Symptomatic spleno-mesenteric-portal venous thrombosis: Recanalization and reconstruction with endovascular stents

Moni Stein, Daniel P Link

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

PURPOSE: To evaluate the safety and efficacy of portal reconstruction in patients with symptomatic spleno-mesenteric-portal venous thrombosis. MATERIALS AND METHODS: Portal reconstruction was attempted in 21 patients (seven women, 14 men; mean age, 53.6 years ± 15.2) with chronic thrombosis of the portal vein alone (n = 8), splenic vein alone (n = 3), or portal, mesenteric, and splenic veins (n = 10). Indications for the procedure were bleeding varices (n = 15), ascites (n = 2), hypersplenism (n = 2), and enteropathy (n = 2). Sixteen procedures were started transhepatically and of these seven were converted to a transjugular intrahepatic portosystemic shunt (TIPS) after successful recanalization of the thrombosed vein. In six patients reconstructions were performed using an intrahepatic portal vein as outflow. Five procedures were performed primarily as TIPS. Wallstents dilated to 7-10 mm were used for reconstruction. The mean follow-up period was 15.2 months ± 15.9. RESULTS: Technical success of portal reconstruction was 85.7% (18 of 21). Thirty-day mortality was 14.3% (three of 21) but was not procedural related. The cumulative rates of survival, primary patency, and palliation at 43 months of follow-up were 61.2% ± 13.5%, 63.5% ± 15.3%, and 31.7% ± 15.7%, respectively. Secondary patency was 79.1% ± 13.8%. The only predictor of mortality was the presence of liver disease (P = .001, Cox regression). CONCLUSION: Portal reconstruction is a safe and effective treatment option for patients with symptomatic chronic portal thrombosis. Liver disease predisposes to a higher mortality.

Original languageEnglish (US)
Pages (from-to)363-371
Number of pages9
JournalJournal of Vascular and Interventional Radiology
Volume10
Issue number3
StatePublished - Mar 1999

Fingerprint

Stents
Portal Vein
Splenic Vein
Transjugular Intrahepatic Portasystemic Shunt
Thrombosis
Mortality
Liver Diseases
Hypersplenism
Mesenteric Veins
Varicose Veins
Ascites
Veins
Survival Rate
Hemorrhage
Safety
Mesenteric Ischemia
Therapeutics

Keywords

  • Portal vein, stenosis or obstruction
  • Portal vein, thrombosis
  • Shunts, portosystemic
  • Stents and prostheses

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Symptomatic spleno-mesenteric-portal venous thrombosis : Recanalization and reconstruction with endovascular stents. / Stein, Moni; Link, Daniel P.

In: Journal of Vascular and Interventional Radiology, Vol. 10, No. 3, 03.1999, p. 363-371.

Research output: Contribution to journalArticle

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abstract = "PURPOSE: To evaluate the safety and efficacy of portal reconstruction in patients with symptomatic spleno-mesenteric-portal venous thrombosis. MATERIALS AND METHODS: Portal reconstruction was attempted in 21 patients (seven women, 14 men; mean age, 53.6 years ± 15.2) with chronic thrombosis of the portal vein alone (n = 8), splenic vein alone (n = 3), or portal, mesenteric, and splenic veins (n = 10). Indications for the procedure were bleeding varices (n = 15), ascites (n = 2), hypersplenism (n = 2), and enteropathy (n = 2). Sixteen procedures were started transhepatically and of these seven were converted to a transjugular intrahepatic portosystemic shunt (TIPS) after successful recanalization of the thrombosed vein. In six patients reconstructions were performed using an intrahepatic portal vein as outflow. Five procedures were performed primarily as TIPS. Wallstents dilated to 7-10 mm were used for reconstruction. The mean follow-up period was 15.2 months ± 15.9. RESULTS: Technical success of portal reconstruction was 85.7{\%} (18 of 21). Thirty-day mortality was 14.3{\%} (three of 21) but was not procedural related. The cumulative rates of survival, primary patency, and palliation at 43 months of follow-up were 61.2{\%} ± 13.5{\%}, 63.5{\%} ± 15.3{\%}, and 31.7{\%} ± 15.7{\%}, respectively. Secondary patency was 79.1{\%} ± 13.8{\%}. The only predictor of mortality was the presence of liver disease (P = .001, Cox regression). CONCLUSION: Portal reconstruction is a safe and effective treatment option for patients with symptomatic chronic portal thrombosis. Liver disease predisposes to a higher mortality.",
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N2 - PURPOSE: To evaluate the safety and efficacy of portal reconstruction in patients with symptomatic spleno-mesenteric-portal venous thrombosis. MATERIALS AND METHODS: Portal reconstruction was attempted in 21 patients (seven women, 14 men; mean age, 53.6 years ± 15.2) with chronic thrombosis of the portal vein alone (n = 8), splenic vein alone (n = 3), or portal, mesenteric, and splenic veins (n = 10). Indications for the procedure were bleeding varices (n = 15), ascites (n = 2), hypersplenism (n = 2), and enteropathy (n = 2). Sixteen procedures were started transhepatically and of these seven were converted to a transjugular intrahepatic portosystemic shunt (TIPS) after successful recanalization of the thrombosed vein. In six patients reconstructions were performed using an intrahepatic portal vein as outflow. Five procedures were performed primarily as TIPS. Wallstents dilated to 7-10 mm were used for reconstruction. The mean follow-up period was 15.2 months ± 15.9. RESULTS: Technical success of portal reconstruction was 85.7% (18 of 21). Thirty-day mortality was 14.3% (three of 21) but was not procedural related. The cumulative rates of survival, primary patency, and palliation at 43 months of follow-up were 61.2% ± 13.5%, 63.5% ± 15.3%, and 31.7% ± 15.7%, respectively. Secondary patency was 79.1% ± 13.8%. The only predictor of mortality was the presence of liver disease (P = .001, Cox regression). CONCLUSION: Portal reconstruction is a safe and effective treatment option for patients with symptomatic chronic portal thrombosis. Liver disease predisposes to a higher mortality.

AB - PURPOSE: To evaluate the safety and efficacy of portal reconstruction in patients with symptomatic spleno-mesenteric-portal venous thrombosis. MATERIALS AND METHODS: Portal reconstruction was attempted in 21 patients (seven women, 14 men; mean age, 53.6 years ± 15.2) with chronic thrombosis of the portal vein alone (n = 8), splenic vein alone (n = 3), or portal, mesenteric, and splenic veins (n = 10). Indications for the procedure were bleeding varices (n = 15), ascites (n = 2), hypersplenism (n = 2), and enteropathy (n = 2). Sixteen procedures were started transhepatically and of these seven were converted to a transjugular intrahepatic portosystemic shunt (TIPS) after successful recanalization of the thrombosed vein. In six patients reconstructions were performed using an intrahepatic portal vein as outflow. Five procedures were performed primarily as TIPS. Wallstents dilated to 7-10 mm were used for reconstruction. The mean follow-up period was 15.2 months ± 15.9. RESULTS: Technical success of portal reconstruction was 85.7% (18 of 21). Thirty-day mortality was 14.3% (three of 21) but was not procedural related. The cumulative rates of survival, primary patency, and palliation at 43 months of follow-up were 61.2% ± 13.5%, 63.5% ± 15.3%, and 31.7% ± 15.7%, respectively. Secondary patency was 79.1% ± 13.8%. The only predictor of mortality was the presence of liver disease (P = .001, Cox regression). CONCLUSION: Portal reconstruction is a safe and effective treatment option for patients with symptomatic chronic portal thrombosis. Liver disease predisposes to a higher mortality.

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