Hypercoagulability status, operative mortality and long-term survival in patients operated on for mesenteric venous thrombosis.

OBJECTIVE: Mesenteric venous thrombosis (MVT) is a rare cause of acute surgical abdomen, with high mortality. The aim of this study was to analyse long-term outcomes and possible factors influencing its prognosis.

METHODS: All patients undergoing urgent surgery for MVT from 1990 to 2020 in our center were reviewed. Epidemiological, clinical, and surgical data, postoperative outcomes, origin of thrombosis, and long-term survival were analysed. Patients were divided in two groups: primary MVT (hypercoagulability disorders or idiopathic MVT) and secondary MVT (underlying disease).

RESULTS: Fifty-five patients, 36 (65.5%) men and 19 (34.5%) women, mean age 66.7 years (SD: ±18.0), underwent surgery for MVT. Arterial hypertension (63.6%) was the most prevalent comorbidity. Regarding the possible origin of the MVT, 41 (74.5%) patients had primary MVT, and 14 (25.5%) patients had secondary MVT. From these, 11 (20%) patients had hypercoagulable states, 7 (12.7%) had neoplasia, 4 (7.3%) had abdominal infection, 3 (5.5%) had liver cirrhosis, 1 (1.8%) had recurrent pulmonary thromboembolism, and 1 (1.8%) had DVT. CT was diagnostic of MVT in 87.9% of the cases. Intestinal resection was performed in 45 patients due to ischemia. Only 6 patients (10.9%) had no complication; 17 patients (30.9%) presented minor complications and 32 patients (58.2%) presented severe complications, according to the Clavien-Dindo classification. Operative mortality was 23.6 %. In univariate analysis, comorbidity measured by Charlson Index (p=0.019), and massive ischemia (p=0.002) were related to operative mortality. The probability of being alive at 1, 3 and 5 years was 66.4%, 57.9% and 51.0%, respectively. In univariate analysis of survival, age (p<0.001), comorbidity (p<0.001), and type of MVT (p=0.003) were associated with a good prognosis. Age (p=0.002; HR:1.05 - CI95%:1.02-1.09), and comorbidity (p=0.019; HR: 1.28 - CI95%: 1.04-1.57), behaved as independent prognostic factors for survival.

CONCLUSIONS: Surgical MVT continues to show high lethality. Age and comorbidity according to the Charlson index correlates well with mortality risk. Primary MVT tends to have better prognosis than secondary MVT.