Objective:

To report a case of acute superior mesenteric vein thrombosis (ASMVT) and acute portal vein thrombosis (APVT) managed with an endovascular-first strategy.

Approach:

• Patient Presentation: A 44-year-old male presented with acute abdominal pain, hematochezia, and vomiting, leading to a diagnosis of complete thrombosis of the superior mesenteric vein and portal vein.
• Diagnostic Assessment: Contrast-enhanced abdominal CT confirmed complete thrombosis and suspected intestinal necrosis.
• Therapeutic Intervention: Emergency endovascular intervention included percutaneous transhepatic portal venography, balloon dilation, thrombolysis, thrombectomy, and catheter-directed thrombolysis.

Key Findings:

• Endovascular therapy combined with anticoagulation was successful in avoiding surgical intervention.
• Vascular recanalization occurred on postoperative day 9.
• The patient had an uneventful recovery and was discharged without the need for bowel resection.

Interpretation:

Endovascular therapy may be a viable treatment option for ASMVT and APVT complicated by intestinal necrosis, warranting further investigation.

Limitations:

• The rarity of ASMVT and APVT limits the generalizability of findings.
• High-level evidence supporting endovascular approaches is still lacking.

Conclusion:

Endovascular intervention may provide a less invasive alternative to traditional surgical approaches in managing acute thrombosis of the superior mesenteric and portal veins.