Mesenteric Vein Thrombosis and Its Interventional-Radiological Management

Mesenteric venous thrombosis (MVT) is a rare but clinically important cause of mesenteric ischemia. It most often affects the superior mesenteric vein and is associated with high morbidity and mortality. Nonspecific symptoms often delay diagnosis. Severe disease courses may occur in the presence of intestinal infarction.

The aim of this article is to provide a structured overview of the etiopathogenesis, imaging findings, and interventional radiological treatment options for MVT.

Narrative, literature-based review taking into consideration current guidelines, radiological imaging protocols, and endovascular techniques.

The pathogenesis of MVT can be classified according to Virchow's triad, including hypercoagulability, stasis, and endothelial injury. Contrast-enhanced computed tomography (CT) is the method of choice for diagnosis. It demonstrates thrombosis as a contrast filling defect within the portomesenteric venous system and allows assessment of bowel viability. Important CT findings include bowel wall thickening, mesenteric edema, ascites, and the halo or target sign. Pneumatosis intestinalis and portomesenteric venous gas suggest transmural ischemia and indicate the need for immediate surgical management. Systemic anticoagulation is the cornerstone of treatment. Mechanical thrombectomy, local thrombolysis, stent angioplasty, and, where appropriate, TIPS placement may be considered in complex or prolonged clinical courses.

Early interdisciplinary, imaging-guided management is crucial for diagnosis and treatment planning. CT guides further management by detecting thrombosis and assessing bowel viability. Interventional radiological recanalization is not a first-line treatment, but it may represent an important escalation strategy in selected patients.

· Mesenteric venous thrombosis is an uncommon but clinically relevant cause of mesenteric ischemia.. · Early interdisciplinary diagnostic work-up is essential to prevent irreversible intestinal ischemic injury.. · Contrast-enhanced CT represents the key imaging modality, enabling both detection of venous thrombosis and assessment of bowel viability.. · In the absence of contraindications, systemic anticoagulation constitutes the cornerstone of treatment.. · Surgical management is indicated in the presence of suspected transmural bowel necrosis or clinical signs of peritonitis.. · Interventional radiological recanalization techniques may be considered as an escalation strategy in selected patients..

· Camp LC, Weber M, Arndt H. Mesenteric Vein Thrombosis and Its Interventional-Radiological Management. Rofo 2026; DOI 10.1055/a-2965-8425.