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Primary percutaneous aspiration and thrombolysis for the treatment of acute embolic superior mesenteric artery occlusion

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Abstract

Objectives:

To evaluate technical success rate and clinical outcome of patients with acute embolic superior mesenteric artery (SMA) occlusion who were treated with primary percutaneous revascularization.

Methods:

At three medical centers the radiological information system databases were used to identify all patients in whom primary percutaneous revascularization for the treatment of acute embolic SMA occlusion was attempted between 2001 and 2010. Percutaneous treatment was performed in 15 patients (median age 80 years, range 49–88 years). These patients represent the study population. Eleven patients reported abdominal pain. Five patients exhibited peritoneal signs. Revascularization was defined as complete technical success if (1) patency of the SMA with residual stenosis of not more than 30% in diameter and (2) sufficient perfusion of the entire bowel were obtained.

Results:

Complete technical success was achieved in eleven patients. After percutaneous revascularization laparotomy was performed in six patients and in three of them bowel resection was carried out (length of resected segments 20–80 cm). The 30-day mortality was 33% (five of 15 patients). None of the surviving patients exhibited short-bowel syndrome.

Conclusions:

Primary percutaneous aspiration and thrombolysis constitutes a promising alternative to surgical revascularization in selected patients with acute embolic SMA occlusion.

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References

  1. Brandt LJ, Boley SJ (2000) AGA technical review on intestinal ischemia. American Gastrointestinal Association. Gastroenterology 118:954–968

    Article  CAS  PubMed  Google Scholar 

  2. Eckstein HH (2003) Die akute mesenteriale Ischämie. Resektion oder Rekonstruktion. [Acute mesenteric ischemia. Resection or reconstruction?]. Chirurg 74:419–431

    Article  PubMed  Google Scholar 

  3. Gore RM, Yaghmai V, Thakrar KH, Berlin JW, Mehta UK, Newmark GM, Miller FH (2008) Imaging in intestinal ischemic disorders. Radiol Clin N Am 46:845–875

    Article  PubMed  Google Scholar 

  4. Schoots IG, Levi MM, Reekers JA, Lameris JS, van Gulik TM (2005) Thrombolytic therapy for acute superior mesenteric artery occlusion. J Vasc Interv Radiol 16:317–329

    PubMed  Google Scholar 

  5. Debus ES, Diener H, Larena-Avellaneda A (2009) Akute intestinale Ischämie. [Acute intestinal ischemia]. Chirurg 80:375–385

    Article  CAS  PubMed  Google Scholar 

  6. Romano S, Niola R, Maglione F, Romano L (2008) Small bowel vascular disorders from arterial etiology and impaired venous drainage. Radiol Clin N Am 46:891–908

    Article  PubMed  Google Scholar 

  7. Luther B (2006) Akute viszerale Ischämie. [Acute visceral ischemia]. Gefässchirurgie 11:167–172

    Article  Google Scholar 

  8. Falkensammer J, Oldenburg WA (2006) Surgical and medical management of mesenteric ischemia. Curr Treat Options Cardiovasc Med 8:137–143

    Article  PubMed  Google Scholar 

  9. Acosta S, Sonesson B, Resch T (2009) Endovascular therapeutic approaches for acute superior mesenteric artery occlusion. Cardiovasc Interv Radiol 32:896–905

    Article  CAS  Google Scholar 

  10. Loomer DC, Johnson SP, Diffin DC, DeMaioribus CA (1999) Superior mesenteric artery stent placement in a patient with acute mesenteric ischemia. J Vasc Interv Radiol 10:29–32

    Article  CAS  PubMed  Google Scholar 

  11. Wakabayashi H, Shiode T, Kurose M, Moritani H, Fujiki S, Morimoto N, Kusachi S (2004) Emergent treatment of acute embolic superior mesenteric ischemia with combination of thrombolysis and angioplasty: report of two cases. Cardiovasc Interv Radiol 27:389–393

    Article  CAS  Google Scholar 

  12. Yilmaz S, Gurkan A, Erdogan O, Sindel T, Ceken K, Luleci E (2003) Endovascular treatment of an acute superior mesenteric artery occlusion following failed surgical embolectomy. J Endovasc Ther 10:386–391

    Article  PubMed  Google Scholar 

  13. Vijayalakshmi K, Whittaker VJ, Kunadian B, Graham J, Wright RA, Hall JA, Sutton A, de Belder MA (2006) Prospective, randomised, controlled trial to study the effect of intracoronary injection of verapamil and adenosine on coronary blood flow during percutaneous coronary intervention in patients with acute coronary syndromes. Heart 92:1278–1284

    Article  CAS  PubMed  Google Scholar 

  14. Bartone G, Severino BU, Armellino MF, Maglio MN, Castriconi M (2008) Clinical symptoms of intestinal vascular disorders. Radiol Clin N Am 46:887–889

    Article  PubMed  Google Scholar 

  15. Kougias P, Lau D, El Sayed HF, Zhou W, Huynh TT, Lin PH (2007) Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J Vasc Surg 46:467–474

    Article  PubMed  Google Scholar 

  16. Funaki B (2004) Microcatheter embolization of lower gastrointestinal hemorrhage: an old idea whose time has come. Cardiovasc Interv Radiol 27:591–599

    Article  Google Scholar 

  17. Kuo WT, Lee DE, Saad WE, Patel N, Sahler LG, Waldman DL (2003) Superselective microcoil embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 14:1503–1509

    PubMed  Google Scholar 

  18. Paterno F, Longo WE (2008) The etiology and pathogenesis of vascular disorders of the intestine. Radiol Clin N Am 46:877–885

    Article  PubMed  Google Scholar 

  19. Demirpolat G, Oran I, Tamsel S, Parildar M, Memis A (2007) Acute mesenteric ischemia: endovascular therapy. Abdom Imaging 32:299–303

    Article  PubMed  Google Scholar 

  20. Ogihara S, Yamamura S, Tomono H, Iwabuchi H, Ebihara T, Minagawa Y, Ogawa T, Kurosawa S, Yakabi K, Nakamura T (2003) Superior mesenteric arterial embolism: treatment by trans-catheter thrombo-aspiration. J Gastroenterol 38:272–277

    Article  PubMed  Google Scholar 

  21. Seder CW, Kramer M, Uzieblo MR, Bove P (2009) Endovascular treatment of a superior mesenteric artery embolism in a high-risk Jehovah’s Witness. J Vasc Surg 49:1050–1052

    Article  PubMed  Google Scholar 

  22. Kawarada O, Sonomura T, Yokoi Y (2006) Direct aspiration using rapid-exchange and low-profile device for acute thrombo-embolic occlusion of the superior mesenteric artery. Catheter Cardiovasc Interv 68:862–866

    Article  PubMed  Google Scholar 

  23. Brountzos EN, Critselis A, Magoulas D, Kagianni E, Kelekis DA (2001) Emergency endovascular treatment of a superior mesenteric artery occlusion. Cardiovasc Interv Radiol 24:57–60

    Article  CAS  Google Scholar 

  24. Moore M, McSweeney S, Fulton G, Buckley J, Maher M, Guiney M (2008) Reperfusion hemorrhage following superior mesenteric artery stenting. Cardiovasc Interv Radiol 31(Suppl 2):S57–S61

    Article  Google Scholar 

  25. Cortese B, Limbruno U (2009) Acute mesenteric ischemia: primary percutaneous therapy. Catheter Cardiovasc Interv 75:283–285

    Article  Google Scholar 

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Acknowledgements

The authors express their gratitude to Dietlinde Ulsperger for editing the figures.

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Correspondence to Peter Heiss.

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Heiss, P., Loewenhardt, B., Manke, C. et al. Primary percutaneous aspiration and thrombolysis for the treatment of acute embolic superior mesenteric artery occlusion. Eur Radiol 20, 2948–2958 (2010). https://doi.org/10.1007/s00330-010-1859-7

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  • DOI: https://doi.org/10.1007/s00330-010-1859-7

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