Successful Percutaneous Transluminal Angioplasty and Stenting in Acute Mesenteric Ischemia

Gartenschlaeger, S.; Bender, Siegfried; Maeurer, Juergen; Schroeder, Ralf Juergen

doi:10.1007/s00270-006-0147-z

Cited by 21 publications

(7 citation statements)

References 18 publications

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“…After removal of a thrombotic clot by aspiration, thrombolysis or angioplasty, treatment of the underlying stenotic or occlusive lesions can be achieved during the same session. Angioplasty and stenting, if performed early, have been shown to prevent intestinal infarction and obviate the need for laparotomy [ 33 , 34 ]. The hybrid approach facilitates endovascular intervention and represents a useful technique for the management of patients with AMI who require emergency laparotomy [ 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

The role of endovascular therapy in acute mesenteric ischemia

Ierardi¹

2017

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BackgroundEndovascular therapy, including aspiration thrombectomy and local thrombolytic therapy, often associated with angioplasty and stent placement, has been described in the literature. The purpose of this study was to review case series of patients with acute mesenteric ischemia treated with endovascular therapy and evaluate their outcomes.MethodsAn online review using PubMed was carried out to identify all English articles about this topic in the time interval from 2005 to 2016.The following variables were extractednumber of patients, cause of occlusion, symptoms, arteries involved, number of sessions of treatment, technical success, clinical success, recurrence rate, complications, mortality rate, number of patients who underwent diagnostic laparoscopy or surgical resection of ischemic bowel.ResultsEighteen papers met the inclusion criteria and were included. Among the patients with arterial mesenteric ischemia treated with endovascular approach, the technical success rate was high (up to 100%) and data regarding clinical success are encouraging, even though they are few and heterogeneous. Technical success rate and clinical success of patients with acute venous mesenteric ischemia approached with endovascular treatment was 74-100% and 87.5-100% respectively.ConclusionsCurrent advances in endovascular therapies have made these treatments feasible for mesenteric ischemia.

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Section: Discussionmentioning

confidence: 99%

The role of endovascular therapy in acute mesenteric ischemia

Ierardi¹

2017

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“…In patients with arterial occlusive AMI, when sufficient bowel is potentially viable, revascularization prior to resection of the infarcted bowel may improve the survival [2] . Although surgical revascularization is the standard procedure [81] , embolectomy, thrombectomy, endarterectomy [38] , as well as endovascular techniques such as antegrade percutaneous stenting [82] , and open retrograde stenting [83][84][85] provide attractive alternatives with good short-term outcome. A high stent restenosis rate is the drawback of these techniques, requiring close follow-up of the patients [85,86] .…”

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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“…Angioplasty has also been used in combination with suction [23] and thrombolysis [24] to good effect. Stenting if performed early has been shown to prevent intestinal infarction and obviates the need for laparotomy [25,26] . Self-expanding stents are not generally used as they lack the required strength, but can be used in the tortuous distal SMA or immediately distal to an implanted stent to prevent hinging [14] .…”

Section: Discussionmentioning

confidence: 99%

Endovascular recanalisation of an acute superior mesenteric artery occlusion. A case report and review of the literature

McGarry

McEvoy

Brophy

2015

Annals of Medicine &Amp; Surgery

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IntroductionAcute mesenteric ischaemia (AMI) continues to have a high mortality, ranging from 60 to 80%.Presentation of caseA 78-year-old male presented with a 20-hour history of abdominal pain, secondary to a superior mesenteric artery (SMA) thromboembolic occlusion diagnosed on computed tomography (CT) angiography. Following confirmation of bowel viability at laparotomy, endovascular intervention using combined thrombolysis, angioplasty and thromboaspiration was performed. Despite successful recanalisation of the occlusion, his condition continued to deteriorate fatally due to progressive sepsis.DiscussionWe discuss the role of biphasic CT in diagnosis of AMI, and review the evidence for endovascular interventions now increasingly used in the emergent management of thromboembolic AMI.ConclusionEarly diagnosis using CT angiography is essential, as it is highly sensitive in detecting a visceral arterial occlusion. However, laparotomy is often required to accurately determine bowel viability and the need for resection. Endovascular interventions appear to be effective alternatives to open surgery with appropriate patient selection.

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Successful Percutaneous Transluminal Angioplasty and Stenting in Acute Mesenteric Ischemia

Cited by 21 publications

References 18 publications

The role of endovascular therapy in acute mesenteric ischemia

The role of endovascular therapy in acute mesenteric ischemia

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Endovascular recanalisation of an acute superior mesenteric artery occlusion. A case report and review of the literature

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