Kuetting Daniel, Wolter Karsten, Luetkens Julian, Trebicka Jonel, Praktiknjo Michael, Thomas Daniel, Meyer Carsten
University of Bonn, Germany.
Pol J Radiol. 2018 Dec 28;83:e536-e544. doi: 10.5114/pjr.2018.81380. eCollection 2018.
To evaluate AngioJet-assisted transvenous portal vein (PV) thrombectomy for non-cirrhotic patients with total portal vein and mesenteric vein thrombosis (PVMVT).
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).
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.
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.
评估AngioJet辅助经静脉门静脉（PV）血栓切除术治疗非肝硬化性全门静脉和肠系膜静脉血栓形成（PVMVT）患者的效果。
2015年至2016年，4例（3例男性，平均43.9岁，年龄范围33 - 52岁）急性（3例）和慢性急性（1例）PVMVT患者接受了经静脉溶栓治疗。所有患者均首先接受AngioJet（美国波士顿科学公司，马萨诸塞州纳蒂克）血栓切除术，随后用尿激酶（德国韦德尔Medac公司）进行持续导管定向溶栓22 - 52小时。所有患者均植入了使用Viatorr覆膜支架（美国亚利桑那州W.L. Gore及伙伴公司；平均直径：10 mm，长度：60 - 80 mm）的经颈静脉肝内门体分流术（TIPS）。对患者进行临床及影像学随访（平均646天，范围392至936天）。
技术成功率为100%。75%的病例获得治疗成功。AngioJet辅助血栓切除术在急性病例中显著降低了血栓负荷，而在慢性急性病例中仅略有改善。持续溶栓在急性病例中部分重建了PV血流，而在慢性急性病例中仅见极小改善。TIPS植入后，所有急性病例均实现了PV完全再通。在慢性急性病例中，最初可见PV血流停滞；然而，PV和TIPS在植入后10天再次闭塞。随访期间，急性病例中PV保持通畅。
AngioJet辅助血栓切除术在我们所有患者中技术上可行且操作简单。初步结果表明，AngioJet辅助血栓切除术有助于PVMVT急性和严重病例的再通。
