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European Journal of Haematology Jan 2019Thrombosis of unusual venous sites encompasses a large part of consultative hematology and is encountered routinely by practicing hematologists. Contrary to the more... (Review)
Review
Thrombosis of unusual venous sites encompasses a large part of consultative hematology and is encountered routinely by practicing hematologists. Contrary to the more commonly encountered lower extremity venous thrombosis and common cardiovascular disorders, the various thromboses outlined in this review have unique presentations, pathophysiology, workup, and treatments that all hematologists should be aware of. This review attempts to outline the most up to date literature on cerebral, retinal, upper extremity, hepatic, portal, splenic, mesenteric, and renal vein thrombosis, focusing on the incidence, pathophysiology, provoking factors, and current recommended treatments for each type of unusual thrombosis to provide a useful and practical review for the hematologist.
Topics: Budd-Chiari Syndrome; Cerebral Veins; Disease Management; Humans; Mesenteric Veins; Portal Vein; Renal Veins; Retinal Vein; Splenic Vein; Upper Extremity; Venous Thrombosis
PubMed: 30267448
DOI: 10.1111/ejh.13177 -
Scandinavian Journal of Surgery : SJS :... Jun 2021Acute mesenteric venous thrombosis accounts for up to 20% of all patients with acute mesenteric ischemia in high-income countries. Acute mesenteric venous thrombosis is...
BACKGROUND AND AIMS
Acute mesenteric venous thrombosis accounts for up to 20% of all patients with acute mesenteric ischemia in high-income countries. Acute mesenteric venous thrombosis is nowadays relatively more often diagnosed with intravenous contrast-enhanced computed tomography in the portal phase than at explorative laparotomy No high-quality comparative studies between anticoagulation alone, endovascular therapy, or surgery exists. The aim of the present systematic review was to offer a contemporary overview on management.
MATERIALS AND METHODS
Eleven relevant published original studies with series of at least ten patients were retrieved from a Pub Med search between 2015 and 2020 using the Medical Subject Heading term "mesenteric venous thrombosis."
RESULTS
When MVT is diagnosed early, immediate anticoagulation with either unfractionated heparin or subcutaneous low-molecular-weight heparin should commence. Surgeons need to be aware of the importance to scrutinize the computed tomography images themselves for assessment of secondary intestinal abnormalities to mesenteric venous thrombosis and the risk of bowel resection and worse prognosis. Progression toward peritonitis is an indication for explorative laparotomy and assessment of bowel viability. Frank transmural small bowel necrosis should be resected and bowel anastomosis may be delayed for several days until second look. Meanwhile, intravenous full-dose unfractionated heparin should be given at the end of the first operation. Postoperative major intra-abdominal or gastrointestinal bleeding occurs rarely, but the heparin effect can instantaneously be reversed by . Patients who do not improve during conservative therapy with anticoagulation alone but without developing peritonitis may be subjected to endovascular therapy in expert centers. When the patient's intestinal function has recovered, with or without bowel resection, switch from parenteral unfractionated heparin or low-molecular-weight heparin therapy to oral anticoagulation can be performed. There is a trend that direct oral anticoagulants are increasingly used instead of vitamin K antagonists. Up to now, direct oral anticoagulants have been shown to be equally effective with the same rate of bleeding complications. Patients with no strong permanent trigger factor for mesenteric venous thrombosis such as intra-abdominal cancer should undergo blood screening for inherited and acquired thrombophilia.
CONCLUSION
Early diagnosis with emergency computed tomography with intravenous contrast-enhancement and imaging in the portal phase and anticoagulation therapy is necessary to be able to have a succesful non-operative succesful course.
Topics: Anticoagulants; Heparin; Humans; Mesenteric Ischemia; Mesenteric Veins; Venous Thrombosis
PubMed: 33118463
DOI: 10.1177/1457496920969084 -
European Journal of Vascular and... Apr 2017
Review
Topics: Endovascular Procedures; Humans; Mesenteric Arteries; Mesenteric Veins; Predictive Value of Tests; Risk Factors; Splanchnic Circulation; Treatment Outcome; Vascular Diseases; Vascular Surgical Procedures
PubMed: 28359440
DOI: 10.1016/j.ejvs.2017.01.010 -
Gastroenterology Jun 2022
Topics: Colon; Humans; Hyperplasia; Mesenteric Veins
PubMed: 35247456
DOI: 10.1053/j.gastro.2022.02.046 -
Journal of Vascular Surgery. Venous and... Oct 2016This review explores the current literature on the natural history, diagnosis, and management of mesenteric venous thrombosis (MVT) in the modern era. (Review)
Review
OBJECTIVE
This review explores the current literature on the natural history, diagnosis, and management of mesenteric venous thrombosis (MVT) in the modern era.
METHODS
A review of the contemporary literature from 1997 to 2016 on MVT and its pathogenesis, diagnosis, and treatment was performed.
RESULTS
MVT is an insidious and lethal disease associated with acute mesenteric ischemia. The prevalence of MVT has increased sharply during the past two decades commensurate with an increase in radiographic imaging for abdominal complaints. The optimal treatment of and approach to MVT is controversial, given the poorly understood natural history of this rare disease. Both endovascular and open surgical strategies in addition to systemic anticoagulation have been used as adjuncts to treat MVT with limited success. Despite advances in treatment, mortality associated with MVT is still high. Furthermore, recent studies have shown that failure to recanalize the portomesenteric venous system leads to an increased risk for development of sequelae of portal hypertension.
CONCLUSIONS
MVT is a challenging disease to treat, given the difficulty in establishing a prompt initial diagnosis and the inability to reliably monitor patients for evidence of impending bowel infarction. Careful selection of patients for endovascular, open, or hybrid approaches is key to achieving improved outcomes. However, the paucity of prospective data and our evolving understanding of the natural history of MVT make consensus treatment strategies difficult to ascertain.
Topics: Acute Disease; Humans; Mesenteric Ischemia; Mesenteric Vascular Occlusion; Mesenteric Veins; Prospective Studies; Venous Thrombosis
PubMed: 27639007
DOI: 10.1016/j.jvsv.2016.04.002 -
Vascular Health and Risk Management 2019Splanchnic vein thrombosis (SVT) including portal, mesenteric, splenic vein thrombosis and the Budd-Chiari syndrome, is a manifestation of unusual site venous... (Review)
Review
Splanchnic vein thrombosis (SVT) including portal, mesenteric, splenic vein thrombosis and the Budd-Chiari syndrome, is a manifestation of unusual site venous thromboembolism. SVT presents with a lower incidence than deep vein thrombosis of the lower limbs and pulmonary embolism, with portal vein thrombosis and Budd-Chiari syndrome being respectively the most and the least common presentations of SVT. SVT is classified as provoked if secondary to a local or systemic risk factor, or unprovoked if the causative trigger cannot be identified. Diagnostic evaluation is often affected by the lack of specificity of clinical manifestations: the presence of one or more risk factors in a patient with a high clinical suspicion may suggest the execution of diagnostic tests. Doppler ultrasonography represents the first line diagnostic tool because of its accuracy and wide availability. Further investigations, such as computed tomography and magnetic resonance angiography, should be executed in case of suspected thrombosis of the mesenteric veins, suspicion of SVT-related complications, or to complete information after Doppler ultrasonography. Once SVT diagnosis is established, a careful patient evaluation should be performed in order to assess the risks and benefits of the anticoagulant therapy and to drive the optimal treatment intensity. Due to the low quality and large heterogeneity of published data, guidance documents and expert opinion could direct therapeutic decision, suggesting which patients to treat, which anticoagulant to use and the duration of treatment.
Topics: Anticoagulants; Humans; Mesenteric Veins; Portal Vein; Predictive Value of Tests; Risk Factors; Splanchnic Circulation; Splenic Vein; Treatment Outcome; Ultrasonography, Doppler; Venous Thrombosis
PubMed: 31695400
DOI: 10.2147/VHRM.S197732 -
Vascular and Endovascular Surgery Jan 2022Traumatic injuries to the mesenteric vessels are rare and often lethal. Visceral vessels, such as the superior mesenteric artery (SMA) and vein (SMV), supply blood to... (Review)
Review
Traumatic injuries to the mesenteric vessels are rare and often lethal. Visceral vessels, such as the superior mesenteric artery (SMA) and vein (SMV), supply blood to the small and large bowel by a rich system of collaterals. Because fewer than 100 such injuries have been described in the literature, they pose challenges in both diagnosis and management and can unfortunately result in high mortality rates. Prompt diagnosis, surgical intervention, and resuscitation can lead to improved outcomes. Here, we review the literature surrounding traumatic injuries of the SMA/SMV and discuss management strategies.
Topics: Abdomen; Humans; Mesenteric Artery, Superior; Mesenteric Veins; Treatment Outcome; Vascular System Injuries
PubMed: 34533371
DOI: 10.1177/15385744211042491 -
Abdominal Radiology (New York) Feb 2019
Review
Topics: Adenocarcinoma; Humans; Mesenteric Veins; Pancreatic Neoplasms; Tomography, X-Ray Computed
PubMed: 30105401
DOI: 10.1007/s00261-018-1738-2 -
Surgical Oncology Clinics of North... Oct 2021Pancreaticoduodenectomy with vascular resection/reconstruction can be safely completed following 6 standard steps plus basic principles of vascular surgery. Particular... (Review)
Review
Pancreaticoduodenectomy with vascular resection/reconstruction can be safely completed following 6 standard steps plus basic principles of vascular surgery. Particular attention is paid to the location of the tumor relative to the 2 first-order vein branches, portal vein -splenic vein -superior mesenteric vein confluence, inferior mesenteric vein, and the presence of arterial perineural invasion. Successful resection following neoadjuvant therapy can result in median survival 3 times that of historical controls.
Topics: Humans; Mesenteric Veins; Pancreatectomy; Pancreatic Neoplasms; Pancreaticoduodenectomy; Splenic Vein
PubMed: 34511193
DOI: 10.1016/j.soc.2021.06.011 -
Pathology, Research and Practice Nov 2020Phlebosclerotic colitis (PC) is a rare chronic ischemic colitis caused by venous reflux disorder. It is also called idiopathic mesenteric phlebosclerosis (IMP) due to...
Phlebosclerotic colitis (PC) is a rare chronic ischemic colitis caused by venous reflux disorder. It is also called idiopathic mesenteric phlebosclerosis (IMP) due to unknown etiology. The disease is characterized by sclerosis of mesenteric vein and its branches as well as fibrosis, hyaline degeneration, calcification, thickening of colon wall. CT images show linear calcification in the colon mucosa as well as mesenteric vein and its branches. Endoscopy shows purple-blue mucosa with multiple erosion and ulceration. Microscopically, the colon mucosa shows fibrosis, hyaline degeneration and extensive thickening. The most characteristic lesion is fibrosis and calcification of the vessels especially the veins. Arteries in all layers of colon are also involved, but the injury is significant mild and less. We collected 10 confirmed patients from 2012 to 2019 in our hospital, studied their clinical histories in detail, summarized typical changes of CT images, endoscopic images and pathological sections, and made a detail follow-up. In addition to typical pathological changes, we also found that gardenia or its metabolites may be the pathogenic factor. Probablely, geniposide which is metabolized to genipin by β-glucosidase of colon flora in proximal colon, results in venous sclerosis. PC is occult onset and irreversible without special symptoms in the early stage, but it will also be stable after removing the pathogenic ingredient. Most of patients may be "cured" by appropriate conservative medication and stopping drinking. Contrary, inappropriate surgery may "trigger" the acute ischemia which results in obstruction rapidly. We hope our colleagues pay attention to the unique lesion and make early diagnosis and treatment.
Topics: Adult; Aged; Colitis, Ischemic; Colon; Female; Humans; Intestinal Mucosa; Male; Mesenteric Veins; Middle Aged; Sclerosis
PubMed: 32927306
DOI: 10.1016/j.prp.2020.153193