Endovascular treatment for nonacute symptomatic portal venous thrombosis through intrahepatic portosystemic shunt approach.

PURPOSE: To study the safety and efficacy of nonacute symptomatic portal vein thrombosis (PVT) treated by mechanical thrombectomy combined with pharmacologic thrombolysis through an intrahepatic portosystemic shunt (IPS) approach.

MATERIALS AND METHODS: Thirteen patients with nonacute symptomatic PVT were included in this study: five women and eight men, with a mean age of 48.9 y. Indications for therapy were variceal bleeding (n = 7) and abdominal pain, distension, or intermittent melena (n = 6). Through an IPS approach, balloon angioplasty, sheath-directed thrombus aspiration, and continuous infusion of urokinase were performed. Clinical follow-up was performed in all patients.

RESULTS: An IPS was successfully created in all patients. After therapy, recanalization of all thrombosed main PVs was achieved. A majority of thrombus was removed and lysed. The overall rate of clinical improvement was 92.3%. One patient died of intraperitoneal bleeding the second day after the procedure, and another two patients experienced minor complications after therapy and recovered completely after conservative medical management. During a mean of 14.9 months of follow-up, two patients experienced recurrent variceal bleeding as a result of shunt dysfunction. Hemostasis was achieved after shunt revision. No other complications occurred.

CONCLUSIONS: Through an IPS approach, mechanical thrombectomy combined with pharmacologic thrombolysis was possible as a therapeutic option for patients with nonacute symptomatic PVT.