Transcatheter thrombolysis centered stepwise management strategy for acute superior mesenteric venous thrombosis Shuofei Yang, Xingjiang Wu, Jieshou.

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Transcatheter thrombolysis centered stepwise management strategy for acute superior mesenteric venous thrombosis Shuofei Yang, Xingjiang Wu, Jieshou Li International Journal of Surgery Volume 12, Issue 5, Pages 442-451 (May 2014) DOI: 10.1016/j.ijsu.2014.03.015 Copyright © 2014 Surgical Associates Ltd Terms and Conditions

Fig. 1 Portography at admission and after transcatheter thrombolysis A, B: thrombus (white arrow) within the superior mesenteric vein (SMV) trunk and branches on coronal and axial contrast-enhanced CT images at admission, bowel edema identified by layered enhancement pattern. C: pre-thrombolysis direct portal venography via percutaneous transhepatic approach shows extensive thrombosis within SMV, portal vein and splenic vein with slight collateral drainage (black arrow). D: pretreatment digital subtraction superior mesenteric artery (SMA) angiogram shows patent SMA and the portal vein faintly opacified with filling defect in the delayed venous phase without visualization of the SMV, and remarkable pooling of contrast medium at the small intestine. E, F: CT image at the same level as A, B after thrombolytic therapy shows the wide patent SMV and portal vein (white arrow) with no obvious residual thrombus. G: direct portal venography via the infusion catheter (white arrow) after thrombolysis shows patent PV and SMV with no thrombus (white arrow). H: improved visualization of the portal vein as well as the primary, secondary, and tertiary branches of the SMV. International Journal of Surgery 2014 12, 442-451DOI: (10.1016/j.ijsu.2014.03.015) Copyright © 2014 Surgical Associates Ltd Terms and Conditions

Fig. 2 Damage control surgery modality for acute superior mesenteric venous thrombosis A. bowel resection of clearly transmural necrotic segments. B. intraoperative thrombectomy to remove as much as possible thrombus. C. bowel resection and double ileostomy instead of primary anastomosis. The intestinal juice from proximal stoma is collected and transfused back to the distal stoma. International Journal of Surgery 2014 12, 442-451DOI: (10.1016/j.ijsu.2014.03.015) Copyright © 2014 Surgical Associates Ltd Terms and Conditions

Fig. 3 Schema of endovascular therapy centered stepwise management strategy for acute superior mesenteric venous thrombosis. International Journal of Surgery 2014 12, 442-451DOI: (10.1016/j.ijsu.2014.03.015) Copyright © 2014 Surgical Associates Ltd Terms and Conditions