Asked to recall the first percutaneous thrombectomy of the sagittal and portal veins performed in Lithuania with a special device, A. Pranculis, a doctor at the Republic Šiauliai Hospital, admits that these are probably the most complex operations for an interventional radiologist, which require particularly high skill of specialists.
“Such a responsible procedure has several very important ingredients without which success is impossible: equipment, conditions, tools and, of course, a good team.” We had everything in the hospital’s operating room that day, so we immediately started the operation,” says interventional radiologist A. Pranculis, thanking the operating room nurses Renata Pačkauskienei and Skaistė Pališkevičiūta and nurse’s assistant Inga Ručinskaite, who worked together at the time.
The radiologist also praises his fellow gastroenterologists for timely noticing a rare and rather difficult to diagnose disorder, intestinal ischemia, the outcome of which can often be fatal.
“This is one of the most dangerous pathologies with extremely high mortality, because a person simply cannot live without the intestine. Intestinal ischemia usually develops after occlusion of the splenic artery.
The mere fact that such a pathology was identified in a patient is a great achievement. When arterial blood does not enter the intestine, necrosis occurs, which is more easily detected.
In this particular case, it was the other way around, the blood could not flow out of the intestine, so a diagnosis of thrombosis of the sagittal or portal vein was made,” says A. Pranculis, a doctor at the Republic Šiauliai Hospital. He is open, without timely professional help, it would be practically impossible to help the patient.
The doctor explains the procedure of removing thrombi from the sagittal and portal veins, which requires special care and attention.
The process is complicated by the fact that the latter are closed and not directly accessible. The only solution is to puncture through the liver, because neither through the groin, nor through the arms, nor through the veins, they cannot be reached.
According to A. Pranculis, basically, puncturing the vein itself is a complicated process, and if it is clogged, it is an additional circumstance that complicates the process. “Getting into a thrombosed vein is difficult. At least the team managed to puncture the portal vein, through it we got to the sagittal vein and cleared both veins of thrombi.
Freshly formed thrombi after strokes are much easier to clean, and in this case the thrombi are already old and established, so their removal becomes much more difficult and requires a special thrombectomy device, which we used,” says A. Pranculis.
After the successful operation, the patient was observed for some time in the Gastroenterology Department, and then discharged home.
