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

Abstract

Occlusion of the superior mesenteric artery by thromboembolism is an uncommon cause of acute intestinal ischemia but carries a high mortality. This report describes a case of mesenteric thromboembolism in an 80-year-old woman treated successfully by selective low-dose infusion of streptokinase over 17 hours. Only twelve previous cases have been reported in the world literature. Selective thrombolytic therapy appears effective in the treatment of mesenteric thromboembolism, particularly in elderly patients with a high operative risk.

Simultaneous Thrombolysis of Superior Mesenteric Artery and Bilateral Renal Artery Thromboembolisms with Three Transfemoral Catheters

“…Ottinger [3] reported a mortality rate of 85% for 103 patients with acute occlusion of the SMA. Other reports [8][9][10][11][12][13][14] indicated that the clinical condition of the patients necessitated the use of fibrinolysis within 12 hr of onset of clinical signs and symptoms, because the mortality rate increases after more than 24 hr from onset [2]. Indication of intraarterial thrombolysis remains controversial, however.…”

Intestinal Ischemia and Gangrene

“…The appropriate therapeutic option is guided by the etiology of ischemia. A less well established approach is local infusion of thrombolytic therapy through angiographic catheter, which has been successful in a selected number of reports [51][52][53]. Treatment decision is guided by the presence or absence of peritoneal signs, partial or complete arterial obstruction, and on whether the location of the embolus proximal to the origin of the ileo-colic artery or in more distal branches.…”

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): Executive Summary

“…Scheduled "second look" operations, 24 to 48 hours after the initial procedure, are the best way to avoid both excessive resection of potentially viable bowel and failure to resect nonviable intestine. Despite limited data, percutaneous treatment (lytic therapy; balloon angioplasty or stenting or both) of the arterial obstruction is reasonable given the high mortality associated with the standard operative approach (223)(224)(225). However, because most patients with acute intestinal ischemia have at least some nonviable intestine at the time of presentation, most will still require laparotomy, and surgical assessment of intestinal viability may be required even if percutaneous therapy is successful in relieving the obstruction.…”