Transjugular intrahepatic portosystemic shunt combined with dual-access thrombolysis for acute severe non-cirrhotic portal-mesenteric vein thrombosis.

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Digestive and Liver Disease Pub Date : 2024-09-17 DOI:10.1016/j.dld.2024.08.054

Bifei Wu,Wei Yang,Yuguan Xie,Haifeng Zhou,Haibin Shi,Sheng Liu,Weizhong Zhou

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Abstract

OBJECTIVE Non-cirrhotic porto-mesenteric vein thrombosis (NC-PMVT) is a rare but severe clinical condition. The study aims to assess the effectiveness and safety of transjugular intrahepatic portosystemic shunt (TIPS) coupled with dual-access thrombolysis in patients with acute severe NC-PMVT. METHODS From January 2018 to February 2023, a total of 25 patients with acute severe NC-PMVT who were treated with TIPS in conjunction with mechanical thrombectomy and dual-access thrombolysis. The period of thrombolysis was determined by the improvement of clinical symptoms and vascular recanalization. The technical success, recanalization rate, clinical success, and procedure-related complications were analyzed. RESULTS The technical success rate was 100 %. The median duration for thrombolytic catheter removal was 5 (IQR 3.5 - 7) days. Full and partial recanalization were accomplished in 10 (40 %) and 15 (60 %) patients respectively before discharge. No significant procedure-related complications were reported. The clinical success rate was 88 %, with a mortality rate of 12 %. Over a median follow-up of 8 months, 3/22 (13.64 %) patients had a recurrence of thrombosis; 1/22 (4.54 %) patients underwent partial intestinal resection one and a half months post-discharge; the remaining patients did not experience any portal hypertensive complications. CONCLUSION The combination of TIPS and dual-access thrombolysis appears to be safe and effective for patients with acute severe NC-PMVT.

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经颈静脉肝内门体系统分流术联合双入口溶栓治疗急性重度非肝硬化门-肠静脉血栓形成。

目的非肝硬化性肠系膜门静脉血栓形成（NC-PMVT）是一种罕见但严重的临床病症。该研究旨在评估经颈静脉肝内门体分流术（TIPS）联合双通道溶栓治疗急性重度NC-PMVT患者的有效性和安全性。方法从2018年1月至2023年2月，共有25例急性重度NC-PMVT患者接受了TIPS联合机械取栓术和双通道溶栓治疗。溶栓时间以临床症状改善和血管再通情况为准。结果技术成功率为100%。溶栓导管移除的中位时间为 5 天（IQR 3.5 - 7 天）。分别有 10 名（40%）和 15 名（60%）患者在出院前完成了全部和部分再通路。无重大手术相关并发症报告。临床成功率为 88%，死亡率为 12%。在中位随访 8 个月期间，3/22（13.64%）名患者血栓复发；1/22（4.54%）名患者在出院后一个半月接受了部分肠切除术；其余患者未出现任何门静脉高压并发症。

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.