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Theodore S, Xia T, Saillant N. Intestinal Ischemia - Etiology and Foundational Concepts. NEJM EVIDENCE 2024; 3:EVIDra2300266. [PMID: 38411445 DOI: 10.1056/evidra2300266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Intestinal Ischemia: Etiology and Foundational ConceptsThe authors provide an overview of the intestinal anatomy and the pathophysiology and etiology of intestinal ischemia.
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Affiliation(s)
- Sheina Theodore
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Boston University School of Medicine, Boston
| | - Tony Xia
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Boston University School of Medicine, Boston
| | - Noelle Saillant
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Boston University School of Medicine, Boston
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Ramalingam V, Weinstein J, Gimenez J, Curry M, Yang L, Sarwar A, Ahmed M. Technical Feasibility of Suction Thrombectomy Using a Large-Bore Aspiration System in the Portomesenteric Venous System. J Vasc Interv Radiol 2023; 34:351-356. [PMID: 36521795 DOI: 10.1016/j.jvir.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/18/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To assess technical feasibility and safety of portal vein thrombectomy with suction thrombectomy using a large-bore thrombectomy device for portomesenteric venous thrombosis (PMVT). MATERIALS AND METHODS After receiving approval from institutional review board, patients undergoing PMVT treatment using a large-bore aspiration thrombectomy device (Inari FlowTriever or ClotTriever) between July 2019 and June 2021 were identified at 2 medical centers. Charts were reviewed for demographic information, imaging findings, and procedural details. PMVT was categorized using the Yerdel grading system. The thrombectomy procedure was performed via transjugular access through the existing or a new transjugular intrahepatic portosystemic shunt (TIPS) or transsplenic or transhepatic approach. Technical success was defined as successful clot reduction and restoration of portal venous flow at the conclusion of the procedure. Patient outcomes based on clinical presentation, adverse events, and thrombectomy-associated adverse events were recorded. RESULTS Twenty patients, with a median age of 58 years (range, 23-72 years), underwent large-bore aspiration thrombectomy, which was technically successful in 19 of 20 (95%) patients. In 9 of 20 (45%) patients, 9 of 20 (45%) patients, and 2 of 20 (10%) patients, the 20-F, 16-F, and 24-F devices were used, respectively. Fourteen patients had a pre-existing TIPS, and 6 patients had a TIPS created. In 5 of 20 (25%) patients, overnight lysis was performed in conjunction with Inari thrombectomy. Thrombus resolution with restoration of flow was achieved in 19 of 20 (95%) cases. There were no thrombectomy-associated adverse events. The mean follow-up time was 70 days (±113) at which time primary patency of the portal venous system was present in 16 of 20 (80%) patients. CONCLUSIONS Large-bore aspiration portal vein thrombectomy is feasible for PMVT.
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Affiliation(s)
- Vijay Ramalingam
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Jeff Weinstein
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Juan Gimenez
- Division of Interventional Radiology, Ochsner Medical Center, New Orleans, Louisiana
| | - Michael Curry
- Division of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lauren Yang
- Division of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ammar Sarwar
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Muneeb Ahmed
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Tripolino C, Pizzini AM, Zaccaroni S, Cicognani C, Dapporto S, Cipollini ML, Giannone C, Cavoli C, Silingardi M. Is SARS-CoV-2 infection an emerging risk factor for splanchnic venous thrombosis? Clin Hemorheol Microcirc 2021; 79:347-355. [PMID: 34511494 DOI: 10.3233/ch-211256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Thrombosis represents one of the most feared complications of the COronaVIrus Disease-2019 (COVID-19). Although pulmonary embolism and deep venous thrombosis are the most described complications, some investigations reported thrombotic localization also in the splanchnic venous district. METHODS We describe the case of a patient with SARS-CoV-2 infection presenting with abdominal pain and diagnosed with portal vein thrombosis. In addition, we shortly review available literature supporting the possible role of COVID-19 as leading cause of splanchnic venous thrombosis. RESULTS After in-depth diagnostic workup, we excluded the commonest causes of portal thrombosis and concluded that SARS-CoV-2 infection represented the main explanation of this finding. CONCLUSIONS Our study warns the clinicians to maintain a high index of suspicion for thrombosis in patients diagnosed with SARS-CoV-2 infection manifesting gastrointestinal symptoms. An appropriate diagnostic work-up could allow to obtain an early diagnosis and consequently improve the clinical outcome of patients.
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Affiliation(s)
- Cesare Tripolino
- Department of Internal Medicine, Ospedale Maggiore "Carlo Alberto Pizzardi", Bologna, Italy
| | - Attilia Maria Pizzini
- Department of Internal Medicine, Ospedale Maggiore "Carlo Alberto Pizzardi", Bologna, Italy
| | - Stefania Zaccaroni
- Department of Internal Medicine, Ospedale Maggiore "Carlo Alberto Pizzardi", Bologna, Italy
| | - Camilla Cicognani
- Department of Internal Medicine, Ospedale Maggiore "Carlo Alberto Pizzardi", Bologna, Italy
| | - Susanna Dapporto
- Department of Internal Medicine, Ospedale Maggiore "Carlo Alberto Pizzardi", Bologna, Italy
| | - Maria Luigia Cipollini
- Department of Internal Medicine, Ospedale Maggiore "Carlo Alberto Pizzardi", Bologna, Italy
| | - Claudia Giannone
- Department of Internal Medicine, Ospedale Maggiore "Carlo Alberto Pizzardi", Bologna, Italy
| | - Carlotta Cavoli
- Department of Internal Medicine, Ospedale Maggiore "Carlo Alberto Pizzardi", Bologna, Italy
| | - Mauro Silingardi
- Department of Internal Medicine, Ospedale Maggiore "Carlo Alberto Pizzardi", Bologna, Italy
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Abdel-Razik A, Mousa N, Shabana W, Yassen AH, Abdelsalam M, Wahba MM, Helmy EM, Tawfik AM, Zalata K, Hasan AS, Elhelaly R, Elzehery R, Fathy AA, El-Wakeel N, Eldars W. De novo Portal Vein Thrombosis in Non-Cirrhotic Non-Alcoholic Fatty Liver Disease: A 9-Year Prospective Cohort Study. Front Med (Lausanne) 2021; 8:650818. [PMID: 33996858 PMCID: PMC8117420 DOI: 10.3389/fmed.2021.650818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/15/2021] [Indexed: 01/05/2023] Open
Abstract
Background and Aims: Approximately 30-40% of portal vein thrombosis (PVT) remains of unknown origin. The association between non-alcoholic fatty liver disease (NAFLD) and PVT is a matter of debate. This study aimed to investigate the association between PVT and NAFLD. Methods: We included 94 out of 105 consecutive NAFLD patients in this prospective cohort study in addition to 94 from the healthy control group. We evaluated biochemical, clinical, immunological, and histopathological parameters; waist circumference (WC); leptin; adiponectin; and leptin/adiponectin ratio (LAR) for all participants at baseline and every 3 years thereafter. We described the characteristics of participants at baseline and showed individual WC, LAR, and PVT characteristics. Potential parameters to predict PVT development within 9 years were determined. Results: PVT developed in eight (8.5%) patients, mainly in the portal trunk. Univariate analysis showed three PVT-associated factors: diabetes mellitus (P = 0.013), WC (P < 0.001), and LAR (P = 0.002). After adjusting multiple confounding variables, the multivariate model showed that the only significant variables were WC and LAR. By applying the receiver operating characteristic curve, WC had 98.8% specificity, 87.5% sensitivity, and 0.894 area under the curve (AUC) for prediction of PVT (P < 0.001) at cutoff values of > 105 cm. In comparison, LAR had 60.5% specificity, 87.5% sensitivity, and 0.805 AUC for PVT prediction (P < 0.001) at cutoff values of >7.5. Conclusions: This study suggests that increased central obesity and LAR were independently associated with PVT development in non-cirrhotic NAFLD patients, and they should be considered risk factors that may participate in PVT multifactorial pathogenesis.
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Affiliation(s)
- Ahmed Abdel-Razik
- Tropical Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nasser Mousa
- Tropical Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Walaa Shabana
- Tropical Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed H Yassen
- Tropical Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mostafa Abdelsalam
- Nephrology and Dialysis Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed M Wahba
- Nephrology and Dialysis Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Eman Mohamed Helmy
- Diagnostic & Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed M Tawfik
- Diagnostic & Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Khaled Zalata
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmad S Hasan
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rania Elhelaly
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rasha Elzehery
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Aya Ahmed Fathy
- Public Health and Community Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Niveen El-Wakeel
- Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Waleed Eldars
- Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Northup P. A History of Coagulopathy in Liver Disease: Legends and Myths. Clin Liver Dis (Hoboken) 2020; 16:56-72. [PMID: 33042527 PMCID: PMC7538927 DOI: 10.1002/cld.954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/06/2020] [Indexed: 02/04/2023] Open
Abstract
Watch an interview with the author.
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Affiliation(s)
- Patrick Northup
- Division of Gastroenterology and HepatologyUniversity of VirginiaCharlottesvilleVA
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Wei Q, He Z, Wang K, Li C, Al Ameri A, Zheng S, Xu X. Prediction model based on blood urea nitrogen and the leukocyte count for intestinal necrosis in patients with portal vein system thrombosis: a retrospective study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:326. [PMID: 32355770 PMCID: PMC7186628 DOI: 10.21037/atm.2020.02.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Portal vein system thrombosis (PVST) is a serious and potentially fatal disease. No definite parameter can predict intestinal necrosis in patients with PVST to justify early surgical intervention. The current study aimed to explore a simple and accurate model to predict the occurrence of intestinal necrosis in patients with PVST. Methods Records of patients admitted to our emergency department with PVST from January 2010 to October 2018 were reviewed. Clinical parameters, including patient history, physical examination, and the results of laboratory investigations, were analyzed. Results Sixty-nine patients (27 females) were included. All patients were admitted to our emergency department because of abdominal pain. Fourteen patients required exploratory laparotomy, and intestinal necrosis was confirmed. Seven patients received thrombolytic therapy, and the other 48 patients had completed anticoagulation successfully. According to multivariate logistic regression, high blood urea nitrogen (BUN) (OR: 1.413, P=0.048) and the leukocyte count (OR: 1.180, P=0.005) were associated with intestinal necrosis, and a prediction model for intestinal necrosis (PMIN) based on the BUN and leukocyte count was established. Conclusions The PMIN score could effectively predict intestinal necrosis in patients with PVST.
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Affiliation(s)
- Qiang Wei
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Zenglei He
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Kun Wang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Changbiao Li
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Abdulahad Al Ameri
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Shusen Zheng
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xiao Xu
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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Zardi EM, Giorgi C, Zardi DM. Pylephlebitis as a Complication of Cholangitis and Sepsis in an HIV-Positive Patient. Dig Dis Sci 2019; 64:1719-1721. [PMID: 30488240 DOI: 10.1007/s10620-018-5391-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/20/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Enrico Maria Zardi
- Hospitalist Service, "Campus Bio-Medico" University, Via Álvaro del Portillo 200, 00128, Rome, Italy.
| | - Chiara Giorgi
- Radiology Department, S. Maria della Misericordia Hospital, Urbino, Italy
| | - Domenico Maria Zardi
- Division of Cardiology, Faculty of Medicine and Psychology, University of Rome "Sapienza," Sant'Andrea Hospital, Rome, Italy
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Davis JPE, Ogurick AG, Rothermel CE, Sohn MW, Intagliata NM, Northup PG. Anticoagulation and Transjugular Intrahepatic Portosystemic Shunting for Treatment of Portal Vein Thrombosis in Cirrhosis: A Systematic Review and Meta-Analysis. Clin Appl Thromb Hemost 2019; 25:1076029619888026. [PMID: 32942900 PMCID: PMC7649874 DOI: 10.1177/1076029619888026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Portal vein thromboses (PVTs) are associated with hepatic decompensation, worse survival, and worse liver transplant outcomes. We evaluated the impact of anticoagulation (AC) and transjugular intrahepatic portosystemic shunting (TIPS) on recanalization and mortality in patients with cirrhosis and PVT. Systematic search of electronic databases was performed. Clinical trials and observational studies that evaluated primary outcomes of recanalization and survival in patients with cirrhosis having PVT treated with AC or TIPS were included. Risk of bias was assessed. Summary odds ratios (ORs) for pooled data from the included studies were generated using a random effects model. A total of 505 studies were screened for inclusion. After review, 7 studies were ultimately included. Data from 327 patients in total were evaluated. Overall, treatment with either AC or TIPS resulted in partial or complete recanalization (OR: 4.56 [95% confidence interval, CI: 2.46-8.47]) but did not significantly impact mortality (OR: 0.57 [95% CI: 0.21-1.57]). The summary OR of AC for recanalization was 6.00 (95% CI: 2.38-15.07). The summary OR of TIPS for recanalization was 3.80 (95% CI: 1.47-9.83). The summary OR of mortality in patients treated with AC for PVT was 0.28 (95% CI: 0.08-0.95). The mortality summary OR was 1.10 (95% CI 0.23-5.16) in patients who underwent TIPS. There was insufficient data to assess complications such as hepatic encephalopathy or bleeding. Both AC and TIPS have a significant effect on recanalization. Anticoagulation appears to have a protective effect on mortality that is not seen with TIPS. More studies with control groups are need.
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Affiliation(s)
- Jessica P. E. Davis
- University of Virginia Center for the Study of Hemostasis in Liver Diseases, Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA
| | - Amy G. Ogurick
- Department of Internal Medicine, University of Virginia, Charlottesville, VA, USA
| | - Carrie E. Rothermel
- Department of Internal Medicine, University of Virginia, Charlottesville, VA, USA
| | - Min-Woong Sohn
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Nicolas M. Intagliata
- University of Virginia Center for the Study of Hemostasis in Liver Diseases, Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA
| | - Patrick G. Northup
- University of Virginia Center for the Study of Hemostasis in Liver Diseases, Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA
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Gîrleanu I, Trifan A, Stanciu C, Sfarti C. Portal vein thrombosis in cirrhotic patients - it is always the small pieces that make the big picture. World J Gastroenterol 2018; 24:4419-4427. [PMID: 30356984 PMCID: PMC6196341 DOI: 10.3748/wjg.v24.i39.4419] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/02/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023] Open
Abstract
Portal vein thrombosis (PVT) is a frequent and serious complication in patients with liver cirrhosis (LC). Recently, a new classification of PVT was proposed, although the functional component was not completed included. The status of liver disease (compensated/decompensated) should be added to this classification. Reduced portal flow velocity and the acquired hypercoagulable status associated with LC are the main risk factors for PVT development, although endothelial dysfunction may play an important role that needs to be further evaluated. The European Association for the Study of the Liver and the American Association for the Study of Liver Disease recommend that the anticoagulant treatment should be consider in cirrhotic patients with PVT. Low molecular weight heparin and vitamin K antagonists proved their efficacy and relatively safety in PVT treatment, although in addition to recanalization rates, more complex end-points such as mortality and decompensation rate should be evaluated. The new oral anticoagulant therapies offers the advantage of oral administration in the absence of laboratory monitoring, however, there are a few reports regarding their use in cirrhotic patients, most of them referring to compensated isolated cases. Transjugular intrahepatic portosystemic shunt could be an alternative if thrombosis progresses despite anticoagulatant therapy and/or when PVT is associated with portal hypertension complications. The aim of this editorial is to discuss the different aspects of pathophysiology, clinical relevance, diagnosis and management of PVT in patients with LC.
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Affiliation(s)
- Irina Gîrleanu
- Department of Gastroenterology, “Grigore T Popa” University of Medicine and Pharmacy, Iași 700115, Romania
- Institute of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, Iași 700115, Romania
| | - Anca Trifan
- Department of Gastroenterology, “Grigore T Popa” University of Medicine and Pharmacy, Iași 700115, Romania
- Institute of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, Iași 700115, Romania
| | - Carol Stanciu
- Department of Gastroenterology, “Grigore T Popa” University of Medicine and Pharmacy, Iași 700115, Romania
- Institute of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, Iași 700115, Romania
| | - Cătălin Sfarti
- Department of Gastroenterology, “Grigore T Popa” University of Medicine and Pharmacy, Iași 700115, Romania
- Institute of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, Iași 700115, Romania
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Wang CY, Wei LQ, Niu HZ, Gao WQ, Wang T, Chen SJ. Agitation thrombolysis combined with catheter-directed thrombolysis for the treatment of non-cirrhotic acute portal vein thrombosis. World J Gastroenterol 2018; 24:4482-4488. [PMID: 30357003 PMCID: PMC6196336 DOI: 10.3748/wjg.v24.i39.4482] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/13/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the safety and efficacy of agitation thrombolysis (AT) combined with catheter-directed thrombolysis (CDT) for the treatment of non-cirrhotic acute portal vein thrombosis (PVT).
METHODS Nine patients with non-cirrhotic acute PVT who underwent AT combined with CDT were analyzed retrospectively. Portography was carried out via the transjugular intrahepatic portosystemic (commonly known as TIP) or percutaneous transhepatic (commonly known as PT) route, followed by AT combined with CDT. Complications of the procedure, and the changes in clinical symptoms, hemodynamics of the portal vein and liver function were recorded. Follow-up was scheduled at 1, 3 and 6 mo after treatment, and every 6 mo thereafter, or when the patients developed clinical symptoms related to PVT. Color Doppler ultrasound and contrast-enhanced computed tomography/magnetic resonance imaging were performed during the follow-up period to determine the condition of the portal vein.
RESULTS AT combined with CDT was successfully performed. The portal vein was reached via the TIP route in 6 patients, and via the PT route in 3 patients. All clinical symptoms were relieved or disappeared, with the exception of 1 patient who died of intestinal necrosis 9 d after treatment. Significant differences in the changes in portal vein hemodynamics were observed, including the maximum lumen occupancy of PVT, portal vein pressure and flow velocity between pre- and post-treatment (P < 0.05). During the follow-up period, recurrence was observed in 1 patient at 19 mo after the procedure, and the portal vein was patent in the remaining patients.
CONCLUSION AT combined with CDT is a safe and effective method for the treatment of non-cirrhotic acute PVT.
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Affiliation(s)
- Chao-Yang Wang
- Department of Interventional Radiology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technolgy, Luoyang 471000, Henan Province, China
| | - Le-Qun Wei
- Department of Interventional Radiology, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang 471000, Henan Province, China
| | - Huan-Zhang Niu
- Department of Interventional Radiology, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang 471000, Henan Province, China
| | - Wan-Qin Gao
- Department of Interventional Radiology, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang 471000, Henan Province, China
| | - Tong Wang
- Department of Interventional Radiology, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang 471000, Henan Province, China
| | - Shun-Jun Chen
- Department of Interventional Radiology, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang 471000, Henan Province, China
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Ponzetto A, Figura N, Cruz-Ramón V, Chinchilla-López P, Ramírez-Pérez O, Aguilar-Olivos NE, Alva-López LF, Fajardo-Ordoñez E, Ponciano-Rodríguez G, Northup PG, Intagliata N, Caldwell SH, Qi X, Méndez-Sánchez N. Thrombosis of the Portal Venous System in Cirrhotic Patients. Ann Hepatol 2018; 17:1078-1080. [PMID: 30600284 DOI: 10.5604/01.3001.0012.7209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Antonio Ponzetto
- Department of Medical Sciences, University of Torino Corso AM, Turin, Italy
| | - Natale Figura
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
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