Effectiveness of endovascular thrombolysis in acute mesenteric vein thrombosis
© Milone et al; licensee BioMed Central Ltd. 2011
Published: 24 August 2011
Mesenteric vein thrombosis (MVT) is a rare, often lethal, entity that accounts for approximately 10-15% of all cases of mesenteric ischemia [1, 2]. Current indications for surgery in patients with acute MVT include signs of peritonitis, bowel infarction and hemodynamic instability.
In all other cases, long-lasting anticoagulation is the strategy of choice [3, 4], patients with MVT have a fairly good prognosis and long-term outcomes once appropriate anticoagulation is achieved [4, 5]. At variance with the slow onset of recanalization that takes place during anticoagulation, thrombolysis leads to a rapid re-opening of a vessel, with immediate tissue reperfusion .
Materials and methods
Clinical diagnosis on admission
P = 0.712
P = 0.950
Duration of symptom
≤ 2 day
≤ 7 day
≤ 14 day
P = 0.865
MVT is still a serious disease, with a high mortality rate (25-35%), mostly related to transmural necrosis and bowel perforation due to the delay in diagnosis [1, 6]. In the absence of major clinical signs and symptoms, the severity of bowel ischemia on admission is based on the evaluation of bowel wall thickness by contrast-enhanced CT scan (90% sensitivity). Macroscopically infarcted small bowel without transmural necrosis is potentially reversible with long-lasting anticoagulation [1, 7–10]. Encouraging results of endovascular thrombolytic treatments have been reported in literature [11, 12]. According to our results, when administered promptly, endovascular intervention using percutaneous transhepatic thrombolysis and mechanical thrombectomy appears to have a lower rate of early and late complications compared to warfarin treatment alone.
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