Direct thrombolytic therapy in portal and mesenteric vein thrombosis

A 34-year-old female from Laos presented to the emergency department with a 3-week history of worsening abdominal pain; she subsequently developed an acute abdomen requiring emergent exploratory laparotomy. An intraoperative angiography was performed, which revealed complete portal vein thrombosis. A 5F 20-cm infusion catheter was placed through an omental vein, and tissue plasminogen activator was administered directly into the catheter with successful decrease in thrombus burden. There are few controlled data on which to base clinical decisions in patients with portal vein thrombosis. Our case expands on these earlier reports that direct thrombolysis can be safely performed using local, intraclot infusions for portal vein thrombosis, and thrombolytic doses can be kept relatively low, limiting the risk of bleeding complications. (J Vasc Surg 2012;56:1124-6.)