Combined Pharmacomechanical Thrombolysis of Complete Portomesenteric Thrombosis in a Liver Transplant Recipient

Treatment options for portomesenteric venous thrombosis range from anticoagulation to surgery, depending on chronicity, severity of symptoms, extent of thrombosis, and the availability of local expertise. For acute and subacute cases, a variety of endovascular options have been described in limited...

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Bibliographic Details
Published in:Cardiovascular and interventional radiology 2014-02, Vol.37 (1), p.262-266
Main Authors: Lorenz, Jonathan M., Bennett, Shelby, Patel, Jay, Van Ha, Thuong G., Funaki, Brian
Format: Article
Language:English
Subjects:
Adult
ADULTS
Anticoagulants - therapeutic use
AVAILABILITY
BALLOONS
BIOLOGICAL RECOVERY
Cardiology
Case Report
Contrast Media
GRAFTS
Humans
Imaging
LIVER
Liver Transplantation
Male
Medicine
Medicine & Public Health
Mesenteric Veins
Nuclear Medicine
Portal Vein
Postoperative Complications - diagnostic imaging
Postoperative Complications - etiology
Postoperative Complications - therapy
Radiology
RADIOLOGY AND NUCLEAR MEDICINE
SURGERY
SYMPTOMS
Thrombectomy - methods
Thrombolytic Therapy - methods
THROMBOSIS
Tomography, X-Ray Computed
Ultrasound
Vascular Patency
VEINS
Venous Thrombosis - diagnostic imaging
Venous Thrombosis - etiology
Venous Thrombosis - therapy
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Description
Summary:Treatment options for portomesenteric venous thrombosis range from anticoagulation to surgery, depending on chronicity, severity of symptoms, extent of thrombosis, and the availability of local expertise. For acute and subacute cases, a variety of endovascular options have been described in limited published series and case reports, including thrombolysis and mechanical thrombectomy. We report what is to our knowledge the first case in which the Trellis pharmacomechanical thrombolysis device was used successfully to treat complete acute thrombosis of the entire superior mesenteric vein and the entire portal vein with extension into all segmental intrahepatic portal branches in a young adult after liver transplantation. This device, coupled with adjunctive techniques using balloon catheters, facilitated complete restoration of flow, resulting in graft salvage and long-term patency.
ISSN:0174-1551
1432-086X
DOI:10.1007/s00270-013-0568-4