[Acute portomesenteric venous thrombosis - an active and multidisciplinary approach may prevent surgery and save suffering]. / Överväg tidig intervention vid akut portomesenteriell trombotisering.

Acute mesenteric venous thrombosis causes impaired mesenteric blood supply which may lead to bowel infarction and, in a longer perspective, severe portal hypertension. Early diagnosis, immediate anticoagulation, and active expectancy are critical for the outcome. The patients should be evaluated and treated in a multidisciplinary context, involving gastroenterologists, interventional radiologists, vascular and colorectal surgeons, and consultants in clinical coagulation. Percutaneous thrombectomy, including transjugular intrahepatic portosystemic shunt (TIPS), should be considered in cases with imminent bowel necrosis despite adequate anticoagulation, but can also serve as a complement to surgery. Here we provide a clinical overview of acute mesenteric venous thrombosis, exemplified with authentic patient cases, especially discussing the role for interventional radiology.

Renal effects of CO2 and iodinated contrast media in patients undergoing renovascular intervention: a prospective, randomized study.

PURPOSE: CO2 gas has been proposed for use instead of iodinated contrast media in angiographic examinations in patients at risk of developing renal failure from contrast media. The influence of intraarterial injection of CO2 with small added amounts of ioxaglate (200 mgI/mL) or ioxaglate alone on renal function in patients with suspected renal artery stenosis was studied in a prospective, randomized study. MATERIALS AND METHODS: One hundred twenty-three patients underwent renovascular intervention (n = 83) and/or renal angiography (n = 40) for suspected renal artery stenosis. Patients with a serum creatinine concentration less than 200 micromol/L (n = 82) were randomized prospectively to receive CO2 with small added amounts of ioxaglate (n = 37) or only ioxaglate (n = 45). Patients with serum creatinine levels greater than 200 micromol/L (n = 41) were not randomized and initially received CO2. Serum creatinine concentrations were measured within 1 day before and 1 day, 2 days, and 2-3 weeks after the procedure. RESULTS: The amount of injected CO2 did not relate to an increase in serum creatinine level. In the randomized groups, and also when the whole patient sample was considered, the amount of injected iodine was significantly correlated (P = .011) with an increase in serum creatinine level and a decrease in estimated creatinine clearance after 2 days. Among the randomized patients, one in the CO2 group and three in the ioxaglate group had a more than 25% increase in serum creatinine level within the first 2 days after the intervention. CONCLUSION: The risk of impairment of renal function is lower after injection of CO2 with small amounts of added ioxaglate compared with injection of a larger amount of ioxaglate alone. The larger the amount of administered iodinated contrast medium, the greater the risk of development of renal failure.