Abstract
There is no established interventional radiology treatment for superior mesenteric venous thrombosis (SMVT) or portal vein thrombosis (PVT). Recently, concentrated antithrombin III preparations have been approved by insurance for PVT treatment and randomized controlled trials of several direct oral anticoagulants (DOAC) for PVT to replace warfarin were conducted. The outcomes have been generally favorable although they are yet to be covered by Japanese health insurance. The cornerstone of SMVT/PVT treatment without associated bowel ischemia is immediate systemic anticoagulation with heparin, bowel rest, and fluid and electrolyte correction. The initial treatment of acute SMVT gradually shifted from surgical management to nonoperative management and now includes endovascular techniques, although this remains highly controversial. Transcatheter thrombolysis as the only revascularization method, or in combination with mechanical thrombectomy or other endovascular manipulations as a hybrid procedure, has been reported in many cases. However, definitive recommendations are difficult because of the lack of high-quality data. Treatment should be considered on a case-by-case basis.
