Hybrid technique to treat superior mesenteric artery occlusion in patients with acute mesenteric ischemia.

Abstract

Acute mesenteric ischemia is a condition with a high mortality rate. In the present study, a novel hybrid technique for the treatment of acute mesenteric ischemia was investigated. The retrospective study population included six patients, of which five were male and one was female, with a mean age of 69 years (age range, 59-73 years). The hybrid technique involved isolating the superior mesenteric artery (SMA) for cannulation and subsequently performing a fluoroscopically-assisted embolectomy, retrograde balloon angioplasty and stenting. Intra-arterial, catheter-directed thrombolysis was performed if required. Bowels showing evident necrosis were resected, while ischemic bowels with the potential for recovery were left for 48 h before being re-examined during the second-look surgery. Retrograde open mesenteric stenting (ROMS) was successfully performed on two patients without bowel resection. Four patients were successfully treated by intra-arterial catheter-directed thrombolysis following recanalization of the SMA, and the ischemic bowels had exhibited a full recovery by the second-look operation. Three patients underwent a massive bowel resection, but did not develop short bowel syndrome. Two patients developed acute renal failure, one of which recovered after 10 days of dialysis, while the other patient succumbed to acute renal failure. In the five surviving patients, the SMA remained patent for the duration of the follow-up period. Therefore, ROMS was shown to be a viable alternative procedure for emergent SMA revascularization. In addition, intra-arterial catheter-directed thrombolysis following recanalization of the SMA was demonstrated as an alternative technique for inhibiting necrosis in bowels with acute mesenteric ischemia.