Local streptokinase infusion for superior mesenteric artery thromboembolism

Thrombolysis of a partially occluding superior mesenteric artery thromboembolus by infusion of streptokinase

“…It differs from other reports, however, in that the patient apparently survived an initial acute event to later develop mesenteric angina from a partially occluding thromboembolism. In previous reports the clinical condition of the patient necessitated the use of fibrinolytics within 12 hours of presentation [5,11,17]. In all 12 previous successful cases of thrombolysis the patients did not have complete occlusion at the origin of the superior mesenteric artery but usually had at least some of the proximal jejunal branches patent.…”

“…However it would appear that revascularization occurs earlier (in less than 3 hours) with a high dose (1-2 million units) of UK [9,10]. In the various reports using low dose SK infusion at 5,000-10,000 units per hour normal vascularity was restored within 30 to 80 hours [3,[5][6][7][8]. We feel that the latter approach carries fewer overall risks, as long as the patient is continuously monitored closely.…”

Management of Acute and Chronic Mesenteric Ischemia

“…The artery is then irrigated with heparinized saline and closed with interrupted 6 -0 polypropylene sutures. Intraoperative thrombolytic therapy can be used if the embolus has caused distal thrombosis in smaller vessels that cannot be reached by the Fogarty catheter (39,40) .…”

Acute mesenteric ischemia: recent advances in diagnosis and endovascular therapy

“…In addition, many of the patients are elderly, debilitated, and have underlying cardiac disease which increases their operative risk. Recently, a variety of less invasive approaches to thromboembolic occlusion of the visceral arteries have been described, including intra-arterial thrombolysis, percutaneous transluminal angioplasty, and stent placement [11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26].…”

“…Since then, there have been several additional case reports of successful thrombolysis of superior mesenteric artery emboli using streptokinase or urokinase [12,13,14,15,16,17,18,19,20,21,22]. Simo et al reported the largest series to date consisting of ten patients who underwent local infusion of urokinase for superior mesenteric artery embolism [23].…”