Christoph Klinger1, Bettina Riecken1, Arthur Schmidt1, Andrea De Gottardi2, Benjamin Meier1, Jaime Bosch3, Karel Caca4. 1. Department of Gastroenterology, Hepatology and Oncology, Hospital of Ludwigsburg, Germany. 2. Hepatology, Inselspital, University of Berne, Switzerland. 3. Hepatology, Inselspital, University of Berne, Switzerland; Hepatic Hemodynamic Laboratory, Liver Unit Hospital Cliníc, IDIBAPS and Ciberehd, Barcelona, Spain. 4. Department of Gastroenterology, Hepatology and Oncology, Hospital of Ludwigsburg, Germany; Hepatology, Inselspital, University of Berne, Switzerland. Electronic address: karel.caca@kliniken-lb.de.
Abstract
BACKGROUND & AIMS: Therapeutic anticoagulation is the standard treatment in patients with acute non-cirrhotic portal vein thrombosis (PVT). In critically ill patients, anticoagulation only may not suffice to achive rapid and stable recanalization. This study evaluates efficacy and safety of transjugular interventional therapy in acute non-cirrhotic PVT. METHODS: This retrospective study includes 17 consecutive patients with acute noncirrhotic, non-malignant PVT. Main indication for interventional therapy was imminent intestinal infarction (n=10). Treatment consisted of a combination of transjugular thrombectomy, local fibrinolysis and - depending on thrombus resolution - transjugular intrahepatic portosystemic shunt. RESULTS: Recanalization was successful in 94.1%. One- and two-year secondary PV patency rates were 88.2%. Major complications (n=3) resolved spontaneously in all but one patient (heparin induced thrombocytopenia type 2 with intestinal infarction). Symptoms improved in all patients. However, segmental bowel resection had to be performed in two (11.8%). During a median follow-up of 28.6 months, no patient experienced portal hypertensive complications. Presence of JAK2 V617F mutation predicted both short-term and long-term technical success. CONCLUSIONS: Transjugular recanalization is safe and effective in patients with acute non-cirrhotic, non-malignant PVT. It should be considered especially in patients with imminent bowel infarction and low likelihood of recanalization following therapeutic anticoagulation. Patients with JAK2 mutation ought to be followed meticulously.
BACKGROUND & AIMS: Therapeutic anticoagulation is the standard treatment in patients with acute non-cirrhotic portal vein thrombosis (PVT). In critically illpatients, anticoagulation only may not suffice to achive rapid and stable recanalization. This study evaluates efficacy and safety of transjugular interventional therapy in acute non-cirrhotic PVT. METHODS: This retrospective study includes 17 consecutive patients with acute noncirrhotic, non-malignant PVT. Main indication for interventional therapy was imminent intestinal infarction (n=10). Treatment consisted of a combination of transjugular thrombectomy, local fibrinolysis and - depending on thrombus resolution - transjugular intrahepatic portosystemic shunt. RESULTS: Recanalization was successful in 94.1%. One- and two-year secondary PV patency rates were 88.2%. Major complications (n=3) resolved spontaneously in all but one patient (heparin induced thrombocytopenia type 2 with intestinal infarction). Symptoms improved in all patients. However, segmental bowel resection had to be performed in two (11.8%). During a median follow-up of 28.6 months, no patient experienced portal hypertensive complications. Presence of JAK2 V617F mutation predicted both short-term and long-term technical success. CONCLUSIONS: Transjugular recanalization is safe and effective in patients with acute non-cirrhotic, non-malignant PVT. It should be considered especially in patients with imminent bowel infarction and low likelihood of recanalization following therapeutic anticoagulation. Patients with JAK2 mutation ought to be followed meticulously.
Authors: Sandra Emily Stoll; Patrick Werner; Wolfgang A Wetsch; Fabian Dusse; Alexander C Bunck; Matthias Kochanek; Felix Popp; Thomas Schmidt; Christiane Bruns; Bernd W Böttiger Journal: J Med Case Rep Date: 2022-07-11
Authors: Charlotte Ebeling Barbier; Fredrik Rorsman; Lars-Gunnar Eriksson; Per Sangfelt; Reza Sheikhi; Johan Vessby; Rickard Nyman Journal: Acta Radiol Open Date: 2020-10-13
Authors: Dhiraj Tripathi; Adrian J Stanley; Peter C Hayes; Simon Travis; Matthew J Armstrong; Emmanuel A Tsochatzis; Ian A Rowe; Nicholas Roslund; Hamish Ireland; Mandy Lomax; Joanne A Leithead; Homoyon Mehrzad; Richard J Aspinall; Joanne McDonagh; David Patch Journal: Gut Date: 2020-02-29 Impact factor: 23.059