therapy</subject><issn>1867-1071</issn><issn>1867-108X</issn><issn>1867-108X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kstu1TAQhi0EoqXwAiyQJTZsAr4d21khVJWLVIlNF-wsx5n0uEri4EtQd7wDb8Fj8SS4TTlcFqw80nz_7xn7R-gpJS8pIepVolQS0RDGGkK5Uk17Dx1TLVVDif50_1AreoQepXRFiBRciIfoiEupiSL8GH0_GwbvrLvGYcAw92G1yZXRRpwj2DzBnPEQInZhWkbIMFbQubEkvwK2rmT48fVbKt1tiZcQsx2xnXs8QapaiN7hFfyM8z6GqQvJJ_zF5z1OsEKEzbcOkH2YE67cUssq3KhQMnY-xv2N7jF6MNgxwZO78wRdvD27OH3fnH989-H0zXnjRNvmpu11awFUr5mVUJ9Aih1wat2OdkJprncdd4oRpykAB0Z6xSSjfJCEq4HwE_R6s11KN0Hv6jDRjmaJfrLx2gTrzd-d2e_NZVgNJVQoJVR1eHHnEMPnAimbyScH42hnCCUZpqRmnDPJK_r8H_QqlDjX9QzTLeFcC00rxTbKxZBShOEwDSXmJgpmi4KpUTC3UTBtFT37c4-D5NffV4BvQKqt-RLi77v_Y_sT9XvF_A</recordid><startdate>20230501</startdate><enddate>20230501</enddate><creator>Saito, Hidemasa</creator><creator>Sugihara, Fumie</creator><creator>Ueda, Tatsuo</creator><creator>Hayashi, Hiromitsu</creator><creator>Shirai, Sayaka</creator><creator>Matsumoto, Taiga</creator><creator>Fujitsuna, Ryutaro</creator><creator>Kumita, Shin-ichiro</creator><general>Springer Nature Singapore</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TK</scope><scope>7U7</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-7270-7126</orcidid></search><sort><creationdate>20230501</creationdate><title>Efficacy of endovascular treatment for completely occlusive acute–subacute portal and mesenteric vein thrombosis with severe complications in patients without cirrhosis</title><author>Saito, Hidemasa ; Sugihara, Fumie ; Ueda, Tatsuo ; Hayashi, Hiromitsu ; Shirai, Sayaka ; Matsumoto, Taiga ; Fujitsuna, Ryutaro ; Kumita, Shin-ichiro</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c499t-9d89aee7d82a6e186645e31ac51b478385b3c720c81ee3e20d726213f6037f03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Angioplasty</topic><topic>Anticoagulants</topic><topic>Balloon treatment</topic><topic>Cardiovascular system</topic><topic>Catheters</topic><topic>Cirrhosis</topic><topic>Complications</topic><topic>Computed tomography</topic><topic>Female</topic><topic>Humans</topic><topic>Imaging</topic><topic>Implants</topic><topic>Liver cirrhosis</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver Cirrhosis - therapy</topic><topic>Male</topic><topic>Medical instruments</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mesenteric Veins - diagnostic imaging</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Nuclear Medicine</topic><topic>Original</topic><topic>Original Article</topic><topic>Portal vein</topic><topic>Portal Vein - diagnostic imaging</topic><topic>Prognosis</topic><topic>Radiology</topic><topic>Radiotherapy</topic><topic>Retrospective Studies</topic><topic>Thrombectomy - methods</topic><topic>Thromboembolism</topic><topic>Thrombolysis</topic><topic>Thrombolytic Therapy - adverse effects</topic><topic>Thrombolytic Therapy - methods</topic><topic>Thrombosis</topic><topic>Thrombosis - etiology</topic><topic>Treatment Outcome</topic><topic>Veins</topic><topic>Venous Thrombosis - complications</topic><topic>Venous Thrombosis - diagnostic imaging</topic><topic>Venous Thrombosis - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Saito, Hidemasa</creatorcontrib><creatorcontrib>Sugihara, Fumie</creatorcontrib><creatorcontrib>Ueda, Tatsuo</creatorcontrib><creatorcontrib>Hayashi, Hiromitsu</creatorcontrib><creatorcontrib>Shirai, Sayaka</creatorcontrib><creatorcontrib>Matsumoto, Taiga</creatorcontrib><creatorcontrib>Fujitsuna, Ryutaro</creatorcontrib><creatorcontrib>Kumita, Shin-ichiro</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Japanese journal of radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Saito, Hidemasa</au><au>Sugihara, Fumie</au><au>Ueda, Tatsuo</au><au>Hayashi, Hiromitsu</au><au>Shirai, Sayaka</au><au>Matsumoto, Taiga</au><au>Fujitsuna, Ryutaro</au><au>Kumita, Shin-ichiro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy of endovascular treatment for completely occlusive acute–subacute portal and mesenteric vein thrombosis with severe complications in patients without cirrhosis</atitle><jtitle>Japanese journal of radiology</jtitle><stitle>Jpn J Radiol</stitle><addtitle>Jpn J Radiol</addtitle><date>2023-05-01</date><risdate>2023</risdate><volume>41</volume><issue>5</issue><spage>541</spage><epage>550</epage><pages>541-550</pages><issn>1867-1071</issn><issn>1867-108X</issn><eissn>1867-108X</eissn><abstract>Purpose
Completely occlusive acute–subacute portal and mesenteric vein thrombosis (PVMVT) with severe complications is fatal. Endovascular treatments (EVTs) of acute–subacute PVMVT are not standardized. Thrombectomy combined with continuous catheter-directed thrombolysis is considered an effective treatment. Here, we aimed to evaluate the outcome of EVTs of completely occlusive acute–subacute PVMVT with severe complications in patients without cirrhosis.
Materials and methods
Nineteen patients (nine men and 10 women; age, 60.1 ± 16.8 years) with completely occlusive acute–subacute PVMVT were retrospectively assessed. Acute–subacute PVMVT was defined as symptom onset within 40 days, with no cavernous transformation observed on contrast-enhanced computed tomography. The patients were treated with EVTs, a combination of thrombectomy (including aspiration thrombectomy, plain old balloon angioplasty, single injection of thrombolytic agents, and stent placement) and continuous catheter-directed thrombolysis. Kaplan–Meier analyses were performed to assess all-cause mortality, acute–subacute PVMVT-related mortality, and portal vein (PV) patency. The degree of recanalization and patency of PV, complications, factors related to acute–subacute PVMVT-related mortality, and factors related to patency of PV were also evaluated.
Results
The all-cause and acute–subacute PVMVT-related mortality rates were 36.8% (7/19) and 31.6% (6/19), respectively. Seven (36.8%) and 11 (57.9%) patients achieved complete and partial recanalization, respectively. Among the 18 patients who achieved recanalization, follow-up images after 608.7 ± 889.5 days confirmed recanalization in 83.3% (15/18) patients, and 53.3% (8/15) of these patients achieved patency of PV. Seven patients (36.8%) developed complications, and two (10.5%) required interventional treatment for complications. Deterioration of liver function significantly worsened the prognosis (
P
= 0.046), while anticoagulation therapy significantly maintained portal patency (
P
= 0.03).
Conclusion
This endovascular method for acute–subacute PVMVT, which combines thrombectomy and continuous catheter-directed thrombolysis EVT approach was effective for thrombus resolution. However, further studies must define conditions that improve patient prognosis.</abstract><cop>Singapore</cop><pub>Springer Nature Singapore</pub><pmid>36680703</pmid><doi>10.1007/s11604-022-01377-9</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-7270-7126</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1867-1071 |
| ispartof | Japanese journal of radiology, 2023-05, Vol.41 (5), p.541-550 |
| issn | 1867-1071 1867-108X 1867-108X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10147747 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adult Aged Angioplasty Anticoagulants Balloon treatment Cardiovascular system Catheters Cirrhosis Complications Computed tomography Female Humans Imaging Implants Liver cirrhosis Liver Cirrhosis - complications Liver Cirrhosis - therapy Male Medical instruments Medicine Medicine & Public Health Mesenteric Veins - diagnostic imaging Middle Aged Mortality Nuclear Medicine Original Original Article Portal vein Portal Vein - diagnostic imaging Prognosis Radiology Radiotherapy Retrospective Studies Thrombectomy - methods Thromboembolism Thrombolysis Thrombolytic Therapy - adverse effects Thrombolytic Therapy - methods Thrombosis Thrombosis - etiology Treatment Outcome Veins Venous Thrombosis - complications Venous Thrombosis - diagnostic imaging Venous Thrombosis - therapy |
| title | Efficacy of endovascular treatment for completely occlusive acute–subacute portal and mesenteric vein thrombosis with severe complications in patients without cirrhosis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-23T16%3A20%3A17IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Efficacy%20of%20endovascular%20treatment%20for%20completely%20occlusive%20acute%E2%80%93subacute%20portal%20and%20mesenteric%20vein%20thrombosis%20with%20severe%20complications%20in%20patients%20without%20cirrhosis&rft.jtitle=Japanese%20journal%20of%20radiology&rft.au=Saito,%20Hidemasa&rft.date=2023-05-01&rft.volume=41&rft.issue=5&rft.spage=541&rft.epage=550&rft.pages=541-550&rft.issn=1867-1071&rft.eissn=1867-108X&rft_id=info:doi/10.1007/s11604-022-01377-9&rft_dat=%3Cproquest_pubme%3E2890338481%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2890338481&rft_id=info:pmid/36680703&rfr_iscdi=true |