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Early endovascular treatment of superior mesenteric occlusion secondary to thromboemboli.
Eur J Vasc Endovasc Surg. 2014 Feb; 47(2):196-203.EJ

Abstract

OBJECTIVE

To evaluate our early experience with endovascular revascularization in patients with acute thromboembolic occlusion of the superior mesenteric artery (SMA).

METHODS

A retrospective review was conducted of all patients who underwent endovascular revascularization for acute thromboembolic SMA occlusion from May 2005 to May 2012. Endovascular revascularization was performed using aspiration, intra-arterial thrombolysis, and adjunctive stent-placement techniques. Laparotomy was performed if the patient developed clinical signs of advanced bowel ischemia after endovascular procedure.

RESULTS

Twenty-one patients underwent endovascular revascularization for acute thromboembolic SMA occlusion. All presented with acute-onset abdominal pain. Three patients had rebound tenderness before the procedure. Computed tomography angiography revealed complete occlusion in seven cases and incomplete occlusion in 14 cases, with no evidence of free gas or bowel necrosis. The median duration from onset of symptoms to revascularization was 8.7 ± 4.1 hours (range, 2-18 hours). Completely successful endovascular revascularization occurred in six cases (aspiration alone, 3 cases; combined aspiration and urokinase, 3 cases); partial success was achieved in 15 cases (aspiration alone, 4 cases; combined aspiration and urokinase, 10 cases; and combined aspiration, urokinase, and stent placement, 1 case). Laparotomy was required in five patients, all of whom had SMA main trunk complete occlusion and required small bowel resection. The 30-day mortality for all patients was 9.5%. During a median follow-up of 26 months, 15 patients remained asymptomatic, three patients reported occasional abdominal pain, and one patient had temporary short-bowel syndrome.

CONCLUSIONS

Percutaneous revascularization is a promising alternative to surgery for acute SMA occlusion in selected patients who have no signs of advanced bowel ischemia. Early diagnosis followed by prompt endovascular intervention with close postprocedural monitoring is key. Laparotomy is indicated in patients who develop new or worsening signs of peritonism after endovascular procedure, particularly in those who had complete occlusion of the main trunk of the SMA.

Authors+Show Affiliations

Department of Interventional Radiography, The Second Hospital of Changzhou Affiliated to Nanjing Medical University, Jiangsu Province, China.Department of Interventional Radiography, The Second Hospital of Changzhou Affiliated to Nanjing Medical University, Jiangsu Province, China. Electronic address: 747094035@qq.com.Department of Interventional Radiography, The Second Hospital of Changzhou Affiliated to Nanjing Medical University, Jiangsu Province, China.Department of Interventional Radiography, The Second Hospital of Changzhou Affiliated to Nanjing Medical University, Jiangsu Province, China.Department of Interventional Radiography, The Second Hospital of Changzhou Affiliated to Nanjing Medical University, Jiangsu Province, China.Department of Interventional Radiography, The Second Hospital of Changzhou Affiliated to Nanjing Medical University, Jiangsu Province, China.Department of Interventional Radiography, The Second Hospital of Changzhou Affiliated to Nanjing Medical University, Jiangsu Province, China.Department of Interventional Radiography, The Second Hospital of Changzhou Affiliated to Nanjing Medical University, Jiangsu Province, China.Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24183620

Citation

Jia, Z, et al. "Early Endovascular Treatment of Superior Mesenteric Occlusion Secondary to Thromboemboli." European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, vol. 47, no. 2, 2014, pp. 196-203.
Jia Z, Jiang G, Tian F, et al. Early endovascular treatment of superior mesenteric occlusion secondary to thromboemboli. Eur J Vasc Endovasc Surg. 2014;47(2):196-203.
Jia, Z., Jiang, G., Tian, F., Zhao, J., Li, S., Wang, K., Wang, Y., Jiang, L., & Wang, W. (2014). Early endovascular treatment of superior mesenteric occlusion secondary to thromboemboli. European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, 47(2), 196-203. https://doi.org/10.1016/j.ejvs.2013.09.025
Jia Z, et al. Early Endovascular Treatment of Superior Mesenteric Occlusion Secondary to Thromboemboli. Eur J Vasc Endovasc Surg. 2014;47(2):196-203. PubMed PMID: 24183620.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early endovascular treatment of superior mesenteric occlusion secondary to thromboemboli. AU - Jia,Z, AU - Jiang,G, AU - Tian,F, AU - Zhao,J, AU - Li,S, AU - Wang,K, AU - Wang,Y, AU - Jiang,L, AU - Wang,W, Y1 - 2013/10/02/ PY - 2013/04/27/received PY - 2013/09/24/accepted PY - 2013/11/5/entrez PY - 2013/11/5/pubmed PY - 2014/3/29/medline KW - Embolus KW - Endovascular revascularization KW - Occlusion KW - Superior mesenteric artery KW - Thrombolytic therapy KW - Thrombus SP - 196 EP - 203 JF - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery JO - Eur J Vasc Endovasc Surg VL - 47 IS - 2 N2 - OBJECTIVE: To evaluate our early experience with endovascular revascularization in patients with acute thromboembolic occlusion of the superior mesenteric artery (SMA). METHODS: A retrospective review was conducted of all patients who underwent endovascular revascularization for acute thromboembolic SMA occlusion from May 2005 to May 2012. Endovascular revascularization was performed using aspiration, intra-arterial thrombolysis, and adjunctive stent-placement techniques. Laparotomy was performed if the patient developed clinical signs of advanced bowel ischemia after endovascular procedure. RESULTS: Twenty-one patients underwent endovascular revascularization for acute thromboembolic SMA occlusion. All presented with acute-onset abdominal pain. Three patients had rebound tenderness before the procedure. Computed tomography angiography revealed complete occlusion in seven cases and incomplete occlusion in 14 cases, with no evidence of free gas or bowel necrosis. The median duration from onset of symptoms to revascularization was 8.7 ± 4.1 hours (range, 2-18 hours). Completely successful endovascular revascularization occurred in six cases (aspiration alone, 3 cases; combined aspiration and urokinase, 3 cases); partial success was achieved in 15 cases (aspiration alone, 4 cases; combined aspiration and urokinase, 10 cases; and combined aspiration, urokinase, and stent placement, 1 case). Laparotomy was required in five patients, all of whom had SMA main trunk complete occlusion and required small bowel resection. The 30-day mortality for all patients was 9.5%. During a median follow-up of 26 months, 15 patients remained asymptomatic, three patients reported occasional abdominal pain, and one patient had temporary short-bowel syndrome. CONCLUSIONS: Percutaneous revascularization is a promising alternative to surgery for acute SMA occlusion in selected patients who have no signs of advanced bowel ischemia. Early diagnosis followed by prompt endovascular intervention with close postprocedural monitoring is key. Laparotomy is indicated in patients who develop new or worsening signs of peritonism after endovascular procedure, particularly in those who had complete occlusion of the main trunk of the SMA. SN - 1532-2165 UR - https://www.unboundmedicine.com/medline/citation/24183620/Early_endovascular_treatment_of_superior_mesenteric_occlusion_secondary_to_thromboemboli_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1078-5884(13)00589-3 DB - PRIME DP - Unbound Medicine ER -