Percutaneous Aspiration Embolectomy Using Guiding Catheter for the Superior Mesenteric Artery Embolism

OBJECTIVE: To evaluate the technical feasibility and clinical outcome of percutaneous aspiration embolectomy for embolic occlusion of the superior mesenteric artery (SMA). MATERIALS AND METHODS: Between January 2010 and December 2013, 9 patients with embolic occlusion of the SMA were treated by percutaneous aspiration embolectomy in 2 academic teaching hospitals. The aspiration embolectomy procedure was performed with the 6-Fr and 7-Fr guiding catheter. Thrombolysis was performed with urokinase using a multiple-sidehole infusion catheter. The clinical outcome was investigated retrospectively. RESULTS: Superior mesenteric artery occlusion was initially diagnosed by computed tomography (CT) in all patients, and all patients had no obvious evidence of bowel infarction on CT scan. Percutaneous aspiration embolectomy was primarily performed in 6 patients, and thrombolysis was initially performed in 3 patients. In 3 patients who received primary thrombolysis, percutaneous aspiration was undertaken because the emboli were resistant to urokinase. Complete angiographic success was achieved in 6 patients and partial angiographic success was accomplished in 3 patients. One patient underwent bowel resection. One patient died of whole bowel necrosis and sepsis, and 8 patients survived without complications. CONCLUSION: Percutaneous aspiration embolectomy is a useful tool in recanalization of embolic occlusion of the SMA in select patients.

Rapidly Aggravated Dissecting Flap by Angiography during Percutaneous Stent Placement for Acute Isolated Superior Mesenteric Artery Dissection

Acutely aggravated dissecting flap and consequent occlusion of the superior mesenteric artery (SMA) by simple contrast passage during initial angiography for percutaneous stent placement is a uncommon event, which usually is not reported. After analysis of many factors that underlie development of such complications, we present herein one case of successful treatment of isolated SMA dissection and its complications with favorable outcomes during 25 months follow-up after percutaneous stent placement.

Isolated Spontaneous Dissection of Superior Mesenteric Artery: Treated by Percutaneous Endovascular Stent Placement / 대한소화기학회지

Isolated spontaneous dissection of the superior mesenteric artery (SMA) without aortic dissection is a rare cause of acute mesenteric ischemia. A sudden decrease of intestinal blood flow can lead to fatal complications such as ischemic necrosis, shock, and death. Therefore, early diagnosis and therapeutic approach before the occurrence of intestinal infarction are the most important factor to determine the patient's prognosis. A 52-year-old male presented with postprandial periumbilical pain, and isolated spontaneous dissection of the superior mesenteric artery with mural thrombus was detected by abdominal computed tomography with contrast enhancement. By the percutaneous implantation of vascular metallic stent via femoral artery, he was treated successfully. We report a case of isolated spontaneous dissection of the SMA treated by a percutaneous endovascular stent replacement with a review of literature.

Isolated Spontaneous Dissection of Superior Mesenteric Artery: Treated by Percutaneous Endovascular Stent Placement / 대한소화기학회지

Isolated spontaneous dissection of the superior mesenteric artery (SMA) without aortic dissection is a rare cause of acute mesenteric ischemia. A sudden decrease of intestinal blood flow can lead to fatal complications such as ischemic necrosis, shock, and death. Therefore, early diagnosis and therapeutic approach before the occurrence of intestinal infarction are the most important factor to determine the patient's prognosis. A 52-year-old male presented with postprandial periumbilical pain, and isolated spontaneous dissection of the superior mesenteric artery with mural thrombus was detected by abdominal computed tomography with contrast enhancement. By the percutaneous implantation of vascular metallic stent via femoral artery, he was treated successfully. We report a case of isolated spontaneous dissection of the SMA treated by a percutaneous endovascular stent replacement with a review of literature.

A Case of Spontaneous Dissection of the Superior Mesenteric Artery Treated by Percutaneous Stent Placement / 대한소화기학회지

Acute mesenteric ischemia can result from emboli, arterial and venous thrombi or vasoconstriction secondary to low-flow states. Isolated spontaneous dissection of the superior mesenteric artery is a rare cause of acute mesenteric ischemia. The mortality rates of acute mesenteric ischemia averages 71% with a range of 59-93%. Diagnosis before the occurrence of intestinal infarction is the most important factor in improving survival rate for patients with acute mesenteric ischemia. A 68-year-old female presented with postprandial epigastric pain, and a dissection of the superior mesenteric artery and a gallbladder polyp were shown in abdominal computed tomographic scan. After the percutaneous metalic stent placement and laparoscopic cholecystectomy, her symptoms improved. We report a case of spontaneous dissection of main trunk of the superior mesenteric artery which was successfully treated by percutaneous stent placement with a review of literature.

Dímero D e isquemia intestinal aguda: un nuevo marcador en plasma? / D-dimer (plasmatic marker) in acute intestinal ischemia

Antecedentes: La isquemia intestinal tiene una mortalidad mayor al 70 por ciento. Su diagnóstico es un desafío. No existe estudio de certeza para determinar su presencia. El Dímero D (DD) es un marcador de fibrinolisis. Se aplica en el diagnóstico de la trombosis venosa profunda y el tromboembolismo pulmonar. Su nivel plasmático elevado indicaría la presencia de isquemia intestinal aguda (IIA) por enfermedad trombólica. Objetivo: Determinar el valor diagnóstico del DD en la IIA de cualquier etiología. Lugar de aplicación: Hospital Privado de la Comunidad. Diseño: Longitudinal, consecutivo, prospectivo no randomizado. Período: 2001-2002. Población: Determinación de DD en 26 pacientes con diagnóstico presuntivo de IIA. Métodos: Se analizaron la sensibilidad (S), especificidad (E), valor predictivo negativo (VPN) y positivo (VPP) del DD para determinar la IIA (Epidat 2,1). Resultados: Se comprobó la ausencia de isquemia intestinal en 6 casos, en todos ellos el DD fue negativo. En los 4 casos tratados médicamente no se pudo certificar isquemia, asimismo el DD fue negativo. Dichos pacientes evolucionaron favorablemente sin necesidad de cirugía. En 15 de los 16 casos con certeza de isquemia el DD fue positivo. La S del DD para diagnosticar isquemia fue de 93,3 por ciento - VPN 87,5 por ciento - E y VPP, 100 por ciento (Alfa=0,05)

Acute mesenteric venous thrombosis complicating endoscopic variceal sclerotherapy with absolute alcohol.

We report two patients, one with liver cirrhosis and another with extrahepatic portal vein obstruction, who developed acute mesenteric vein thrombosis following endoscopic variceal sclerotherapy with absolute alcohol. Both patients recovered after emergency laparotomy and resection of gangrenous bowel loop.

Isquemia mesentérica aguda / Acute mesenteric ischemia

La isquemia mesentérica aguda aún no es considerada en muestro medio dentro de las hipótesis diagnósticas de un paciente con un cuadro abdominal agudo, además la reticencia de muchos colegas para indicar estudio angiográfico o la falta de disponibilidad inmediata de éste, es otro punto en contra. Lo anteriormente expuesto determina la diferencia entre isquemia e infarto intestinal y no permite modificar sustancialmente el resultado final del paciente

Estenosis segmentaria de intestino delgado luego de trombosis de vena mesentérica superior: caso clínico / Segmental short bowel stenosis after a superior mesenteric vein thrombosis: report of 1 case

We report a 24 years old female with a superior mesenteric and portal vein thrombosis due to an antithrombin III factor deficiency, associated to oral contraceptive use and smoking. She presented with severe abdominal pain and the diagnosis was reached after surgery with a CT scan. The patient was treated with intravenous heparin and oral anticoagulation, with a good clinical and doppler endosonographic response. One month after the onset, she developed an intestinal occlusion caused by two concentric jejunal stenoses, measuring 2 and 0.7 cm in length and demonstrated with a barium jejunogram. A 35 cm intestinal resection was done and the patient recovered uneventfully. The pathological study showed granulation tissue on both stenotic zones with an ulcer near to the distal stricture, that reached the internal muscularis propria, with subserosal fibrosis. The development of segmental stenosis is a rare complication superior mesenteric vein thrombosis, that must be bore in mind

Carcinoide de intestino delgado: una causa rara de infarto intestino mesentérico / Carcinoid tumor of small intestine, cause of mesenteric intestinal infarction

Las neoplasias del intestino delgado son poco frecuentes. Los carcinoides son el 20 por ciento de éstas. La mayoría son asintomáticos y son hallazgos incidentales, el resto se presenta por sus complicaciones, como cuadros agudos de abdomen, el más frecuente es la oclusión intestinal. El infarto intestino mesentérico y la isquemia intestinal han sido reconocidos como otra presentación muy rara, en estos casos la terapéutica quirúrgica agresiva, a pesar de la gravedad de la presentación, muestra beneficios en el pronóstico. Se presentan 2 casos y se discuten los eventos patogénicos

Trombose de veia mesentérica superior e anticoagulante lúpico / Thrombosis of the upper mesenteric vein and lupus anticoagulant

Relata-se o caso de uma paciente de 47 anos de idade que procurou o serviço de cirurgia do Hospital de Base - FAMERP (SP) com queixas de dor abdominal em cólica na regiao hipogástrica, náuseas, vômitos e diarréia nao sanguinolenta há um dia. No exame físico encontrava-se taquicárdica, hipotensao e com dor à descompressao brusca do abdome em regiao hipogástrica. Foi submetida a laparotomia exploradora com diagnóstico de trombose de vei mesentérica superior. Constatou-se a positividade para o anticoagulante lúpico com ausência de anticorpos anticardiolipinas, proteína S e C e antitrombina III. Realizou-se a anticoagulaçao com heparina e mesmo na vigência desta apresentou progressao do quadro trombótico com necessidade de novas ressecçoes. Chama-se atençao para a necessidade de se investigar as causas trombogênicas em pacientes com trombose da veia mesentérica superior.

Trombose mesentérica após a desconexão ázigo-portal com esplenectomia para o tratamento das varizes esofageanas sangrantes na esquistossomose mansônica, relato de três casos / Mesenteric venous thrombosis after azygos-portal disconnection with splenectomy for the treatment of bleeding esophageal varices in mansonian schistosomiasis. Three cases reports

The consequence of an acute mesenteric venous thrombosis following porta-azygos disconnection for the treatment of bleeding esophageal varices due to mansonian schistosomiasis has not been well defined in the literature. The clinical manifestations reported were fever, spasmodic abdominal pain associated with food intake. We treated three patients with thrombosis of the portal-mesenteric trunk following porta-azygos disconnection and adopted a conservative clinical approach in two patients while one had to have a surgical small bowel ressection.

Sistemática para diagnóstico de abdomen agudo de causa vascular / Sistematic diagnosis of acute abdome due to vascular disorders

No presente trabalho os autores apresentam uma forma sistemática de diagnóstico clínico e/ou cirúrgico para o abdômen agudo de origem vascular, enfatizando a importância da suspeita diagnóstica e da terapêutica precoce na sobrevida dos pacientes

Comprometimento intestinal pela tromboangiite obliterante: apresentaçäo de um caso / Intestinal compromising by thromboangiitis obliterans: report of one case

Os autores apresentam um caso de isquemia mesentérica aguda em paciente portador de tromboangiitr obliterante. Discutem a raridade do comprometimento intestinal na doença em questäo, assim como as formas de diagnosticá-la

Necrose intestinal segmentar por trombose venosa de mesentérica pós-esplenectomia / Segmental intestinal necrosis due to mesenteric venous thrombosis after splenectomy

Embora os fenômenos trombembólicos pós-esplenectomia sejam bem conhecidos, a trombose venosa de mesentérica é entidade rara e de alta gravidade. Neste trabalho säo analisados 10 doentes com esta complicaçäo que ocorreu o 7- e 38- dia pós-operatório da esplenectomia. Oito doentes foram operados, sendo submetidos a enterectomias parciais que variaram de 50 a 300 cm de extensäo. Dois foram tratados clínicamente. A mortalidade global foi de 30%