Frische venöse Thrombose splanchnischer Gefäße

Zwei Fallberichte zur kathetergestützten lokalen Thrombolyse und -aspiration

Recent thrombosis of splanchnic veins

Two case reports of catheter-assisted local thrombolysis and thrombus aspiration

Zusammenfassung

Die frische Thrombose venöser splanchnischer Gefäße ohne Vorliegen einer Leberzirrhose oder eines Malignoms ist nach dem Baveno-VI-Konsensus von 2015 als eine Thrombose der extrahepatischen Pfortader mit oder ohne Involvierung der Mesenterialvenen neu definiert worden. Aufgrund der unspezifischen Symptome mit abdominalen Schmerzen oder Diarrhö ist eine zeitnahe Diagnose oft herausfordernd, jedoch wegen drohender akuter und chronischer Komplikationen wie mesenterialer Ischämie und portaler Hypertonie äußerst wichtig. Entsprechend ist eine rasche Therapie essenziell. Wir präsentieren zwei schwere Fälle, die eine Therapie mit kathetergestützten lokalen Thrombolyseverfahren notwendig machten. Diese minimal-invasiven kathetergestützten Verfahren werden seit einigen Jahren bei ausgewählten Patienten mit gutem Erfolg eingesetzt. Hierzu geben wir einen Überblick der verfügbaren Literatur. Zusammenfassend ist die Therapie der frischen Thrombose venöser splanchnischer Gefäße individuell zu gestalten. Sie sollte an einem erfahrenen Zentrum erfolgen, das alle therapeutischen Optionen zur Verfügung hat. Transjuguläre, transhepatische kathetergestützte lokale Thrombolyseverfahren bieten bei richtiger Indikationsstellung eine sichere Therapie mit guten Ergebnissen.

Abstract

Recent non-cirrhotic and non-malignant splanchnic vein thrombosis is now defined as extrahepatic portal vein thrombosis with or without involvement of the mesenteric vein according to the Baveno VI consensus from 2015. An early diagnosis is often challenging due to unspecific symptoms with abdominal pain or diarrhea but extremely important because of the potential acute and chronic complications, such as mesenteric ischemia and portal hypertension; therefore, rapid treatment is crucial. We present two cases of severe splanchnic vein thrombosis, which were treated with catheter-directed local thrombolysis and thrombus aspiration. These minimally invasive catheter-directed techniques have recently been successfully used in selected patients. A review of the literature is provided in this article. In summary, the management of splanchnic vein thrombosis must be individually planned for each patient and should be performed at experienced centers, which can provide all therapeutic options. In selected cases with the correct indications transjugular transhepatic catheter-directed local thrombolysis is a safe option with a good outcome.

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Correspondence to Prof. Dr. J. Trebicka.

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M. Praktiknjo, C. Meyer, C.P. Strassburg und J. Trebicka geben an, dass kein Interessenkonflikt besteht.

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H. Haller, Hannover

B. Salzberger, Regensburg

C. Sieber, Nürnberg

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Praktiknjo, M., Meyer, C., Strassburg, C.P. et al. Frische venöse Thrombose splanchnischer Gefäße. Internist 58, 82–89 (2017). https://doi.org/10.1007/s00108-016-0120-0

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Schlüsselwörter

  • Pfortader
  • V. mesenterica superior
  • V. lienalis
  • Transjugulärer, intrahepatischer portosystemischer Shunt
  • Interventionelle radiologische Verfahren

Keywords

  • Portal vein
  • Superior mesenteric vein
  • Splenic vein
  • Portosystemic shunt, transjugular, intrahepatic
  • Interventional radiological procedures