Superior mesenteric arterial embolism: treatment by trans-catheter thrombo-aspiration

Abstract

A 57-year-old woman with hypertension, mixed mitral valve disease, and atrial fibrillation was admitted to our hospital because of abdominal pain continuing for several hours. On the following day, colonoscopy was performed, and diffuse yellow-white pseudomembranous changes were seen in the right hemicolon, but there were no abnormal findings in the left hemicolon; 24 h after onset, a diagnosis of superior mesenteric arterial embolism was made on the computed tomography (CT) scan findings. Abdominal angiography was performed and showed complete occlusion of the superior mesenteric artery (SMA). Then conservative treatment, using per-catheteric thrombus aspiration, was done, followed by intraarterial injection of tissue type plasminogen activator. After the thrombo-aspiration, the filling deficit of the main artery had disappeared, and the branches on the right side were clearly delineated. After the treatment, the symptoms such as abdominal pain and diarrhea improved accordingly. She was discharged from the hospital 27 days later. Our case suggests that trans-catheter thrombo-aspiration is a possible alternative to open embolectomy for some cases of SMA embolism more than 10 h post-onset.

Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-Year Single-Centre Experience

“…We mainly considered the transcatheter aspiration technique to be an extremely useful and highly effective method. Ogihara published the first case report of this technique combined with thrombolysis in the region of the mesenteric artery in 2003 [1]. We began using this technique in a modified fashion in 2004, and in 2005, we published our first experience with emboli aspiration [15].…”

“…The endovascular approach includes several revascularization techniques, among which transcatheter aspiration is considered a relatively new and revolutionary method [1]. This technique was introduced into clinical practice in the 1980s for the extraction of thromboembolic material and the subsequent treatment of acute limb ischemia [2,3].…”

Initial diagnostic modality for superior mesenteric artery occlusion: risky colonoscopy or safe CT?

“…2,3,5 Because such patients are often frail and elderly and tolerate laparotomy poorly, transcatheter thrombolytic therapy is a less invasive, favorable alternative before occurrence of intestinal necrosis. 2,3,5 Although Kim et al 1 initially performed colonoscopy in the patient with acute abdominal pain and hematochezia, colonoscopy could precipitate the crisis condition in vulnerable patients because of increased intra-bowel pressure, resulting in induction of SMA occlusion. 7 The occlusion can be detected effectively by noninvasive imaging modalities, such as contrast-enhanced CT and multidetector-row CT angiography.…”

“…[2][3][4] Although the diagnosis is often difficult and delayed, only early recognition and treatment can minimize the potential for a devastating outcome. 4,5 Angiography has been the criterion standard for the diagnosis of mesenteric occlusion, but it is usually time consuming and not universally available.…”

“…4,5 Angiography has been the criterion standard for the diagnosis of mesenteric occlusion, but it is usually time consuming and not universally available. [2][3][4][5][6] The mainstay treatment has been surgical resection of the infarcted bowel. 2,3,5 Because such patients are often frail and elderly and tolerate laparotomy poorly, transcatheter thrombolytic therapy is a less invasive, favorable alternative before occurrence of intestinal necrosis.…”