Successful Recanalization of Acute Superior Mesenteric Artery Thromboembolic Occlusion by a Combination of Intraarterial
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CASE REPORT
Successful Recanalization of Acute Superior Mesenteric Artery Thromboembolic Occlusion by a Combination of Intraarterial Thrombolysis and Mechanical Thrombectomy with a Carotid Filter Kamil Zelenˇa´k • Igor Sˇina´k • Ja´n Janı´k Anton Mikolajcˇ´ık • Dusˇan Misˇtuna
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Received: 14 May 2012 / Accepted: 27 August 2012 / Published online: 25 September 2012 Ó Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2012
Abstract Acute superior mesenteric artery (SMA) occlusion is a life-threatening disease, and acute intestinal ischemia develops from the sudden decrease in perfusion to the intestines. The key to saving the patient’s life is early diagnosis, and prompt revascularization of the SMA can prevent intestinal infarction and decrease the risk of bowel segment necrosis. Computed tomographic angiography may be useful for rapid diagnosis. We report recanalization of an SMA occlusion in an 80-year-old man with a combination of intraarterial thrombolysis and mechanical thrombectomy with a carotid filter. Keywords Acute intestinal ischemia Carotid filter Superior mesenteric artery occlusion Thrombolysis
sepsis, and death. Computed tomographic angiography (CTA) may be useful for rapid diagnosis. Therapeutic endovascular options include aspiration embolectomy, administering intraarterial thrombolytic agents and/or vasodilators, and angioplasty with or without stent or stent graft placement. Surgical techniques include SMA embolectomy or visceral artery bypass, which should be used before bowel resection to ensure that only nonviable bowel is resected [1, 2]. Bowel resection may be complicated by subsequent permanent short-bowel syndrome. We performed recanalization of an SMA occlusion in an 80-year-old man with a combination of intraarterial thrombolysis and mechanical thrombectomy with a carotid filter. This procedure preserved the viability of the bowel, and no bowel resection was necessary.
Introduction Case Report Acute superior mesenteric artery (SMA) occlusion is a lifethreatening disease associated with a high mortality rate. Acute intestinal ischemia is caused by a critical reduction in blood flow and perfusion to the intestines. The key to saving the patient’s life is early diagnosis, and prompt revascularization of the SMA can prevent intestinal infarction, decrease the risk of bowel segment necrosis, and salvage bowel viability. Patients with prolonged ischemia are at risk of bowel infarction, wall perforation, subsequent K. Zelenˇa´k (&) Department of Radiology, University Hospital, Kolla´rova 2, 036 59 Martin, Slovakia e-mail: [email protected] I. Sˇina´k J. Janı´k A. Mikolajcˇ´ık D. Misˇtuna Department of Surgery, University Hospital, Kolla´rova 2, 036 59 Martin, Slovakia
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An 80-year-old man with a history of ischemic stroke and renal infarction due to atrial fibrillation was admitted to our hospital 9 h after the onset of abdominal pain. Despite known atrial fibrillation, the patient (a retired doctor) refused warf
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