[Application of percutaneous AngioJet thrombectomy in patients with acute symptomatic portal and superior mesenteric...

Objective: To evaluate the clinical value of percutaneous AngioJet thrombectomy in treatment of acute symptomatic portal and superior mesenteric venous thrombosis venous thrombosis (PVMVT) . Method: From January 2014 to January 2016, a total of 8 patients in Nanjing First Hospital with PVMVT verified by color Doppler ultrasound and computed tomographic angiography (CTA) were analyzed retrospectively. Under ultrasound guidance , the branch of the right portal vein(PV) was punctured with a micropuncture set and a 4-F infusion catheter was advanced to the superior mesenteric vein(SMV). The venogram demonstrated the thrombosis in the PV/SMV and a 6-F AngioJet Xpeeedior catheter was advanced over the guidewire and positioned in the distal SMV. Percutaneous thrombectomy was performed after a mixture of 250 000 U of urokinase in 100 ml of normal saline for mechanical pulse spray of thrombus in all patients for approximately 15 minutes. 2 patients underwent PTA and stent implantation after the thrombectomy procedure, 1 of them and the others 6 patients received continuous transcatheter infusion of urokinase (500 000 U/d) for 24 or 48 hours until the thrombosis was completely dissolved confirmed by angiography at 24 and 48 hours.After procedure and the thrombolytic therapy was discontinued, removal of the infusion catheter and the sheath from the liver, the transhepatic tract was embolized with coils or gelfoam to reduce the risk of bleeding. The patency rate of PV /SMV was assessed by CTA at 1 and 6 months after the procedure. Patients were discharged with oral anticoagulation regimen for at least 6 months.The following criteria were used in evaluation of thrombolysis: grade Ⅰ<50% thrombus removal; grade Ⅱ 50%~90% thrombus removal, and grade Ⅲ>90% thrombus removal. Results: All 8 patients with PVMVT were treated by AngioJet thrombectomy. Angiography after the thrombectomy procedure showed complete thrombus removal (>90%) was in 3 cases, substantial thrombus removal (50%~90%) in 5 cases. Grade Ⅲ (complete) thrombolysis was achieved in 7 cases and grade Ⅱ (50%~90%) lysis in 1 case post thrombolytic therapy for 24 or 48 hours. 2 patients had underwent PTA and stent implantation. Large volume intraperitoneal hemorrhage was discovered in 1 patient after removal of the catheter and sheath from the liver. The patient restored stability after a blood transfusion.Venous patency was comfirmed in all 8 patients at 1 or 6 months after the treatment. There was no patient with major complications death related to the procedure. Conclusion: Percutaneous AngioJet thrombectomy with adjunctive thrombolytic therapy is an effective and safe treatment modality in patients with acute symptomatic PVMVT.