{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T09:34:13Z","timestamp":1792748053827,"version":"4.5.0"},"reference-count":38,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2022,8,12]],"date-time":"2022-08-12T00:00:00Z","timestamp":1660262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Purpose: To report our thrombolytic technique, treatment strategy, and clinical outcomes for porto-mesenteric venous thrombosis (PMVT) in non-cirrhotic patients. Methods: Sixteen acute or chronic non-cirrhotic PMVT patients (mean age: 48.6 years) with imminent intestinal ischemia were enrolled from 2004 to 2020. Eight patients presented thrombus extension into the peripheral mesenteric vein, close to the venous arcade. Transhepatic catheter-directed thrombolysis (CDT) was performed by urokinase infusion (60,000\u201330,000 IU\/h concomitant with heparin 300\u2013400 IU\/h), catheter aspiration, and\/or balloon dilation\/stent placement. Additional intra-arterial mesenteric infusion of urokinase (30,000 IU\/h) was given in patients with the peripheral mesenteric venules involved. Transjugular intrahepatic porto-systemic shunt (TIPS) was created in patients with poor recanalization of the intrahepatic portal flow (PV). Results: The transhepatic route was adopted in all patients, with adjunct indirect mesenteric arterial thrombolytic infusion in eight patients. A total of up to 20.4 million IU urokinase was infused for 1\u201321 days\u2019 treatment duration. TIPS was created in three patients with recanalization failure of the intrahepatic PV. Technical success was achieved in 100% of patients with complete recanalization of 80% and partial recanalization of 20%. No major procedure-related complications were encountered. The 30-day mortality rate was 6.7%. The overall two-year primary patency was 84.6%. Conclusions: CDT can be performed as a primary salvage treatment once the diagnosis is made. CDT via the transhepatic route with tailored thrombolytic regimen is safe and effective for both acute and chronic PMVT. TIPS creation can be preserved in non-cirrhotic PMVT patients if intrahepatic PV recanalization fails.<\/jats:p>","DOI":"10.3390\/jcm11164721","type":"journal-article","created":{"date-parts":[[2022,8,15]],"date-time":"2022-08-15T01:47:21Z","timestamp":1660528041000},"page":"4721","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Primary Catheter-Directed Thrombolysis for Porto-Mesenteric Venous Thrombosis (PMVT) in Non-Cirrhotic Patients"],"prefix":"10.3390","volume":"11","author":[{"given":"Chia-Ling","family":"Chiang","sequence":"first","affiliation":[{"name":"Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9983-0535","authenticated-orcid":false,"given":"Huei-Lung","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan"},{"name":"Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung 821, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Chi","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3472-9070","authenticated-orcid":false,"given":"Ming-Feng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan"},{"name":"Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung 821, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/0016-5085(82)90028-2","article-title":"Mesenteric venous thrombosis","volume":"82","author":"Grendell","year":"1982","journal-title":"Gastroenterology"},{"key":"ref_2","first-page":"1","article-title":"Survival after splanchnic vein thrombosis: A 20-year nationwide cohort study","volume":"141","author":"Darvalics","year":"2019","journal-title":"Thromb. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jceh.2014.12.008","article-title":"Portal vein thrombosis","volume":"5","author":"Chawla","year":"2015","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1007\/s00270-022-03065-7","article-title":"Liver Growth and Portal Hypertension Improvement AfterPercutaneous Recanalization of Chronic Portal Vein Thrombosisin Non-Cirrhotic Participants","volume":"45","author":"Levigard","year":"2022","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver. Electronic address eee (2016). EASL Clinical Practice Guidelines: Vascular diseases of the liver. J. Hepatol., 64, 179\u2013202.","DOI":"10.1016\/j.jhep.2015.07.040"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1002\/hep.22772","article-title":"American Association for the Study Liver D: Vascular disorders of the liver","volume":"49","author":"DeLeve","year":"2009","journal-title":"Hepatology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1111\/apt.15479","article-title":"A stepwise thrombolysis regimen in the management of acute portal vein thrombosis in patients with evidence of intestinal ischaemia","volume":"50","author":"Benmassaoud","year":"2019","journal-title":"Aliment Pharm."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1007\/s00270-004-0241-z","article-title":"Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Treatment of Venous Symptomatic Chronic Portal Thrombosis in Non-Cirrhotic Patients","volume":"27","author":"Bilbao","year":"2004","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1097\/01.RVI.0000156265.79960.86","article-title":"Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis","volume":"16","author":"Hollingshead","year":"2005","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"5028","DOI":"10.3748\/wjg.15.5028","article-title":"Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis","volume":"15","author":"Liu","year":"2009","journal-title":"World J. Gastroenterol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"659726","DOI":"10.1155\/2014\/659726","article-title":"Transjugular intrahepatic portosystemic shunt for the treatment of portal hypertension in noncirrhotic patients with portal cavernoma","volume":"2014","author":"Luo","year":"2014","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1177\/0284185117742683","article-title":"Treatment of acute portomesenteric venous thrombosis with thrombectomy through a transjugular intrahepatic portosystemic shunt: A single-center experience","volume":"59","author":"Rosenqvist","year":"2018","journal-title":"Acta Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1016\/j.dld.2017.05.020","article-title":"Transjugular local thrombolysis with\/without TIPS in patients with acute non-cirrhotic, non-malignant portal vein thrombosis","volume":"49","author":"Klinger","year":"2017","journal-title":"Dig. Liver Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1007\/s00270-019-02354-y","article-title":"Percutaneous Pharmaco-Mechanical Thrombectomy of Acute Symptomatic Superior Mesenteric Vein Thrombosis","volume":"43","author":"Rabuffi","year":"2020","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1160\/TH08-01-0015","article-title":"Risks and benefits of transcatheter thrombolytic therapy in patients with splanchnic venous thrombosis","volume":"100","author":"Smalberg","year":"2008","journal-title":"Thromb. Haemost."},{"key":"ref_16","first-page":"991","article-title":"Application of percutaneousAngioJet thrombectomy in patients with acute symptomaticportal and superior mesenteric venous thrombosis","volume":"97","author":"Song","year":"2017","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1002\/bjs.6319","article-title":"Epidemiology, risk and prognostic factors in mesenteric venous thrombosis","volume":"95","author":"Acosta","year":"2008","journal-title":"Br. J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1177\/1358863X10379673","article-title":"Mesenteric venous thrombosis","volume":"15","author":"Harnik","year":"2010","journal-title":"Vasc. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1056\/NEJMra010076","article-title":"Mesenteric venous thrombosis","volume":"345","author":"Kumar","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2510","DOI":"10.1007\/s00268-011-1198-0","article-title":"Management of acute non-cirrhotic and non-malignant portal vein thrombosis: A systematic review","volume":"35","author":"Hall","year":"2011","journal-title":"World J. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1002\/hep.23259","article-title":"Acute portal vein thrombosis unrelated to cirrhosis: A prospective multicenter follow-up study","volume":"51","author":"Plessier","year":"2010","journal-title":"Hepatology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2464","DOI":"10.1111\/j.1572-0241.2007.01477.x","article-title":"Prognostic factors in noncirrhotic patients with splanchnic vein thromboses","volume":"102","author":"Amitrano","year":"2007","journal-title":"Am. J. Gastroenterol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1016\/j.cgh.2008.07.031","article-title":"Portal hypertension-related complications after acute portal vein thrombosis: Impact of early anticoagulation","volume":"6","author":"Turnes","year":"2008","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.dld.2010.06.001","article-title":"Transjugular intrahepatic portosystemic shunt with expanded-polytetrafuoroethylene-covered stents in non-cirrhotic patients with portal cavernoma","volume":"43","author":"Fanelli","year":"2011","journal-title":"Dig. Liver Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1007\/s10620-011-1975-5","article-title":"Transjugular intrahepatic portosystemic shunt for portal cavernoma with symptomatic portal hypertension in non-cirrhotic patients","volume":"57","author":"Qi","year":"2012","journal-title":"Dig. Dis. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"497.e1","DOI":"10.1016\/j.avsg.2012.09.009","article-title":"Omental vein catheter thrombolysis for acute porto-mesenteric vein thrombosis","volume":"27","author":"Fonseca","year":"2013","journal-title":"Ann. Vasc. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.avsg.2016.06.029","article-title":"Comparison of Systemic Thrombolysis Versus Indirect Thrombolysis via the Superior Mesenteric Artery in Patients with Acute Portal Vein Thrombosis","volume":"39","author":"Liu","year":"2017","journal-title":"Ann. Vasc. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1053\/j.tvir.2016.01.005","article-title":"Thrombolysis and Transjugular Intrahepatic Portosystemic Shunt Creation for Acute and Subacute Portal Vein Thrombosis","volume":"19","author":"Chamarthy","year":"2016","journal-title":"Tech. Vasc. Interv. Radiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1007\/s00270-007-9097-3","article-title":"Interventional radiological management of prehepatic obstruction of [corrected] the splanchnic venous system","volume":"30","author":"Keussen","year":"2007","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1111\/j.1365-2036.2006.02820.x","article-title":"Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with and without cavernous transformation","volume":"23","author":"Senzolo","year":"2006","journal-title":"Aliment Pharm."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1097\/MEG.0b013e328338d995","article-title":"Feasibility and long-term evolution of TIPS in cirrhotic patients with portal thrombosis","volume":"22","author":"Perarnau","year":"2010","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3431","DOI":"10.1007\/s00330-015-3777-1","article-title":"Percutaneous transhepatic balloon-assisted transjugular intrahepatic portosystemic shunt for chronic, totally occluded, portal vein thrombosis with symptomatic portal hypertension: Procedure technique, safety, and clinical applications","volume":"25","author":"Chen","year":"2015","journal-title":"Eur. Radiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1007\/s12072-011-9324-5","article-title":"Transjugular intrahepatic portosystemic shunt in the treatment of portal vein thrombosis: A critical review of literature","volume":"6","author":"Qi","year":"2012","journal-title":"Hepatol. Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1016\/j.jfma.2020.10.033","article-title":"Endovascular management of aorto-iliac occlusive disease (Leriche syndrome)","volume":"120","author":"Liang","year":"2020","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1067\/mva.2002.127526","article-title":"Percutaneous transhepatic treatment of symptomatic mesenteric venous thrombosis","volume":"36","author":"Lopera","year":"2002","journal-title":"J. Vasc. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/S0720-048X(01)00289-3","article-title":"Catheter-directed thrombolysis with transjugular access in portal vein thrombosis secondary to pancreatitis","volume":"39","author":"Aytekin","year":"2001","journal-title":"Eur. J. Radiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1097\/00129689-200204000-00013","article-title":"Transhepatic thrombolysis in acute portal vein thrombosis after laparoscopic splenectomy","volume":"12","author":"Kercher","year":"2002","journal-title":"Surg. Laparosc. Endosc. Percutaneous Tech."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1002\/bjs.4459","article-title":"Systematic review of survival after acute mesenteric ischaemia according to disease aetiology","volume":"91","author":"Schoots","year":"2004","journal-title":"Br. J. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/16\/4721\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:08:03Z","timestamp":1760141283000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/16\/4721"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,12]]},"references-count":38,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["jcm11164721"],"URL":"https:\/\/doi.org\/10.3390\/jcm11164721","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,12]]}}}