Endovascular Treatment for Acute Thromboembolic Occlusion of the Superior Mesenteric Artery and the Outcome Comparison between Endovascular and Open Surgical Treatments: A Retrospective Study.

Zhao Zhang,Dan Wang,Gang Li,Tao Jiang,Guoxun Li,Yuxiang Wang,Ximo Wang

doi:10.1155/2017/1964765

Abstract

We reported our experience with endovascular treatment for patients with acute thromboembolic occlusion of the superior mesenteric artery (ATOS) as well as comparing the efficacy between endovascular and traditional open surgical treatments. Eighteen consecutive patients with ATOS who received endovascular treatment and 12 patients who received open surgical treatment between February 2007 and October 2012 at Tianjin Union Medical Center (Tianjin, China) were retrospectively reviewed. Primary clinical outcomes included the technical success, requirement of laparotomy, length of bowel resection, perioperative mortality within 30 days, and surgical complications. The patients were followed up for 0.1 to 98 months. For patients who underwent endovascular treatment, complete technical success was achieved in 8 (44.4%) patients and partial success was achieved in the remaining 10 (55.6%) patients. Laparotomy was required in 6 (33.3%) patients. The 30-day mortality was 16.7%. In comparison to open surgical therapy, endovascular therapy achieved lower requirement of laparotomy (in 33.3% versus in 58.3% of cases, p = 0.18), significantly shorter average length of bowel resection (88 ± 44 versus 253 ± 103 cm, p = 0.01), and lower mortality rate (16.7% versus 33.3%, p = 0.68). The endovascular therapy is a promising treatment alternative for ATOS.

Highlights

Acute thromboembolic occlusion of the superior mesenteric artery (ATOS) is a life-threatening disease characterized by strangulated obstruction and a final physiopathology of bowel necrosis and poor patient prognosis
It was shown by very few studies that endovascular treatment resulted in significantly less bowel resection and shorter bowel syndrome and mortality than open surgery [13]; whether or not endovascular interventional therapy should be the primary treatment for ATOS is still controversial [14, 15]
Fourteen patients were found with main trunk occlusions (7 complete and 7 incomplete), 1 was found with branch occlusion, and 3 were found with trunk occlusions mixed with branch occlusions (1 complete and 2 incomplete)

Summary

Introduction

Acute thromboembolic occlusion of the superior mesenteric artery (ATOS) is a life-threatening disease characterized by strangulated obstruction and a final physiopathology of bowel necrosis and poor patient prognosis. A few studies reported the employment of endovascular revascularization in the treatment of ATOS [8,9,10,11,12], with rapid blood supply reestablished and relatively small resultant trauma. It was shown by very few studies that endovascular treatment resulted in significantly less bowel resection and shorter bowel syndrome and mortality than open surgery [13]; whether or not endovascular interventional therapy should be the primary treatment for ATOS is still controversial [14, 15]

Methods

Results

Conclusion