Local fibrinolysis for superior mesenteric artery thromboembolism

Boyer, L.; Delorme, Jessica; Alexandre, M; Boissier, A; Gimbergues, Pierre; Glanddier, G; Viallet, J. F.

doi:10.1007/bf00571538

Cited by 28 publications

(13 citation statements)

References 6 publications

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“…Thrombolytic therapy is most likely to be successful if treatment is started within 12 h of the onset of symptoms and if the thrombus partially occludes the SMA trunk or occludes a single SMA branch distal to the ileocolic artery. [62][63][64][65][66][67][68][69] It was reported that a routine transcatheter infusion of papaverine improved survival in highly selected patients with major emboli of the SMA, although the experience is limited. 50,70 …”

Section: Acute Mesenteric Arterial Embolus and Thrombusmentioning

confidence: 99%

Acute Mesenteric Ischemia: The Challenge of Gastroenterology

2005

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Intestinal ischemia has been classified into three major categories based on its clinical features, namely, acute mesenteric ischemia (AMI), chronic mesenteric ischemia (intestinal angina), and colonic ischemia (ischemic colitis). Acute mesenteric ischemia is not an isolated clinical entity, but a complex of diseases, including acute mesenteric arterial embolus and thrombus, mesenteric venous thrombus, and nonocclusive mesenteric ischemia (NOMI). These diseases have common clinical features caused by impaired blood perfusion to the intestine, bacterial translocation, and systemic inflammatory response syndrome. Reperfusion injury, which exacerbates the ischemic damage of the intestinal microcirculation, is another important feature of AMI. There is substantial evidence that the mortality associated with AMI varies according to its cause. Nonocclusive mesenteric ischemia is the most lethal form of AMI because of the poor understanding of its pathophysiology and its mild and nonspecific symptoms, which often delay its diagnosis. Mesenteric venous thrombosis is much less lethal than acute thromboembolism of the superior mesenteric artery and NOMI. We present an overview of the current understanding of AMI based on reported evidence. Although AMI is still lethal and in-hospital mortality rates have remained high over the last few decades, accumulated knowledge on this condition is expected to improve its prognosis.

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Section: Acute Mesenteric Arterial Embolus and Thrombusmentioning

confidence: 99%

Acute Mesenteric Ischemia: The Challenge of Gastroenterology

2005

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“…In the setting of a hemodynamically stable patient, with no signs of peritonitis, conservative medical [63][64][65][66] . Thrombolytic therapy seems to be most successful in distal clots, when used within 12 h after the onset of symptoms [66] .…”

Section: Therapeutic Approachesmentioning

confidence: 99%

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Abboud¹,

Daher²,

Boujaoude³

2008

WJG

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Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency. Several pathophysiologic events (arterial obstruction, venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow. Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities, leading to multi-organ failure and death. Early diagnosis is difficult because the clinical presentation is subtle, and the biological and radiological diagnostic tools lack sensitivity and specificity. Therapeutic options vary from conservative resuscitation, medical treatment, endovascular techniques and surgical resection and revascularization. A high index of suspicion is required for diagnosis, and prompt treatment is the only hope of reducing the mortality rate. Studies are in progress to provide more accurate diagnostic tools for early diagnosis. AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB). Several factors contribute to the systemic hypo-perfusion state, which is the most frequent pathophysiologic event. In this particular setting, the clinical presentation of AMI can be misleading, while the laboratory and radiological diagnostic tests often produce inconclusive results. The management strategies are controversial, but early treatment is critical for saving lives. Based on the experience of our team, we consider prompt exploratory laparotomy, irrespective of the results of the diagnostic tests, is the only way to provide objective assessment and adequate treatment, leading to dramatic reduction in the mortality rate.

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“…A less frequent indication for thrombolysis is mesenteric thromboembolism [22,23]. There are case reports in the literature showing good clinical results but no single large body of experience.…”

Section: Other Indicationsmentioning

confidence: 97%

Thrombolysis in the Peripheral Vascular System

Belli

1998

Cardiovasc Intervent Radiol

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Local fibrinolysis for superior mesenteric artery thromboembolism

Cited by 28 publications

References 6 publications

Acute Mesenteric Ischemia: The Challenge of Gastroenterology

Acute Mesenteric Ischemia: The Challenge of Gastroenterology

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Thrombolysis in the Peripheral Vascular System

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