Catheter-Directed Thrombolysis in the Treatment of Acute Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy

Abstract Background: Portomesenteric vein thrombosis (PMVT) following Laparoscopic Sleeve Gastrectomy (LSG) is an uncommon but potentially debilitating complication. Catheter-directed thrombolysis (CDT) has an evolving role in recanalizing the venous flow and preventing thrombus propagation. It can be used as an alternative or in combination with systemic anticoagulants in selected patients. We report two cases of trans-hepatic and trans-splenic CDT of acute PMVT developed in post LSG. The patient's clinical details, radiological findings, safety, and efficacy are reported.Cases presentation: Two patients presented to the emergency department (ED) within 14 days of surgery. The presenting complaints were generally nonspecific. The diagnosis of PMVT was established in both patients based on abdominal contrast-enhanced computed tomography (CECT). The two patients received a combined therapy of intravenous (IV) heparinization and CDT using trans-hepatic approach in case 1 and trans-splenic approach in case 2, determined by the extent of thrombosis. Subsequent post-procedure venograms and CECT were performed and showed significant thrombus resolution. Both patients received long-term anticoagulant therapy upon discharge with a successful overall recovery. Conclusion: PMVT is an infrequent and severe post LSG complication. Various approaches for re-establishing the portal venous flow have been described according to the severity of venous thrombosis. This article describes CDT therapy as a safe and effective option for treating PMVT in symptomatic patients.