Venous mesenteric ischemia carries high procedural burden and elevated mortality in patients with severe presentation

Published:March 16, 2021DOI:



      Venous mesenteric ischemia (VMI) presents with variable severity resulting in a spectrum of outcomes. This study sought to characterize the natural history of VMI and identify drivers of intervention and adverse outcomes.


      All patients who presented to our institution with acute and subacute VMI between 1993 and 2016 were identified. Images were reviewed to determine thrombosis location and charts were reviewed to identify clinical factors and outcomes. Univariate analysis was performed for demographics, comorbidities, and presenting characteristics, with primary outcomes of intervention, readmission, and 30-day mortality. A survival analysis was performed with log-rank difference testing for demographics, comorbidities, and presenting characteristics.


      We identified 103 patients with acute and subacute VMI. The locations of the thrombosis included the superior mesenteric vein (SMV) (31.1%); SMV and portal vein (35.9%); SMV, portal, and splenic veins (15.5%); and other combinations of portomesenteric veins (17.4%), without correlation between the location and outcomes. Most patients were male (60.6%), 22.3% were actively smoking, and the median Charlson comorbidity score was 4 (interquartile range, 2-7). The mean patient age was 61.3 years. More than one-half had a known hypercoagulability (52.4%), 22.3% had prior bowel resection, and 8.7% had prior mesenteric venous intervention, including transjugular intrahepatic portosystemic shunt procedures. Thirty-five patients underwent 83 procedures during their hospitalization, and 23 patients underwent surgical intervention specifically. Prior mesenteric venous procedure, abdominal tenderness, and lactatemia of more than 1.5 mmol/L were associated with an increased need for surgical intervention (P < .05). Patients with leukocytosis of greater than 10K/μL had increased surgical intervention (P = .10), although without statistical significance. However, symptoms for less than 2 weeks (P < .05) were associated with decreased surgical intervention. The 30-day mortality was low in this cohort (6.8%), but was increased in patients requiring intervention (11.4%). For those undergoing procedures, a shorter time to intervention was associated with an improved 30-day mortality (8.7% for procedures on hospital days 0-1 vs 16.7% for hospital day 2 or later; P = .01). Abdominal tenderness and lactatemia were associated with increased 30-day mortality (6.8% vs 3.6% [P < .01] and 16.0% vs 3.8% [P = .03], respectively). A Kaplan-Meier survival analysis revealed a median survival of 7.1 years, with a 1-year survival rate of 74.9%, a 3-year survival rate of 67.1%, and a 5-year survival rate of 57.9%. Negative predictors of survival included a higher Charlson comorbidity index (hazard ratio, 3.7; P < .01) and malignancy (hazard ratio, 3.1; P < .01).


      The 30-day mortality of VMT is low, but more than one-third of patients required an intervention beyond anticoagulation. Comorbidity, a prior mesenteric vessel or intestinal operation, and presentation with tenderness or relevant laboratory abnormalities portend worse outcomes. Early intervention is associated with improved outcomes.


      To read this article in full you will need to make a payment
      SVS Member Login
      Society Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Warren S.
        • Eberhard T.P.
        Mesenteric venous thrombosis.
        Surg Gynecol Obstet. 1935; : 102-121
        • Kumar S.
        • Sarr M.G.
        • Kamath P.S.
        Mesenteric venous thrombosis.
        N Engl J Med. 2001; 345: 1683-1688
        • Grendell J.H.
        • Ockner R.K.
        Mesenteric venous thrombosis.
        Gastroenterology. 1982; 82: 358-372
        • Ageno W.
        • Riva N.
        • Schulman S.
        • Beyer-Westendorf J.
        • Bang S.M.
        • Senzolo M.
        • et al.
        Long-term clinical outcomes of splanchnic vein thrombosis: results of an international registry.
        JAMA Intern Med. 2015; 175: 1474-1480
        • Intagliata N.M.
        • Caldwell S.H.
        • Tripodi A.
        Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis.
        Gastroenterology. 2019; 156 (1582-99.e1)
        • Salim S.
        • Ekberg O.
        • Elf J.
        • Zarrouk M.
        • Gottsater A.
        • Acosta S.
        Clinical implications of CT findings in mesenteric venous thrombosis at admission.
        Emerg Radiol. 2018; 25: 407-413
        • Russell C.E.
        • Wadhera R.K.
        • Piazza G.
        Mesenteric venous thrombosis.
        Circulation. 2015; 131: 1599-1603
        • Ansell J.
        The subtle benefit of anticoagulant therapy for splanchnic vein thrombosis.
        JAMA Intern Med. 2015; 175: 1481-1482
        • Riva N.
        • Donadini M.P.
        • Dentali F.
        • Squizzato A.
        • Ageno W.
        Clinical approach to splanchnic vein thrombosis: risk factors and treatment.
        Thromb Res. 2012; 130: S1-S3
        • Shaheen O.
        • Siejka J.
        • Thatigotla B.
        • Pham D.T.
        A systematic review of portomesenteric vein thrombosis after sleeve gastrectomy.
        Surg Obes Relat Dis. 2017; 13: 1422-1431
        • Charlson M.
        • Szatrowski T.P.
        • Peterson J.
        • Gold J.
        Validation of a combined comorbidity index.
        J Clin Epidemiol. 1994; 47: 1245-1251
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Morasch M.D.
        • Ebaugh J.L.
        • Chiou A.C.
        • Matsumura J.S.
        • Pearce W.H.
        • Yao J.S.
        Mesenteric venous thrombosis: a changing clinical entity.
        J Vasc Surg. 2001; 34: 680-684
        • Plessier A.
        • Darwish-Murad S.
        • Hernandez-Guerra M.
        • Consigny Y.
        • Fabris F.
        • Trebicka J.
        • et al.
        Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study.
        Hepatology. 2010; 51: 210-218
        • Lee E.J.
        • Dykas D.J.
        • Leavitt A.D.
        • Camire R.M.
        • Ebberink E.
        • Garcia de Frutos P.
        • et al.
        Whole-exome sequencing in evaluation of patients with venous thromboembolism.
        Blood Adv. 2017; 1: 1224-1237
        • Simeoni I.
        • Stephens J.C.
        • Hu F.
        • Deevi S.V.
        • Megy K.
        • Bariana T.K.
        • et al.
        A high-throughput sequencing test for diagnosing inherited bleeding, thrombotic, and platelet disorders.
        Blood. 2016; 127: 2791-2803
        • Jakimowicz J.
        • Stultiens G.
        • Smulders F.
        Laparoscopic insufflation of the abdomen reduces portal venous flow.
        Surg Endosc. 1998; 12: 129-132
        • Takagi S.
        Hepatic and portal vein blood flow during carbon dioxide pneumoperitoneum for laparoscopic hepatectomy.
        Surg Endosc. 1998; 12: 427-431
        • Harnik I.G.
        • Brandt L.J.
        Mesenteric venous thrombosis.
        Vasc Med. 2010; 15: 407-418
        • Dane B.
        • Clark J.
        • Megibow A.
        Multidetector computed tomography evaluation of mesenteric venous thrombosis following laparoscopic bariatric surgery.
        J Comput Assist Tomogr. 2017; 41: 56-60
        • Acosta S.
        • Ogren M.
        • Sternby N.H.
        • Bergqvist D.
        • Bjorck M.
        Mesenteric venous thrombosis with transmural intestinal infarction: a population-based study.
        J Vasc Surg. 2005; 41: 59-63
        • Janssen H.L.
        • Wijnhoud A.
        • Haagsma E.B.
        • van Uum S.H.
        • van Nieuwkerk C.M.
        • Adang R.P.
        • et al.
        Extrahepatic portal vein thrombosis: aetiology and determinants of survival.
        Gut. 2001; 49: 720-724