Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 7, 2022; 10(1): 217-226
Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.217
Superior mesenteric venous thrombosis: Endovascular management and outcomes
Khaled Alnahhal, Beau B Toskich, Samuel Nussbaum, Zhuo Li, Young Erben, Albert G Hakaim, Houssam Farres
Khaled Alnahhal, Samuel Nussbaum, Young Erben, Albert G Hakaim, Houssam Farres, Department of Surgery, Division of Vascular Surgery, Mayo Clinic Florida, Jacksonville, FL 32224, United States
Beau B Toskich, Department of Radiology, Mayo Clinic Florida, Jacksonville, FL 32224, United States
Zhuo Li, Department of Biostatistics, Mayo Clinic Florida, Jacksonville, FL 32224, United States
Author contributions: Alnahhal K, Nussbaum S, and Farres H designed the study; Alnahhal K, Nussbaum S, and Li Z participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Toskich BB, Erben YM, Hakaim AG, and Farres H revised the article critically for important intellectual content.
Institutional review board statement: The study was reviewed and approved by the Mayo Clinic Institutional Review Board (Approval No. 19-005202).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare that there are no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Houssam Farres, MD, Doctor, Surgeon, Department of Surgery, Division of Vascular Surgery, Mayo Clinic Florida, 4500 San Pablo Road South, Jacksonville, FL 32224, United States. farres.houssam@mayo.edu
Received: July 16, 2021
Peer-review started: July 16, 2021
First decision: August 19, 2021
Revised: September 5, 2021
Accepted: November 28, 2021
Article in press: November 28, 2021
Published online: January 7, 2022
Processing time: 166 Days and 15.1 Hours
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: Superior mesenteric venous thrombosis; Endovascular; Anticoagulation; Retrospective; Thrombectomy; Mesenteric; Thrombolysis

Core Tip: Superior mesenteric venous thrombosis (SMVT) is a rare condition with a high mortality rate of up to 23%. In our retrospective study, we investigated the use of endovascular treatments after anticoagulation therapies had failed on patients diagnosed with SMVT. By looking at the technical success and patency rates after intervention, we evaluated the effectiveness of these endovascular interventions.