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Mesenteric and Portal Venous Thrombosis Treated by Transjugular Mechanical Thrombolysis

Daniel Y. Sze1, Gerard J. O'Sullivan1,2, Denise L. Johnson3 and Michael D. Dake1

1 Division of Cardiovascular and Interventional Radiology, Stanford University Medical Center, 300 Pasteur Dr., Ste. H3600, Stanford, CA 94305-5642.
2 Present address: Division of Vascular and Interventional Radiology, Rush-Presbyterian-St. Luke's Medical Center, 1725 W. Harrison St., Ste. 400, Chicago, IL 60612.
3 Department of General Surgery, Stanford University Medical Center, Stanford, CA 94305-5655.



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Fig. 1A. —37-year-old man with spontaneous splanchnic and portal venous thromboses. CT scan obtained at presentation shows thrombosed main trunk of superior mesenteric vein (arrow). Note thick-walled ischemic jejunum (arrowheads).

 


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Fig. 1B. —37-year-old man with spontaneous splanchnic and portal venous thromboses. Venous phase of splenic arteriogram shows thrombus in main portal vein (arrow) and no inflow from superior mesenteric vein. Note occlusion of anterior right portal vein (arrowhead).

 


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Fig. 1C. —37-year-old man with spontaneous splanchnic and portal venous thromboses. Transjugular superior mesenteric venogram obtained after bowel resection and manual expression of superior mesenteric vein branch thrombus confirms complete occlusion and poor collateral drainage.

 


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Fig. 1D. —37-year-old man with spontaneous splanchnic and portal venous thromboses. Splenic venogram obtained after thrombolysis shows flow into left portal vein.

 


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Fig. 1E. —37-year-old man with spontaneous splanchnic and portal venous thromboses. CT scan obtained 12 days after thrombolysis shows patent superior mesenteric vein (arrow).

 

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