Catheter-Directed Thrombolysis in the treatment of acute Portomesenteric Vein Thrombosis after Laparoscopic Sleeve Gastrectomy
Abstract Background Portomesenteric Vein Thrombosis (PMVT) following Laparoscopic Sleeve Gastrectomy (LSG) is an uncommon but potentially debilitating complication. Catheter-Directed Thrombolysis (CDT) has an evolving role in recanalizing the venous flow and preventing thrombus propagation. Therefor...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-09-01
|
| Series: | Thrombosis Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12959-022-00415-w |
| _version_ | 1818025994552868864 |
|---|---|
| author | Ali Barah Israa Al-Hashimi Rahil Kassamali Qayed Aldebyani Omran Almokdad Ayman Elmagdoub Mohammed Khader Saad U. Rehman Ahmed Omar |
| author_facet | Ali Barah Israa Al-Hashimi Rahil Kassamali Qayed Aldebyani Omran Almokdad Ayman Elmagdoub Mohammed Khader Saad U. Rehman Ahmed Omar |
| author_sort | Ali Barah |
| collection | DOAJ |
| description | Abstract Background Portomesenteric Vein Thrombosis (PMVT) following Laparoscopic Sleeve Gastrectomy (LSG) is an uncommon but potentially debilitating complication. Catheter-Directed Thrombolysis (CDT) has an evolving role in recanalizing the venous flow and preventing thrombus propagation. Therefore, it can be used as an alternative or in combination with systemic anticoagulants in selected patients. We report two trans-hepatic and trans-splenic CDT. The patient’s clinical details, radiological findings, safety, and efficacy are reported. Cases presentation Two patients presented to the Emergency Department (ED) within 14 days of surgery. The presenting complaints were generally nonspecific. The diagnosis of PMVT was established in both patients based on abdominal Contrast-Enhanced Computed Tomography (CECT). The two patients received a combined therapy of subcutaneous (SC) heparinization and CDT using a trans-hepatic approach in case 1 and a trans-splenic approach in case 2. Subsequent post-procedure venograms and CECT were performed and showed significant thrombus resolution. Both patients received oral anticoagulant therapy upon discharge with a successful overall recovery. Conclusion PMVT is an infrequent and severe post LSG complication. Various approaches for re-establishing the portal venous flow have been described according to the severity of venous thrombosis. This article describes CDT therapy as a safe and effective option for treating PMVT in symptomatic patients. |
| first_indexed | 2024-12-10T04:24:57Z |
| format | Article |
| id | doaj.art-923ddd068aee427a8d07807b90135149 |
| institution | Directory Open Access Journal |
| issn | 1477-9560 |
| language | English |
| last_indexed | 2024-12-10T04:24:57Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Thrombosis Journal |
| spelling | doaj.art-923ddd068aee427a8d07807b901351492022-12-22T02:02:18ZengBMCThrombosis Journal1477-95602022-09-012011610.1186/s12959-022-00415-wCatheter-Directed Thrombolysis in the treatment of acute Portomesenteric Vein Thrombosis after Laparoscopic Sleeve GastrectomyAli Barah0Israa Al-Hashimi1Rahil Kassamali2Qayed Aldebyani3Omran Almokdad4Ayman Elmagdoub5Mohammed Khader6Saad U. Rehman7Ahmed Omar8Clinical Imaging Department, Hamad Medical CorporationClinical Imaging Department, Hamad Medical CorporationClinical Imaging Department, Hamad Medical CorporationClinical Imaging Department, Hamad Medical CorporationClinical Imaging Department, Hamad Medical CorporationClinical Imaging Department, Hamad Medical CorporationClinical Imaging Department, Hamad Medical CorporationClinical Imaging Department, Hamad Medical CorporationClinical Imaging Department, Hamad Medical CorporationAbstract Background Portomesenteric Vein Thrombosis (PMVT) following Laparoscopic Sleeve Gastrectomy (LSG) is an uncommon but potentially debilitating complication. Catheter-Directed Thrombolysis (CDT) has an evolving role in recanalizing the venous flow and preventing thrombus propagation. Therefore, it can be used as an alternative or in combination with systemic anticoagulants in selected patients. We report two trans-hepatic and trans-splenic CDT. The patient’s clinical details, radiological findings, safety, and efficacy are reported. Cases presentation Two patients presented to the Emergency Department (ED) within 14 days of surgery. The presenting complaints were generally nonspecific. The diagnosis of PMVT was established in both patients based on abdominal Contrast-Enhanced Computed Tomography (CECT). The two patients received a combined therapy of subcutaneous (SC) heparinization and CDT using a trans-hepatic approach in case 1 and a trans-splenic approach in case 2. Subsequent post-procedure venograms and CECT were performed and showed significant thrombus resolution. Both patients received oral anticoagulant therapy upon discharge with a successful overall recovery. Conclusion PMVT is an infrequent and severe post LSG complication. Various approaches for re-establishing the portal venous flow have been described according to the severity of venous thrombosis. This article describes CDT therapy as a safe and effective option for treating PMVT in symptomatic patients.https://doi.org/10.1186/s12959-022-00415-wLaparoscopic Sleeve GastrectomyPortomesenteric Vein ThrombosisCatheter-Directed Thrombolysis |
| spellingShingle | Ali Barah Israa Al-Hashimi Rahil Kassamali Qayed Aldebyani Omran Almokdad Ayman Elmagdoub Mohammed Khader Saad U. Rehman Ahmed Omar Catheter-Directed Thrombolysis in the treatment of acute Portomesenteric Vein Thrombosis after Laparoscopic Sleeve Gastrectomy Thrombosis Journal Laparoscopic Sleeve Gastrectomy Portomesenteric Vein Thrombosis Catheter-Directed Thrombolysis |
| title | Catheter-Directed Thrombolysis in the treatment of acute Portomesenteric Vein Thrombosis after Laparoscopic Sleeve Gastrectomy |
| title_full | Catheter-Directed Thrombolysis in the treatment of acute Portomesenteric Vein Thrombosis after Laparoscopic Sleeve Gastrectomy |
| title_fullStr | Catheter-Directed Thrombolysis in the treatment of acute Portomesenteric Vein Thrombosis after Laparoscopic Sleeve Gastrectomy |
| title_full_unstemmed | Catheter-Directed Thrombolysis in the treatment of acute Portomesenteric Vein Thrombosis after Laparoscopic Sleeve Gastrectomy |
| title_short | Catheter-Directed Thrombolysis in the treatment of acute Portomesenteric Vein Thrombosis after Laparoscopic Sleeve Gastrectomy |
| title_sort | catheter directed thrombolysis in the treatment of acute portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy |
| topic | Laparoscopic Sleeve Gastrectomy Portomesenteric Vein Thrombosis Catheter-Directed Thrombolysis |
| url | https://doi.org/10.1186/s12959-022-00415-w |
| work_keys_str_mv | AT alibarah catheterdirectedthrombolysisinthetreatmentofacuteportomesentericveinthrombosisafterlaparoscopicsleevegastrectomy AT israaalhashimi catheterdirectedthrombolysisinthetreatmentofacuteportomesentericveinthrombosisafterlaparoscopicsleevegastrectomy AT rahilkassamali catheterdirectedthrombolysisinthetreatmentofacuteportomesentericveinthrombosisafterlaparoscopicsleevegastrectomy AT qayedaldebyani catheterdirectedthrombolysisinthetreatmentofacuteportomesentericveinthrombosisafterlaparoscopicsleevegastrectomy AT omranalmokdad catheterdirectedthrombolysisinthetreatmentofacuteportomesentericveinthrombosisafterlaparoscopicsleevegastrectomy AT aymanelmagdoub catheterdirectedthrombolysisinthetreatmentofacuteportomesentericveinthrombosisafterlaparoscopicsleevegastrectomy AT mohammedkhader catheterdirectedthrombolysisinthetreatmentofacuteportomesentericveinthrombosisafterlaparoscopicsleevegastrectomy AT saadurehman catheterdirectedthrombolysisinthetreatmentofacuteportomesentericveinthrombosisafterlaparoscopicsleevegastrectomy AT ahmedomar catheterdirectedthrombolysisinthetreatmentofacuteportomesentericveinthrombosisafterlaparoscopicsleevegastrectomy |