Acute Mesenteric and Portal Vein Thrombosis: Etiology, Diagnosis, and Interventional Management

Acute portal and mesenteric vein thrombosis (PVT) can lead to fatal mesenteric ischemia, with mortality rates ranging from 37% to 76%. Early diagnosis and prompt venous revascularization are crucial in symptomatic cases. Spontaneous recanalization in portal vein thrombosis (PVT) is rare, making systemic anticoagulation the first-line treatment. However, even with early anticoagulation, recanalization occurs in only 35%-40% of cases. Involvement of the superior mesenteric vein (SMV) increases the risk of bowel ischemia, which is associated with poor outcomes. The primary goals of endovascular treatment for portomesenteric thrombectomy and lysis are to restore blood flow, prevent bowel ischemia, and reduce thrombus burden. This approach aims to alleviate symptoms, preserve liver and intestinal function, and facilitate anticoagulation while minimizing procedural risks. For patients who deteriorate despite anticoagulation, catheter-directed thrombolysis (CDT) via percutaneous transhepatic or transjugular access provides a safe and effective minimally invasive adjunctive treatment.