Initial transcatheter thrombolysis for acute superior mesenteric venous thrombosis
Open accessAbstract
AIM: To determine the optimal initial treatment modality for acute superior mesenteric vein thrombosis (ASMVT) in patients with circumscribed peritonitis. METHODS: A retrospective review was made of the Vascular Surgery Department's medical records to identify adult patients (≥ 18 years old) presenting with circumscribed peritonitis and diagnosed with ASMVT by imaging or endoscopic examination. Patients were selected from the time period between October 2009 and October 2012 to assess the overall performance of a new first-line treatment policy implemented in May 2011 for patients with circumscribed peritonitis, which recommends transcatheter thrombolysis with local anticoagulation and endovascular mechanical thrombectomy. Of the 25 patients selected for study inclusion, 12 had undergone emergency surgical exploration (group 1) and 13 had undergone the initial catheter-directed thrombolysis (group 2). Data extracted from each patient's records for statistical analyses included method of diagnosis, symptoms, etiology and risk factors, thrombus location, initial management, morbidity, mortality, duration and total cost of hospitalization (in Renminbi, RMB), secondary operation, total length of bowel resection, duration of and findings in follow-up, and death/survival. RESULTS: The two treatment groups showed similar rates of morbidity, 30-d mortality, and 1-year survival, as well as similar demographic characteristics, etiology or risk factors, computed tomography characteristics, symptoms, findings of blood testing at admission, complications, secondary operations, and follow-up outcomes. In contrast, the patients who received the initial non-operative treatment of transcatheter thrombolysis had significantly shorter durations of admission to symptom elimination (group 1: 18.25 ± 7.69 d vs group 2: 7.23 ± 2.42 d) and hospital stay (43.00 ± 13.77 d vs 20.46 ± 6.59 d), and early enteral or oral nutrition restoration (20.50 ± 5.13 d vs 8.92 ± 1.89 d), as well as significantly less total length of bowel resection (170.83 ± 61.27 cm vs 29.23 ± 50.24 cm) and lower total cost (200020.4 ± 91505.62 RMB vs 72785.6 ± 21828.16 RMB) (P < 0.05 for all). Statistical analyses suggested that initial transcatheter thrombolysis is correlated with quicker resolution of the thrombus, earlier improvement of symptoms, stimulation of collateral vessel development, reversal of intestinal ischemia, receipt of localizing bowel resection to prevent short bowel syndrome, shorter hospitalization, and lower overall cost of treatment. CONCLUSION: For ASMVT patients with circumscribed peritonitis, early diagnosis is key to survival, and non-operative transcatheter thrombolysis is feasible and effective as an initial treatment.
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Systemic thrombolysis with recombinant tissue-type plasminogen activator or transcatheter thrombolysis with urokinase can be an initial effective treatment for acute superior MVT.
“Systemic thrombolysis with recombinant tissue–type plasminogen activator or transcatheter thrombolysis with urokinase can also be an initial effective treatment for acute superior MVT[105,106].”
From Ischemic bowel disease in 2021. (2021) · cites this paper as [106]
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- Authors
- Yang, S.-F.
- Venue
- World Journal of Gastroenterology
- Publisher
- Baishideng Publishing Group Inc.
- Published
- 2014
- Volume
- 20
- Issue
- 18
- Pages
- 5483
- ISSN
- 1007-9327 (ISSN-L)
- PMC
- PMC4017063
- OpenAlex
- W1989274288
- Cited by
- 34
- References
- 56
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 4 · 2022: 3 · 2021: 4 · 2020: 1 · 2019: 4 · 2018: 1 · 2017: 6 · 2016: 3 · 2014: 1
- FWCI
- 3.31
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- World Journal of Gastroenterology (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Natural Science Foundation of China (81300278)
- Government of Jiangsu Province
- Natural Science Foundation of Jiangsu Province (BK20130697)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Surgery › Vascular anomalies and interventions
- Keywords
- superior mesenteric vein thrombosis, catheter-directed thrombolysis, conservative treatment, emergency surgery, endovascular mechanical thrombectomy, length of hospital stay, hospital costs, bowel resection, post-thrombotic syndrome
- MeSH terms
- Acute Disease, Adult, Catheterization, Peripheral, Cost-Benefit Analysis, Female, Fibrinolytic Agents, Humans, Length of Stay, Male, Mesenteric Veins, Middle Aged, Peritonitis, Phlebography, Predictive Value of Tests, Retrospective Studies, Time Factors, Tomography, X-Ray Computed, Abdominal Pain, Angiography, Digital Subtraction, Thrombolytic Therapy, Drug Costs, Treatment Outcome, Hospital Costs, Magnetic Resonance Angiography, Venous Thrombosis
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