Transhepatic catheter-directed thrombolysis for portal vein thrombosis after partial splenic embolization in combination with balloon-occluded retrograde transvenous obliteration of splenorenal shunt

doi:10.3748/wjg.v12.i31.5071

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Aug 21, 2006 (publication date) through Nov 4, 2024

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Aug 21, 2006; 12(31): 5071-5074
Published online Aug 21, 2006. doi: 10.3748/wjg.v12.i31.5071

Transhepatic catheter-directed thrombolysis for portal vein thrombosis after partial splenic embolization in combination with balloon-occluded retrograde transvenous obliteration of splenorenal shunt

Motoki Nakai, Morio Sato, Shinya Sahara, Nobuyuki Kawai, Masashi Kimura, Yoshimasa Maeda, Yumiko Ibata, Katsuhiko Higashi

Motoki Nakai, Morio Sato, Shinya Sahara, Nobuyuki Kawai, Masashi Kimura, Department of Radiology, Wakayama Medical University, 811-1, Kimiidera, Wakayama Shi, Wakayama 641-8510, Japan

Yoshimasa Maeda, Yumiko Ibata, Katsuhiko Higashi, the First Department of Internal Medicine, Hidaka General Hospital, 116-2 Sono, Gobo Shi, Wakayama 644-8655, Japan

Author contributions: All authors contributed equally to the work.

Correspondence to: Motoki Nakai, Department of Radiology, Hidaka General Hospital, 116-2 Sono, Gobo Shi, Wakayama 644-8655, Japan. nakai@hidakagh.gobo.wakayama.jp

Telephone: +81-738-221111 Fax: +81-738-232253

Received: April 7, 2006
Revised: April 20, 2006
Accepted: April 27, 2006
Published online: August 21, 2006

Abstract

A 66-year-old woman underwent partial splenic embolization (PSE) for hypersplenism with idiopathic portal hypertension (IPH). One week later, contrast-enhanced CT revealed extensive portal vein thrombosis (PVT) and dilated portosystemic shunts. The PVT was not dissolved by the intravenous administration of urokinase. The right portal vein was canulated via the percutaneous transhepatic route under ultrasonic guidance and a 4 Fr. straight catheter was advanced into the portal vein through the thrombus. Transhepatic catheter-directed thrombolysis was performed to dissolve the PVT and a splenorenal shunt was concurrently occluded to increase portal blood flow, using balloon-occluded retrograde transvenous obliteration (BRTO) technique. Subsequent contrast-enhanced CT showed good patency of the portal vein and thrombosed splenorenal shunt. Transhepatic catheter-directed thrombolysis combined with BRTO is feasible and effective for PVT with portosystemic shunts.

Keywords: Portal vein thrombosis; Idiopathic portal hypertension; Partial splenic embolization; Portosystemic shunts; Transhepatic catheter-directed thrombolysis; Balloon-occluded retrograde transvenous obliteration