Role of endovascular interventions in treatment of thromboembolic occlusion of superior mesenteric artery

El-Laboudy, Medhat E.; Abouissa, Ahmed H.; Sorour, Waleed A.; Salem, Ayman A.; Tawfik, Ahmed M.

doi:10.4103/ejs.ejs_198_19

Role of endovascular interventions in treatment of thromboembolic occlusion of superior mesenteric artery

Authors

Abstract

Objective
The aim was to evaluate the efficacy and safety of endovascular management of acute thromboembolic occlusion of superior mesenteric artery (SMA).
Patients and methods
Our prospective study was conducted at Vascular Surgery Department, Zagazig University Hospitals, Egypt, and Vascular Surgery and Intervention Radiology Departments, Alnoor Specialist Hospital, Makkah, Saudi Arabia, from March 2015 to September 2019. Eleven cases diagnosed as having thromboembolic occlusion of SMA by computerized tomographic angiography underwent endovascular intervention. Mean age was 54±11 years, and seven patients (63.6%) were males. Abdominal pain and nausea were the commonest symptoms, and none of the patients had acute peritonitis. Median time from start of symptoms to hospital admission was 9 h and from hospital admission to endovascular intervention was 11 h. Etiology was embolic in six (54.5%) patients and thrombotic in five (45.5%) patients. All patients underwent catheter-directed thrombolysis. Median dose of alteplase was 23 mg, and median infusion rate was 0.8 mg/h. Median duration of thrombolysis was 24 h. Two patients underwent balloon dilatation, and one patient underwent balloon dilatation and stenting.
Results
Technical success was seen in seven (63.6%) patients, whereas failure of endovascular revascularization in four (36.4%) patients (two of them were thrombotic and died before planned laparotomy and the other two patients were embolic and underwent laparotomy for surgical embolectomy and resection of necrotic bowel segment). Postoperative complications occurred as bleeding in four (36.4%) patients and technical complications in two (18.2%) patients. Three (27.3%) patients died during hospital admission.
Conclusion
Endovascular intervention can be an alternative to open surgery for intestinal revascularization for the treatment of early cases of acute SMA occlusion. Computerized tomographic angiography rapid diagnosis, urgent endovascular management, and intensive care and follow-up are the cornerstone for good prognosis.

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