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Prognostic Factors and Treatment Outcome in Mesenteric Vein Thrombosis

Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine & the Michael E. DeBakey VA Medical Center, Houston, Texas

Gordon M. Riha, MD

Department of Surgery, Oregon Health & Science University, Portland, Oregon

Panagiotis Kougias, MD

Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine & the Michael E. DeBakey VA Medical Center, Houston, Texas

Tam T. Huynh, MD

Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine & the Michael E. DeBakey VA Medical Center, Houston, Texas

Charlie Cheng, MD

Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine & the Michael E. DeBakey VA Medical Center, Houston, Texas

Carlos Bechara, MD

Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine & the Michael E. DeBakey VA Medical Center, Houston, Texas

Jean Bismuth, MD

Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine & the Michael E. DeBakey VA Medical Center, Houston, Texas

Alan Dardik, MD

Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, and VA Connecticut Healthcare System, New Haven, Connecticut

Peter H. Lin, MD

Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine & the Michael E. DeBakey VA Medical Center, Houston, Texas, plin{at}bcm.tmc.edu

Background Mesenteric vein thrombosis (MVT) can result in intestinal ischemia and is associated with high morbidity and mortality due in part to its frequent delay in diagnosis. The purpose of this study was to evaluate clinical presentation, diagnostic evaluation, and treatment outcome of MVT.

Methods Hospital records and clinical data of all patients treated for MVT were reviewed during a recent 14-year period. Clinical outcome and factors affecting survival were analyzed.

Results A total of 68 patients were included in the study. Abdominal exploration was performed in 23 patients (34%), and second-look operation was necessary in 18 patients (26%). Three patients (4%) underwent unsuccessful operative mesenteric vein thrombectomy, whereas percutaneous transhepatic mesenteric thrombectomy was performed successfully in 3 patients (4%). The 30-day mortality rate was 20%. Forty-six of the 54 survivors were treated with long-term oral anticoagulation therapy. Actuarial survival at 2, 4, 6, and 10 years was 68%, 57%, 43%, and 22%, respectively. Risk factor analysis showed malignancy (P < .002), age >60 years (P < .005), cirrhosis (P < .02), symptom duration (P < .005), and bowel resection (P < .03) were associated with mortality. Logistic regression analysis showed age >60 years (odds ratio [OR], 3.64; P = .03), malignancy (OR, 3.88; P = .02), and prolonged symptom duration (OR, 5.62; P = .01) were independent predictors of mortality.

Conclusions MVT is associated with significant mortality. Prompt diagnostic evaluation with computed tomography may reduce potential treatment delay. Underlying malignancy, advanced age, and prolonged symptom duration are predictive of poor outcome.

Key Words: mesenteric vein thrombosis • intestinal ischemia • clinical outcome

This version was published on June 1, 2008

Vascular and Endovascular Surgery, Vol. 42, No. 3, 217-224 (2008)
DOI: 10.1177/1538574407312653


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