Transcatheter thrombolysis centered stepwise management strategy for acute superior mesenteric venous thrombosis

Acute superior mesenteric venous thrombosis (ASMVT) is a rare but potentially lethal abdominal calamity. Outcome depends on prompt recognition and revascularization before progresses to bowel gangrene. Despite better understanding of pathogenesis and development of modern treatment technique, management of ASMVT remains a great clinical challenge. Transcatheter thrombolysis as the main revascularization method, combined with mechanical thrombectomy and other endovascular manipulations, alone or as a hybrid procedure, has got favorable outcomes. Thus on the basis of early diagnosis and close evaluation of intestinal ischemia and thrombus evolution, a coordinated stepwise management strategy involving a specialized approach of initial anticoagulation, preferred endovascular therapy, and damage-control surgery modality with surgical thrombectomy, may show benefits in rapid revascularization, prompt symptom improvement, and short bowel syndrome avoidance, with shortened hospitalization and less cost. This article presents an evidence-based review of the state-of-the-art advancements of this transcatheter thrombolysis centered stepwise management strategy for ASMVT.