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AngioJet-assisted transvenous-transhepatic mechanical thrombectomy in the portal vein
PURPOSE: To evaluate AngioJet-assisted transvenous portal vein (PV) thrombectomy for non-cirrhotic patients with total portal vein and mesenteric vein thrombosis (PVMVT). MATERIAL AND METHODS: From 2015 to 2016 four patients (3 male, mean 43.9 years, range 33-52 years) with acute (3 cases) and acute...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Termedia Publishing House
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6386773/ https://www.ncbi.nlm.nih.gov/pubmed/30805065 http://dx.doi.org/10.5114/pjr.2018.81380 |
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author | Kuetting, Daniel Wolter, Karsten Luetkens, Julian Trebicka, Jonel Praktiknjo, Michael Thomas, Daniel Meyer, Carsten |
author_facet | Kuetting, Daniel Wolter, Karsten Luetkens, Julian Trebicka, Jonel Praktiknjo, Michael Thomas, Daniel Meyer, Carsten |
author_sort | Kuetting, Daniel |
collection | PubMed |
description | PURPOSE: To evaluate AngioJet-assisted transvenous portal vein (PV) thrombectomy for non-cirrhotic patients with total portal vein and mesenteric vein thrombosis (PVMVT). MATERIAL AND METHODS: From 2015 to 2016 four patients (3 male, mean 43.9 years, range 33-52 years) with acute (3 cases) and acute-on-chronic (1 case) PVMVT underwent transvenous thrombolysis. All patients received initial AngioJet (Boston Scientific, Natick, MA, USA) thrombectomy followed by continuous catheter directed thrombolysis with Urokinase (Medac, Wedel, Germany) for 22-52 hours. Transjugular intrahepatic portosystemic shunts (TIPS), using Viatorr stent grafts (W.L. Gore and Associates, AZ, USA; mean diameter: 10 mm, length: 60-80 mm), were implanted in all patients. Patients were followed clinically and with imaging (mean 646 days, range 392 to 936 days). RESULTS: Technical success was 100%. Therapeutic success was achieved in 75% of cases. AngioJet-assisted thrombectomy substantially reduced thrombus load in the acute cases, while only slight improvement was achieved in the acute-on-chronic case. Continuous thrombolysis subtotally re-established PV flow in the acute cases, while only minimal improvement was seen in the acute-on-chronic case. Following TIPS implantation complete PV recanalisation could be achieved in all acute cases. In the acute-on-chronic case initial stagnant PV flow was seen; however, PV and TIPS re-occluded 10 days after implantation. During follow-up PV remained patent in acute cases. CONCLUSIONS: AngioJet-assisted thrombectomy was technically feasible and uncomplicated in all of our patients. The initial results suggest that AngioJet-assisted thrombectomy facilitates recanalisation in acute and severe cases of PVMVT. |
format | Online Article Text |
id | pubmed-6386773 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Termedia Publishing House |
record_format | MEDLINE/PubMed |
spelling | pubmed-63867732019-02-25 AngioJet-assisted transvenous-transhepatic mechanical thrombectomy in the portal vein Kuetting, Daniel Wolter, Karsten Luetkens, Julian Trebicka, Jonel Praktiknjo, Michael Thomas, Daniel Meyer, Carsten Pol J Radiol Original Paper PURPOSE: To evaluate AngioJet-assisted transvenous portal vein (PV) thrombectomy for non-cirrhotic patients with total portal vein and mesenteric vein thrombosis (PVMVT). MATERIAL AND METHODS: From 2015 to 2016 four patients (3 male, mean 43.9 years, range 33-52 years) with acute (3 cases) and acute-on-chronic (1 case) PVMVT underwent transvenous thrombolysis. All patients received initial AngioJet (Boston Scientific, Natick, MA, USA) thrombectomy followed by continuous catheter directed thrombolysis with Urokinase (Medac, Wedel, Germany) for 22-52 hours. Transjugular intrahepatic portosystemic shunts (TIPS), using Viatorr stent grafts (W.L. Gore and Associates, AZ, USA; mean diameter: 10 mm, length: 60-80 mm), were implanted in all patients. Patients were followed clinically and with imaging (mean 646 days, range 392 to 936 days). RESULTS: Technical success was 100%. Therapeutic success was achieved in 75% of cases. AngioJet-assisted thrombectomy substantially reduced thrombus load in the acute cases, while only slight improvement was achieved in the acute-on-chronic case. Continuous thrombolysis subtotally re-established PV flow in the acute cases, while only minimal improvement was seen in the acute-on-chronic case. Following TIPS implantation complete PV recanalisation could be achieved in all acute cases. In the acute-on-chronic case initial stagnant PV flow was seen; however, PV and TIPS re-occluded 10 days after implantation. During follow-up PV remained patent in acute cases. CONCLUSIONS: AngioJet-assisted thrombectomy was technically feasible and uncomplicated in all of our patients. The initial results suggest that AngioJet-assisted thrombectomy facilitates recanalisation in acute and severe cases of PVMVT. Termedia Publishing House 2018-12-28 /pmc/articles/PMC6386773/ /pubmed/30805065 http://dx.doi.org/10.5114/pjr.2018.81380 Text en Copyright © Polish Medical Society of Radiology 2018 https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0). License allowing third parties to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially. |
spellingShingle | Original Paper Kuetting, Daniel Wolter, Karsten Luetkens, Julian Trebicka, Jonel Praktiknjo, Michael Thomas, Daniel Meyer, Carsten AngioJet-assisted transvenous-transhepatic mechanical thrombectomy in the portal vein |
title | AngioJet-assisted transvenous-transhepatic mechanical thrombectomy in the portal vein |
title_full | AngioJet-assisted transvenous-transhepatic mechanical thrombectomy in the portal vein |
title_fullStr | AngioJet-assisted transvenous-transhepatic mechanical thrombectomy in the portal vein |
title_full_unstemmed | AngioJet-assisted transvenous-transhepatic mechanical thrombectomy in the portal vein |
title_short | AngioJet-assisted transvenous-transhepatic mechanical thrombectomy in the portal vein |
title_sort | angiojet-assisted transvenous-transhepatic mechanical thrombectomy in the portal vein |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6386773/ https://www.ncbi.nlm.nih.gov/pubmed/30805065 http://dx.doi.org/10.5114/pjr.2018.81380 |
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