445 Endovascular treatment of acute mesenteric ischemia: An option to consider in patients unfit for major surgery

Abstract

Abstract Introduction The number of embolectomies for superior mesenteric arterial occlusion has increased over the years. Endovascular embolectomies in acute mesenteric ischemia continue to be performed only in a smaller proportion of cases despite multiple studies reporting promising results. Case description An 85-year-old lady presented to the emergency surgical unit with an acute onset of severe abdominal pain and vomiting. She has a background of atrial fibrillation and hypertension and has been a chronic smoker for the past 50 years. One month before her presentation, she stopped taking her anticoagulation due to intermittent per-rectal bleeding attributed to diverticular disease. Initial CT demonstrated an SMA embolus extending from the first bifurcation approximately 4.5cm distally. In addition, there were features of bowel ischaemia with abnormal thickening of the small bowel loops in that vascular territory. She was deemed too frail for a laparotomy by the surgical and anaesthetic team, and the patient preferred to explore a non-operative approach. Despite treatment dose anticoagulation, her clinical condition deteriorated, with a rise in inflammatory markers, intolerance of food, and worsening abdominal pain. Unfortunately, thrombolysis was not an option because of the large size of the embolus and PR bleeding. She underwent an endovascular vacuum-assisted thrombectomy. The procedure achieved near-complete revascularisation, and the patient sustained a good recovery and was discharged on day 8 of admission. Discussion Available literature has shown promising results with endovascular treatment of acute mesenteric ischemia. The successful revascularisation, in this case, confirms that endovascular techniques are a viable option to consider in acute mesenteric ischemia.