Superior mesenteric venous thrombosis: Endovascular management and outcomes

Khaled Alnahhal; Beau B Toskich; Samuel Nussbaum; Zhuo Li; Young Erben; Albert G Hakaim; Houssam Farres

doi:10.12998/wjcc.v10.i1.217

Superior mesenteric venous thrombosis: Endovascular management and outcomes

World J Clin Cases. 2022 Jan 7;10(1):217-226. doi: 10.12998/wjcc.v10.i1.217.

Authors

Khaled Alnahhal¹, Beau B Toskich², Samuel Nussbaum¹, Zhuo Li³, Young Erben¹, Albert G Hakaim¹, Houssam Farres⁴

Affiliations

¹ Department of Surgery, Division of Vascular Surgery, Mayo Clinic Florida, Jacksonville, FL 32224, United States.
² Department of Radiology, Mayo Clinic Florida, Jacksonville, FL 32224, United States.
³ Department of Biostatistics, Mayo Clinic Florida, Jacksonville, FL 32224, United States.
⁴ Department of Surgery, Division of Vascular Surgery, Mayo Clinic Florida, Jacksonville, FL 32224, United States. farres.houssam@mayo.edu.

Abstract

Background: Superior mesenteric venous thrombosis (SMVT) is a rare but fatal condition that is typically treated initially with anticoagulation therapy, and if this fails, with endovascular interventions. However, due to its rarity, there are not many studies that have explored the effectiveness of anticoagulation and endovascular therapies in treating SMVT.

Aim: To evaluate patients diagnosed with SMVT who received endovascular therapy in addition to anticoagulation and report technical and clinical outcomes.

Methods: A retrospective analysis of the patients who underwent endovascular treatment for SMVT at Mayo Clinic from 2000-2019 was performed. Technical success was defined as angiographic improvement in SMV flow after intervention. Primary patency was defined as the interval from reestablishing mesenteric venous flow until the first repeat thrombotic event or need for additional intervention. Secondary patency was defined as successful restoration of flow after repeat intervention until rethrombosis or last follow-up. The adverse events were reported through Clavien-Dindo classification.

Results: Twenty-four patients were included for analysis. The median age at intervention was 60 years (35-74 years) and 16 (67%) were men. Nineteen patients presented with acute thrombosis (79.2%) and 5 with chronic thrombosis with acute manifestations (20.8%). The most commonly used endovascular modalities were thrombectomy in 12 patients (50.0%) and catheter-directed thrombolysis in 10 patients (41.7%). Technical success was achieved in 18 patients (75%). The 14-d and 30-d primary patency rates were 88.9% and 83.3%, respectively. Adverse events were reported in two patients (8.3%), one marked as grade IIIB, and 1 death marked as grade V. Five-year overall survival rate was 82% (58%-100%).

Conclusion: Endovascular intervention with anticoagulation appears to be effective for managing SMVT. This treatment combination may be considered as first-line therapy for SMVT management in select patients.

Keywords: Anticoagulation; Endovascular; Mesenteric; Retrospective; Superior mesenteric venous thrombosis; Thrombectomy; Thrombolysis.