Large thrombosed portomesenteric venous aneurysm treated with pharmacomechanical thrombolysis combined with TIPS placement

CVIR Endovascular

Adam B Schwertner¹  Alexander R Vogel²  R Peter Lokken³  Ryan Kohlbrenner³  Miles Conrad³ 

[1] Denver Health and Hospital Authority, University of Colorado - Denver, 660 N. Bannock St., Pavilion L, Floor 1, 80204, Denver, CO, United States;Renown Regional Medical Center, Reno Radiological Associates, 1155 Mill St, 89502, Reno, NV, United States;University of California - San Francisco, 505 Parnassus Ave, M361, 94143, San Francisco, CA, USA;

关键词: Portal vein;    Mesenteric veins;    Splanchnic circulation;    Aneurysm;    TIPS;    Thrombectomy;    Thrombosis;   

DOI  :  10.1186/s42155-022-00288-0

来源: Springer

【 摘 要 】

BackgroundAneurysms are rare anomalies of the portomesenteric venous system. Thrombotic complications of these lesions can lead to mesenteric venous ischemia and bowel infarction, potentially requiring surgical intervention. Herein we describe a case of mesenteric ischemia due to a large thrombosed portomesenteric aneurysm treated with endovascular techniques.Case presentationA 37-year-old previously healthy male who presented with abdominal pain to his local emergency department was found to have a thrombosed 12.0 × 5.1 cm portomesenteric venous aneurysm with evidence of mesenteric ischemia on CT. When conservative management with anticoagulation failed, transhepatic pharmacomechanical thrombolysis was initially performed. This was followed by TIPS placement with additional trans-TIPS thrombectomy to improve sluggish portal outflow and prevent re-thrombosis. The patient’s symptoms and imaging findings of ischemia resolved after endovascular therapy. No surgical intervention was required, and the patient was discharged on enoxaparin before being transitioned to apixaban. The TIPS remained patent at 2-year follow-up, with no change in the size of the aneurysm or re-thrombosis noted. The patient’s synthetic liver function was preserved with no evidence of hepatic encephalopathy during the follow-up period.ConclusionsEndovascular therapies may be used to manage thrombotic complications of portomesenteric venous aneurysms, obviating the need for surgical intervention in selected patients.

【 授权许可】

CC BY