| Background and Objective Acute portal venous systemic thrombosis(APVST)usually refers to the thrombosis of the portal venous system with symptoms lasting less than 4 weeks,including portal vein branches,mesenteric vein and splenic vein.Portal vein thrombosis is not uncommon clinically,but its symptoms and signs are not typical.Early misdiagnosis and missed diagnosis are easy.Conventional therapies for APVST that have been clinically reported include anticoagulation,indirect thrombolysis via superior mesenteric artery(SMA),catheter-directed thrombolysis(CDT)through percutaneous transhepatic or transjugular intrahepatic portosystemic shunt(TIPS).Anticoagulation is the basic treatment of portal venous systemic thrombosis(PVST).For acute portal vein systemic thrombosis with definite diagnosis and no anticoagulation contraindication,anticoagulation can prevent the spread and development of thrombosis,and has the possibility of restoring portal recanalization.However,in patients receiving systemic anticoagulation,there are differences in recanalization rate of portal vein thrombosis,and thrombosis may continue to develop and spread.Compared with systemic anticoagulation therapy,catheter-directed thrombolytic(CDT)therapy through various interventional approaches can directly indwell in the venous lumen of thrombosis.The catheter can use smaller dosage of thrombolytic drugs and dissolve thrombus directly and effectively.It can restore venous blood flow faster and reduce portal venous pressure.At the same time,CDT requires long treatment time,and the potential bleeding risk of long-term thrombolysis,such as bleeding at the puncture site,severe intraperitoneal hemorrhage and cerebral hemorrhage,are still the main complications.CDT thrombolysis requires frequent monitoring of blood coagulation function,long bedridden pumping of drugs and hospitalization cycles increase the economic and psychological burden of patients,which to some extent limit its application.Percutaneous mechanical thrombectomy(PMT),as a new method for thrombosis treatment,has been widely used in the treatment of coronary artery,lower extremity arteries and veins,pulmonary artery,hemodialysis pathway thrombosis at abroad because of its short thrombolytic clearance time and no thrombolytic substitution in massive hemorrhage.Angio Jet Ultra thrombus aspiration system is an innovative tool for thrombus clearance.Because it can effectively remove thrombus load and open blood vessels in a short time,it has been widely used in limb arteriovenous thrombosis diseases.However,clinical research on the application of Angio Jet Ultra thrombus aspiration system in portal venous systemic thrombosis has not been studied.We analyzed the clinical data of 20 patients with acute and subacute PVST treated by Angio Jet catheter thrombolysis device retrospectively and analyzed its immediate and long-term efficacy to evaluate the feasibility,efficacy and safety of Angio Jet mechanical thrombolysis combined with transcatheter thrombolysis in the treatment of portal venous thrombosis.Method The clinical data of 20 patients with APVST from Mar 2017 to Dec 2018 were analyzed retrospectively in the Endovascular Surgery Department of the First Affiliated Hospital of Zhengzhou University.Transcatheter thrombolysis was performed after Angio Jet aspiration thrombectomy.The duration of thrombus aspiration,thrombolysis route,thrombolysis time,urokinase dosage and complications were recorded.The effect of the volume reduction of portal venous systemic thrombosis and long-term patency was evaluated by observing the intraoperative angiography and postoperative follow-up results.The follow-ups included complaints,signs,and portal venous ultrasound or CT.Result A total of 20 patients were included in this study.Successful puncture of portal vein was performed in all patients,the portal vein was punctured successfully in 13 patients via transjugular intrahepatic route,2 patients failed to be punctured and were replaced by percutaneous transhepatic puncture,1 patient was successfully punctured through transjugular intrahepatic route with the assistance of percutaneous transhepatic puncture and 4 patients underwent percutaneous transhepatic portal vein successfully.Duration of thrombus aspiration was(262.50±93.40)s and the amount of urokinase in thrombus aspiration was(35.00±8.88)×104U.Portal and superior mesenteric venous thrombosis was dissolved by Angio Jet thrombectomy device in all20 patients,grade ? thrombolysis was achieved in 13 patients and grade ? lysis in 2patients,grade ? lysis in 5 patients.8 patients achieved TIPS;1 patient with stenosis of superior mesenteric vein(SMV)achieved balloon angioplasty;1 patient with stenosis of SMV was stented.Length of transcatheter thrombolysis was(3.05±1.73)days,the dosage of urokinase was(128.00±83.95)×104U.At the completion of transcatheter thrombolysis,angiography showed that 17 patients had grade III clearance and 3patients had grade II clearance.No thrombolytic complications occurred.1 patient underwent intestinal necrosis resection 1 day after surgery.Operative complications were transient hematuria(6 cases)and palpitation(2 case).Patients were discharged in(11.40±6.85)days after admission.No patients died within 30 days.All patients survived and no recurrence developed during the follow–up of(11.00±5.20)months.Stent blood flow was unobstructed in patients with SMV stent implantation.During the follow-up of 8 patients who achieved TIPS,2 of them had shunt dysfunction,including 1 patient of stent "capping" and 1 patient of shunt stenosis.No hepatic encephalopathy occurred.Conclusion Angio Jet aspiration thrombectomy with adjunctive thrombolytic therapy is feasible and effective for APVST.For patients with obvious abdominal symptoms and anticoagulation fails to prevent a new ischemic event,this treatment can effectively restore portal venous recanalization and relieve symptoms.This method can also help to reverse the extensive and local ischemic intestinal tract,avoid intestinal resection in patients without peritonitis,and prevent the occurrence of short bowel syndrome in patients with mild and localized peritonitis and suspected intestinal necrosis.Further evaluation of the treatment and its clinical effects should continue. |
PDF Full Text Request