Mesenteric vein thrombosis

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The European Society for Vascular Surgery (ESVS) has published updated guidelines on the management of mesenteric artery and vein diseases, including mesenteric vein thrombosis (MVT). Contrast-enhanced CT with arterial and portal venous phases is the recommended imaging modality for suspected MVT. Evaluation for underlying etiology should include assessment for intra-abdominal malignancy, inflammatory disease, myeloproliferative neoplasms, cytomegalovirus and SARS-CoV-2 infections, and chronic liver disease. Testing for antiphospholipid antibody syndrome is recommended in patients with recurrent MVT and/or recurrent fetal loss. Thrombophilia testing is suggested in selected patients with acute MVT who are expected to discontinue anticoagulation after 3–6 months. Anticoagulation with unfractionated heparin (UFH) or low molecular weight heparin (LMWH) is recommended as first-line therapy for all patients with acute MVT. Anticoagulation for 3-6 months with a vitamin K antagonist (VKA) or LMWH (or a direct oral anticoagulant [DOAC] as an alternative) is recommended for all patients with acute MVT. Extended anticoagulation beyond 6 months is suggested for patients with transient risk factors for venous thrombosis. Indefinite anticoagulation is recommended for patients with idiopathic acute MVT or permanent risk factors. Endovascular thrombolysis and mechanical thrombectomy are suggested for patients with acute MVT who deteriorate despite anticoagulant therapy. .