Endovascular interventional treatment for acute superior mesenteric artery ischemia

Abstract

Objective To investigate the feasibility and safety of endovascular interventional treatment for acute superior mesenteric artery ischemia. Methods The clinical data of 55 patients with acute superior mesenteric artery ischemia who were admitted to the First Affiliated Hospital of Chongqing Medical University from July 2011 to December 2014 were retrospectively analyzed. The result of preoperative digital subtraction angiography (DSA) was in accord with computed tomography (CT), showing that 34 patients had superior mesenteric artery trunk embolism, 17 patients had superior mesenteric artery branch embolism, and 4 patients had artery dissection complicated with acute thrombosis. All patients firstly received endovascular interventional treatment. Abdominal exploration would be done if abdominal symptoms, signs, blood routine and imaging examinations indicated intestinal necrosis. Enterotomy and enteroanastomosis were done when intestinal necrosis was confirmed during the operation. Patients were followed up by outpatient examination till March 2015. The outcomes of endovascular interventional treatment, sequential treatment after endovascular interventional treatment, postoperative complications, 30-day mortality, recurrence rate and mortality during the follow-up were analyzed. Results The median duration from onset of symptoms to endovascular intervention was 10.1 hours (range, 4.0-15.0 hours). Complete recanalization rate was 32.7%(18/55), including 8 cases of superior mesenteric artery trunk embolism, 9 cases of superior mesenteric artery branch embolism and 1 case of superior mesenteric artery dissection. Partial technical recanalization rate was 63.6%(35/55), including 26 cases of superior mesenteric artery trunk embolism, 8 cases of superior mesenteric artery branch embolism and 1 case of superior mesenteric artery dissection. Two patients who did not respond to endovascular interventional treatment recovered after stent implantation. Nine patients with superior mesenteric artery trunk embolism underwent laparotomy+ enterectomy+ enteroanastomosis within 11-24 hours after thrombolysis. The mean length of resected small intestine was 103 cm (range, 74-201 cm). During hospitalisation, 2 patients suffered from puncture site bleeding and recovered after compression hemostasis and no patient suffered from massive hemorrhage. All the 55 patients were followed up for a median time of 5 months (range, 2-14 months). Five patients died with 30-day mortality of 9.1%(5/55) with in postoperative 30 days. Abdominal pain did not recur in other patients. During postoperative month 5, 3 patients suffered from abdominal pain and were confirmed not caused by superior mesenteric artery ischemia. Two patients with stent implantation had no recurrence during the follow-up 9 months. The rest patients showed no recurrence of superior mesenteric artery ischemia. Conclusion Endovascular interventional treatment can restore the intestinal blood supply quickly and reduce mortality, and is safe and feasible treatment method for superior mesenteric artery ischemia. Key words: Superior mesenteric artery ischemia; Endovascular interventional therapy; Efficacy