Abstract
The purpose of this study was to characterize the outcome of attempted endovascular intervention in patients with acute embolic or thrombotic superior mesenteric artery (SMA) occlusion. The records of 21 patients during a 3-year period between 2005 and 2008 were retrieved from the in-hospital registry. The first group included 10 patients (6 women and 4 men; median age 78 years) with acute embolic occlusion of the SMA. The median duration of symptoms from symptom onset to angiography was 30 hours (range 6 to 120). Synchronous emboli (n = 12) occurred in 6 patients. Embolus aspiration was performed in 9 patients, and 7 of these had satisfactory results. Complementary local thrombolysis was successful in 2 of 3 patients. Residual emboli were present at completion angiography in all 7 patients who underwent successful aspiration embolectomy, and bowel resection was necessary in only 1 of these patients. One serious complication occurred because of a long SMA dissection. The in-hospital survival rate was 90% (9 of 10 patients). The second group included 11 patients (10 women and 1 man; median age 68 years) with atherosclerotic acute SMA occlusions. The median time of symptom duration before intervention was 97 hours (range 17 to 384). The brachial, femoral, and SMA routes were used in 6, 7, and 5 patients, respectively. SMA stenting was performed through an antegrade (n = 7) or retrograde (n = 3) approach. Bowel resection was necessary in 4 patients. No major complications occurred. The in-hospital survival rate was 82% (9 of 11 patients). Endovascular therapy of acute SMA occlusion provides a good alternative to open surgery.
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Mamode N, Pickford I, Leiberman P (1999) Failure to improve outcome in acute mesenteric ischaemia: seven-year review. Eur J Surg 165:203–208
Acosta S, Ögren M, Sternby N-H, Bergqvist D, Björck M (2004) Incidence of acute thromboembolic occlusion of the superior mesenteric artery: a population-based study. Eur J Vasc Endovasc Surg 27:145–150
Block T, Nilsson TK, Björck M, Acosta S (2008) Diagnostic accuracy of plasma biomarkers for intestinal ischemia. Scand J Clin Lab Invest 68:242–248
Batellier J, Kieny R (1990) Superior mesenteric artery embolism: eighty-two cases. Ann Vasc Surg 4:112–116
Zangos S, Steenburg S, Phillips D, Kerl M, Nguyen S, Herzog C et al (2007) Acute abdomen: added diagnostic value of coronal reformations with 64-slice multidetector row computed tomography. Acta Radiol 14:19–27
Aschoff A, Stuber G, Becker BW, Hoffman M, Schmitz B, Schelzig H et al (2008) Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging
Sonesson B, Hinchcliffe R, Dias N, Resch T, Malina M, Ivancev K (2008) Hybrid recanalization of superior mesenteric artery occlusion in acute mesenteric ischemia. J Endovasc Ther 15:129–132
Sternbergh WC III, Ramee SR, DeVun DA, Money SR (2000) Endovascular treatment of multiple visceral artery paradoxical emboli with mechanical and pharmacological thrombolysis. J Endovasc Ther 7:155–160
Ogihara S, Yamamura S, Tomono H, Iwabuchi H, Ebihara T, Mingawa Y et al (2003) Superior mesenteric arterial embolism treatment by transcatheter thrombo-aspiration. J Gastroenterol 38:272–277
Hladik P, Raupach J, Lojik M, Kra**a A, Vobonl Z, Jon B et al (2004) Treatment of acute mesenteric thrombosis/ischemia by transcatheter thromboaspiration. Surgery 137:122–123
Schoots I, Levi M, Reekers J, Lameris J, van Gulik T (2005) Thrombolytic therapy for acute superior mesenteric artery occlusion. J Vasc Interv Radiol 16:317–329
Milner R, Woo EY, Carpenter JP (2004) Superior mesenteric artery angioplasty via a retrograde approach in a patient with bowel ischemia—a case report. Vasc Endovasc Surg 38:89–91
Wyers M, Powell R, Nolan B, Cronenwett J (2007) Retrograde mesenteric stenting during laparotomy for acute occlusive mesenteric ischemia. J Vasc Surg 45:269–275
Moyes LH, McCarter DH, Vass DG, Orr DJ (2008) Intraoperative retrograde mesenteric angioplasty for acute occlusive mesenteric ischaemia: a case series. Eur J Vasc Endovasc Surg 36:203–206
Gartenschlager S, Bender S, Maeurer J, Schroeder RJ (2008) Successful percutaneous transluminal angioplasty and stenting in acute mesenteric ischemia. Cardiovasc Interv Radiol 31:398–400
Acosta S, Ögren M, Sternby N-H, Bergqvist D, Björck M (2005) Clinical implications for the management of acute thromboembolic occlusion of the superior mesenteric artery. Ann Surg 241:516–522
Wadman M, Block T, Ekberg O, Syk I, Elmståhl S, Acosta S (submitted) Impact of multi-detector CT angiography in the survival of patients with acute SMA occlusion
Acosta S, Wadman M, Syk I, Elmståhl S, Ekberg O (submitted) Epidemiology and prognostic factors in acute superior mesenteric artery occlusion—a population-based study
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Acosta, S., Sonesson, B. & Resch, T. Endovascular Therapeutic Approaches for Acute Superior Mesenteric Artery Occlusion. Cardiovasc Intervent Radiol 32, 896–905 (2009). https://doi.org/10.1007/s00270-009-9559-x
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DOI: https://doi.org/10.1007/s00270-009-9559-x