Large-Bore Mechanical Thrombectomy for Subacute Portal Vein Thrombosis in Patient With Acute Bleeding

Portal vein thrombosis remains a clinical challenge with limited treatment options. A patient was admitted with decompensated nonalcoholic steatohepatitis and a history of recurrent esophageal and gastric variceal hemorrhages. Contrast-enhanced computed tomography revealed hepatic cirrhosis with concomitant and extensive thrombosis of the portal, splenic, and superior mesenteric veins. The patient was treated with transjugular intrahepatic portosystemic shunt and mechanical thrombectomy with the FlowTriever System (Inari Medical, Irvine, CA). Post-thrombectomy venography and follow-up computed tomography demonstrated patency and brisk flow. This case report shows that mechanical thrombectomy with the FlowTriever System is promising for treating extensive and subacute portal vein thrombosis.