The effect of catheter-directed thrombolysis in the treatment of acute superior mesenteric artery ischemia

Shaohua Qin ,Ping Liu ,Ji-Guang Zhan ,Tingjia Hao ,Jie Zhang ,Xiaojun Pang

doi:10.3760/cma.j.issn.2096-1863.2019.01.008

Abstract

Objective To investigate the clinical effect of catheter-directed thrombolysis (CDT) in the treatment of acute superior mesenteric artery ischemia (ASMAI). Methods The clinical data of 28 patients with ASMAI including 11 cases with acute superior mesenteric artery embolism (ASMAE) and 17 cases with acute superior mesenteric artery thrombosis (ASMAT) who accepted CDT from January 2014 to March 2017 were retrospectively analyzed.In total, 28 cases were successfully treated by CDT or CDT combined with other endovascular treatment methods, of which 12 cases were treated by CDT alone (ASMAE 9 cases, ASMAT 3 cases) , 8 cases with CDT+ percutaneous transluminal angioplasty (PTA) (ASMAE 1 case, ASMAT 7 cases) , and 8 cases with CDT+PAT+ stent implantation (ASMAE 1 case, ASMAT 7 cases) . Results The time of CDT was (43.2±5) hours. Twenty cases (71.4%, 20/28) were cured, including 10 cases with CDT alone, 2 cases with CDT+PTA, and 8 cases with CDT+PTA+ stent implantation. Six cases (21.4%, 6/28) treated with CDT+PTA were effective. Two cases (7.1%, 2/28) were ineffective, of which 1 case was unsatisfied after 10 hours of CDT treatment, and then was underwent balloon catheter embolectomy by open surgery; while the other case showed peritoneal irritation sign after 30 hours of CDT, and necrotic partial small bowel(150 cm) resection was performed. The two patients were all cured. In this group, 28 cases (100%, 28/28) were followed up for (22±5) months. There was no recurrence and aggravation. Computed tomographic angiography(CTA) in 2 patients underwent stent implantation showed that the restenosis rate in the stents were both about 50%, no further treatment was given because of no clinical symptom. Conclusion CDT is a safe, effective and minimally invasive method in the treatment of acute superior mesenteric artery ischemia. Key words: Acute superior mesenteric artery ischemia; Catheter-directed thrombolysis; Treatment outcome

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