Technique of Open Mesenteric Catheter Embolectomy

Abstract

The arterial perfusion of the gastrointestinal tract is provided by the celiac, superior mesenteric, and inferior mesenteric arteries. The celiac artery (CA) supplies arterial blood flow to the foregut, the spleen, and the hepatobiliary system. The superior mesenteric artery (SMA) supplies the jejunum, ileum, and ascending and transverse colon. The inferior mesenteric artery (IMA) supplies the hindgut from the transverse colon to the rectum. Robust collaterals between each vessel (superior and inferior pancreaticoduodenal arteries and arch of Riolan, respectively) allow for stenosis and occlusion of one or even two of these main arteries without sequelae in the setting of chronic mesenteric ischemia (CMI), where the mesenteric vasculature has had the time to adapt to the reduced blood flow in the usual antegrade manner. However, sudden occlusion of one of the mesenteric arteries without prior development of the collateral network leads to profound ischemia of the bowel. Acute mesenteric ischemia (AMI) is a surgical emergency with a well-documented high in-hospital mortality between 59 and 93 %. The pathophysiology of the situation leading to compromise of the mesenteric circulation and development of AMI can be arterial embolism, arterial thrombosis, nonocclusive mesenteric ischemia (NOMI), and mesenteric venous thrombosis. The focus of this chapter will be the management of AMI secondary to arterial embolism.