AngioJet aspiration thrombectomy combined with transcatheter thrombolysis in treatment of acute portal venous systemic thrombosis

Objective To study the feasibility and clinical effects of percutaneous AngioJet thrombectomy combined with transcatheter thrombolysis in the treatment of acute portal venous systemic thrombosis (APVST). Methods The clinical data of 13 patients with APVST from Mach 2017 to July 2018 were analyzed retrospectively. Transcatheter thrombolysis was performed after AngioJet aspiration thrombectomy. The duration of thrombus aspiration, thrombolysis time, urokinase dosage and complications were recorded. The effect of the volume reduction of portal venous systemic thrombosis was evaluated by intraoperative angiography and postoperative follow-up results. Complaints and signs were recorded during follow-up, and portal venous ultrasound or CT were applied. Results The portal vein was punctured successfully in 7 cases via transjugular intrahepatic route, 2 cases failed to be punctured and were replaced by percutaneous transhepatic puncture, and 4 cases underwent percutaneous transhepatic portal vein access successfully. Duration of thrombus aspiration was(238.46±89.89) s, amount of urokinase in thrombus aspiration was(35.38±8.77) ten thousand units. Portal and superior mesenteric venous thrombosis was dissolved by AngioJet thrombectomy device in all 13 patients, grade Ⅲ thrombolysis was achieved in 8 patients and grade Ⅱ lysis in 1 patient, grade Ⅰ lysis in 4 patients. Length of transcatheter thrombolysis was(3.07±1.75) days, total UK dose was (123.08±70.63) ten thousand units. During the procedure, transjugular intrahepatic portosystemic shunt (TIPS) was co-applied in 4 patients; balloon angioplasty and stent were co-applied in 2 patient with stenosis of superior mesenteric vein (SMV), respectively. 1 patient underwent intestinal necrosis resection 1 day after surgery. Operative complications were transient hematuria (4 cases) and palpitation (1 case). Patients were discharged in (12.00±5.83) days after admission. No recurrence developed during the follow-up of (9.15±3.18) months. Conclusion AngioJet aspiration thrombectomy with adjunctive thrombolytic therapy is feasible and effective for APVST, and this procedure can effectively restore portal vein blood flow and relieve symptoms. Key words: Acute portal vein thrombosis; AngioJet; Percutaneous mechanical thrombectomy; Trans-catheter thrombolysis