Radiological and clinical outcomes of transcatheter thrombolysis via superior mesenteric artery vs percutaneous mechanical thrombectomy in patients with anticoagulation-refractory acute mesenteric venous thrombosis.

Background

The aim of this study was to evaluate the safety and efficacy of indirect catheter-directed thrombolysis (CDT) via the superior mesenteric artery (SMA) and percutaneous mechanical thrombectomy (PMT) for acute mesenteric venous thrombosis (MVT).

Methods

From December 2020 to March 2024, the clinical data of patients with acute MVT who received endovascular therapy were retrospectively reviewed. Patients were stratified by the treatment strategy. The primary outcome measure was technical success, which was assessed by thrombolysis grade. Secondary outcomes were complications, time to resume oral intake, dosage of Urokinase used, postischemia intestinal stenosis and mortality.

Results

Forty-two consecutive patients were identified. CDT was initiated in 24 patients, and 18 patients received PMT treatment. In PMT group, 13 patients (72.2%) received adjunctive indirect CDT after mechanical thrombectomy. The time of thrombolysis and dosage of Urokinase were both less in PMT group(P<0.05). The bowl rest time is less in PMT group (8 vs 5 days; P<0.05). No difference was found in perioperative complications, mortality and bowel stricture between two groups. More patients in the PMT group had better revascularization with lysis grade of III (0% vs 38.9%, P<0.05) and fully revascularization (0% vs 27.8%, P<0.05).

Conclusions

Compared with indirect CDT via SMA, PMT is an effective treatment for anticoagulation-refractory acute MVT without increasing safety risks.