Acute Superior Mesenteric Artery Embolism Research Articles

Percutaneous Mechanical Thrombectomy Using the AcoStream Thrombus Aspiration System for Acute Superior Mesenteric Artery Embolism

BackgroundThis study was performed to summarize our experience in treating acute superior mesenteric artery embolism (SMAE) by percutaneous mechanical thrombectomy (PMT). MethodsBetween January 2023 and October 2023, 18 patients presenting with acute mesenteric ischemia (AMI) were admitted to our center, including 11 cases of superior mesenteric artery embolism (SAME), 3 cases of superior mesenteric artery thrombosis (SMAT) and 4 cases of superior mesenteric vein thrombosis (SMVT). We retrospectively reviewed 8 patients (4 males and 4 females; range, 51–79 years; mean, 62.50 ± 9.67 years) who underwent treatment of acute SMAE using the AcoStream system. The patients had no obvious evidence of intestinal necrosis as shown by peritoneal puncture or computed tomography (CT). Thrombectomy was performed on the superior mesenteric artery (SMA) using an 8F AcoStream thrombus aspiration system (Acotec, China). The demographics, risk factors, therapeutic effect, complications, mortality, and follow-up of the study population were assessed. ResultsThe technical success rate was 100%. After 1-3 passes (2.38 ± 0.92) and aspiration thrombectomy, complete thrombus removal was achieved in 7 (87.50%) patients. 1 patient received an adjunctive catheter-directed thrombolysis (CDT) due to partial thrombus removal. Thrombolysis was conducted for 2 days, resulting in complete resolution of the thrombus. The other 7 patients did not receive adjunctive endovascular intervention due to complete thrombus removal and no residual stenosis. No distal embolization or device-related complications were noted during the procedure. After the procedure, sufficient clinical improvement was seen in 6 patients within 1-2 days. 2 patients showed no significant improvement of their symptoms. Laparotomy was performed on day 1 and day 2 after thrombectomy in patients 3 and 7, respectively. Intestinal necrosis was diagnosed operatively and intestinal resection was performed. All patients were discharged 6–15 days (9.50 ± 3.07) after admission without perioperative complication or death. The mean follow-up period was 5.00 ± 3.30 months (range, 1-10 months), and the follow-up rate was 100%. During the follow-up, all patients remained symptom-free. CTA images showed good flow in the trunk and branches of the SMA in all patients. ConclusionsPMT using the AcoStream system is a minimally invasive, safe, and effective technique for acute SMAE. Early application of PMT can achieve immediate revascularization of the SMA and have the potential advantage of avoiding laparotomy or reducing the extension of enterectomy, as it could theoretically restore intestinal perfusion in less time than open revascularization. If the symptoms do not improve after PMT, exploratory laparotomy should be scheduled as soon as possible. Further studies are necessary on this field to confirm these findings.

Efficacy and safety analysis of AcoStream thrombus aspiration device in the treatment of acute superior mesenteric artery embolism.

Acute superior mesenteric artery embolism is a life-threatening disease caused by the abrupt interruption of mesenteric blood circulation, and the prognosis is very poor. Several studies have confirmed the efficacy and safety of percutaneous mechanical thrombectomy in acute superior mesenteric artery embolism, however, there are currently no literature reports on the latest percutaneous mechanical thrombectomy device-AcoStream™. In the present report, we summarize a series of cases and share our surgical experiences. The clinical data of 10 patients (six men and four women, mean age 77.6 ± 7.4years) with acute superior mesenteric artery embolism treated by AcoStream™ in our center from December 2022 to December 2023 were retrospectively analyzed. Based on the literature, we summarized the diagnosis, therapy, and surgical experience of acute superior mesenteric artery embolism. Percutaneous mechanical thrombectomy was performed for all the patients. The success rate of surgery reached 100% and no perioperative complications occurred. Abdominal pain was significantly relieved and the abdominal signs gradually disappeared in eight patients, while the other two patients still complained of abdominal pain during hospitalization, and eventually, they underwent resection of necrotic bowel. All the patients' symptoms were significantly relieved and they were smoothly discharged from the hospital. As shown in the present study, percutaneous mechanical thrombectomy using AcoStream™ is minimally invasive, safe, and efficient in the initial stage of acute superior mesenteric artery embolism. We believe that percutaneous mechanical thrombectomy can be a promising alternative in selected cases.

Abstract 12186: A Challenging Case of Acute Superior Mesenteric Artery Embolism Diagnosed by Gastroscopy

Introduction: Acute superior mesenteric artery (SMA) occlusion is one of the most lethal causes of acute abdomen that we often experience but mistake for gastrointestinal diseases. The golden time for revascularization in cases of SMA main trunk occlusion is within 5 hours of onset, requiring prompt diagnosis and treatment. We describe a challenging case of acute SMA embolism diagnosed by gastroscopy. Case Summary: A 66-year-old man with a history of hypertension presented to the emergency department for marked epigastric pain after eating raw seafoods. On arrival, electrocardiogram showed atrial flutter with no significant ST-segment changes. Despite the elevation of white blood cell count and lactate dehydrogenase in blood exam, computed tomography (CT) indicated no findings to cause his symptoms. Emergency gastroscopy performed on suspicion of anisakiasis demonstrated pallor findings with hematologic material in the duodenum, suggesting intestinal ischemia (Figure A). Since contrast-enhanced CT revealed an occlusion of SMA (Figure B), we diagnosed acute SMA embolism based on the finding of atrial flutter without anticoagulation. After discussion among cardiologists and gastroenterology surgeons, we selected to perform endovascular treatment. The epigastric pain was improved after reperfusion using a self-expandable stent, but flared up as oral intake progressed. Follow-up CT suggested ischemic enteritis of the proximal jejunum, leading to conduct laparoscopic partial jejunectomy. He was discharged 18 days after the operation with the ability to eat a normal diet. Conclusions: This case highlights that we should keep in mind SMA embolism when examining acute abdomen patients with atrial fibrillation or flutter without anticoagulation.

Acute Superior Mesenteric Artery Embolism Treated with Percutaneous Mechanical Thrombectomy: a Single-Center Preliminary Application and Experience

Acute Superior Mesenteric Artery Embolism Treated with Percutaneous Mechanical Thrombectomy: a Single-Center Preliminary Application and Experience

Role of clinical data and multidetector computed tomography findings in acute superior mesenteric artery embolism.

BACKGROUNDSuperior mesenteric artery embolism (SMAE) has acute onset and fast progression, which seriously threatens the life of patients. Multidetector computed tomography (MDCT) is one of the most important diagnostic methods for SMAE, which plays an important role in the diagnosis and prognosis of SMAE.AIMTo evaluate the value of combined clinical data and MDCT findings in the diagnosis of acute SMAE and predict the risk factors for SMAE-related death.METHODSData from 53 SMAE patients who received abdominal MDCT multi-phase enhancement and superior mesenteric artery digital subtraction angiography examinations were collected. Univariate cox regression and multivariate cox model were used to analyze the correlation between death risk and clinical and computed tomography features in SMAE patients.RESULTSUnivariate Cox regression model showed that intestinal wall thinning, intestinal wall pneumatosis, blood lactate > 2.1 mmol/L and blood pH < 7.35 increased the risk of death in patients with SMAE. After adjusting for age, sex, embolic involvement length and embolic distribution region, multivariate Cox regression model I showed that blood lactate > 2.1 mmol/L (HR = 5.26, 95%CI: 1.04-26.69, P = 0.045) and intestinal wall thinning (HR = 9.40, 95%CI: 1.05-83.46, P = 0.044) were significantly increases the risk of death in patients with SMAE.CONCLUSIONFor patients with SAME, increased blood lactate and intestinal wall thinning are the risk factors for death; hence, close monitoring may reduce the mortality rate. Clinical observation combined with MDCT signs can significantly improve SMAE diagnosis.

Percutaneous mechanical thrombectomy in the management of early acute superior mesenteric artery embolism.

This study was performed to summarize our experience in the management of early-stage acute superior mesenteric artery embolism (ASMAE) by percutaneous mechanical thrombectomy (PMT). The clinical data of 12 patients with early-stage ASMAE treated by PMT in our institution from November 2019 to September 2021 were retrospectively analyzed. The patients had no obvious evidence of bowel infarction as shown by peritoneal puncture and computed tomography angiography. Thrombectomy of the superior mesenteric artery was performed using a 6F AngioJet catheter. The emboli were completely removed in 10 (83.3%) patients. Six patients were treated only by the AngioJet device. The other six patients underwent combined treatment with a 6F multipurpose drainage catheter after PMT, including one patient who underwent simultaneous stent implantation. Two patients showed no significant improvement in their symptoms after the operation; one was found to have intestinal necrosis and underwent resection by exploratory laparotomy, and the other died of septic shock 3days after PMT (further intervention had been discontinued because of complications with multiple underlying diseases). No other PMT-related complications occurred. Only one patient was found to have a pseudoaneurysm of the superior mesenteric artery 1week after PMT and underwent resection by exploratory laparotomy. The 11 surviving patients were smoothly discharged from the hospital after their symptoms were relieved. At a mean follow-up of 13.2months, computed tomography angiography showed smooth patency of the superior mesenteric artery. No patients developed serious symptoms during follow-up. PMT by the AngioJet device is a minimally invasive, safe, and effective technique to remove ASMAE. Early application of PMT can avoid acute intestinal necrosis. Combining the AngioJet device with a 6F multipurpose drainage catheter might be more helpful to remove residual emboli.

Outcome Comparison of Endovascular and Open Surgery for the Treatment of Acute Superior Mesenteric Artery Embolism: A Retrospective Study.

BackgroundFew centers have adopted endovascular revascularization for the treatment of superior mesenteric artery embolism (SMAE). We sought to evaluate the efficacy of endovascular therapy for the treatment of SMAE and identify post-treatment prognostic factors.MethodsThe clinical data of 41 patients with acute SMA embolism between 2013 and 2021 were retrospectively reviewed. Patients with mesenteric artery thrombosis, mesenteric venous thrombosis, and who had only conservative treatment were excluded.ResultsForty-one consecutive patients were identified with SMAE (median age, [range] 35–86 years). Endovascular therapy was initiated in 14 patients with no clinical evidence of bowel necrosis, with mainly mechanical thrombectomy, and technical success was achieved in 93%. Endovascular therapy had advantages in duration surgery time, blood loss, bowel rest time, ICU time, and ventilator use. There was no difference in bowel necrosis, length of necrotic bowel resected, or in-hospital mortality between the two groups. An initial white blood cell (WBC) count >15 × 103/dl and neutrophil count >13 × 103/dl were associated with an increased risk of bowel necrosis, and an initial WBC count, renal function, American Society of Anesthesiologists (ASA >3) and necrotic bowel >2 m were associated with increased mortality.ConclusionsEndovascular treatment has altered the management of SMAE, and it may be adopted in selected patients who are not at risk for bowel necrosis. Avoidance of bowel necrosis patients and close monitoring for bowel necrosis are important.

Percutaneous mechanical thrombectomy for acute superior mesenteric artery embolism via left distal transradial access in the anatomical snuffbox.

Percutaneous mechanical thrombectomy for acute superior mesenteric artery embolism via left distal transradial access in the anatomical snuffbox.

Mesenteric and myocardial ischemia revealing lower limb sarcoma.

Introduction and importanceAlthough most of the causes of acute superior mesenteric artery (SMA) embolism with a poor clinical course originate from the heart, we report a case of SMA embolism secondary to advanced sarcoma of the lower extremities.Case presentationA 66-year-old man presented with chest and epigastric discomfort that lasted for 1 day. Coronary angioplasty was performed, followed by laparotomy with an embolectomy of the SMA, small bowel resection, and ileostomy. After surgery, leiomyosarcoma was diagnosed on a biopsy performed in the left thigh, and lung metastasis was confirmed. He had recurrent peritonitis for 2 months and died of multiple organ failure.Clinical discussionThe common etiologies of SMA embolism include cardioembolic sources with atrial fibrillation and recent myocardial infarction. Rare etiologies include atherosclerotic plaque, mural thrombus of the aneurysm, and cardiac sarcoma.ConclusionEfforts are required for the systemic evaluation of various etiologies in patients with SMA embolism who require rapid diagnosis and intervention.

Nursing management after interventional therapy in five patients with acute superior mesenteric artery embolism

Nursing management after interventional therapy in five patients with acute superior mesenteric artery embolism

Nursing management after interventional therapy in five patients with acute superior mesenteric artery embolism

Nursing management after interventional therapy in five patients with acute superior mesenteric artery embolism

MISC 3. Percutaneous Mechanical Thrombectomy for Acute Superior Mesenteric Artery Embolism: Preliminary Experience in Five Cases

MISC 3. Percutaneous Mechanical Thrombectomy for Acute Superior Mesenteric Artery Embolism: Preliminary Experience in Five Cases

Percutaneous Mechanical Thrombectomy for Acute Superior Mesenteric Artery Embolism: Preliminary Experience in Five Cases

This study was performed to summarize our experience in treating acute superior mesenteric artery embolism (SMAE) by percutaneous mechanical thrombectomy (PMT). The clinical data of five patients with acute SMAE treated by PMT in our center from October 2015 to May 2018 were retrospectively analyzed. PMT was performed under local anesthesia. Access was established via the femoral artery or brachial artery. Thrombectomy was performed on the superior mesenteric artery using a 6F Rotarex catheter (Straub Medical, Wangs, Switzerland). Technical success of PMT was achieved in all five patients; emboli were completely removed in three patients and partially removed in two patients. No PMT-related complications were noted after surgery. Four patients were smoothly discharged from the hospital after their symptoms were relieved. One patient still had symptoms of intestinal ischemia after the operation, and massive small intestinal necrosis was found by exploratory laparotomy. Intestinal resection was performed, and the patient died 4months later. PMT by the Rotarex system is a minimally invasive, safe, and effective technique in removing SMAE. Early application of PMT can avoid intestinal necrosis.

Clinical analysis of 66 cases of acute superior mesenteric artery embolism confirmed by surgery and angiography

Objective To explore the clinical manifestation, treatment and prognosis of patients with acute superior mesenteric artery embolism (ASMAE). Methods From October 2012 to March 2018, the clinical data of 66 patients with ASMAE who were admitted to The First Affiliated Hospital of Chongqing Medical University were collected and retrospectively analyzed. The patients were divided into the death group and the survival group according to whether they died during hospitalization. The clinical features, the time of diagnosis and treatment methods of two groups were compared. T-test and chi-square test were performed for statistical analysis. Results Among 66 ASMAE patients, 16 were in the death group and 50 in the survival group. The age of the death group was (75.6±9.9) years, which was greater than that of the survival group ((68.1±13.2) years), and the difference was statistically significant (t=1.998, P=0.041). Among 16 dead patients, the case numbers of diagnosis time less than six hours, complicated with atrial fibrillation, peritoneal irritation sign, weakened or disappeared bowel sounds and complicated with systemic inflammatory response syndrome were 0, 14, 9, 9 and 16, respectively. However, among 50 survival patients, the case numbers of diagnosis time less than six hours, complicated with atrial fibrillation, peritoneal irritation sign, weakened or disappeared bowel sounds and complicated with systemic inflammatory response syndrome were 15 (30.0%), 30 (60.0%), 14 (28.0%), 14 (28.0%) and 36 (72.0%), respectively. The differences between two groups were all statistically significant (χ2=4.621, 4.125, 4.261, 4.261 and 4.134, all P<0.05). Conclusions When sudden severe abdominal pain occurs in elderly patients with atrial fibrillation, ASMAE should be alerted. Early (less than six hours) and correct diagnosis can improve the prognosis of the ASMAE patients. Key words: Atrial fibrillation; Risk factors; Mortality; Superior mesenteric artery embolism

Review: Acute superior mesenteric artery embolism: A vascular emergency cannot be ignored by physicians.

Background:Acute mesenteric ischemia (AMI) is a life-threatening medical condition that occurs when a sudden decreased perfusion to the intestines which leads to bowel infarction, and acute superior mesenteric artery embolism (ASMAE) is the main cause of AMI. Unfortunately, with the improvement of diagnosis and treatment technology, the mortality remains high due to less frequent clinical suspicion resulted from the unclear clinical manifestation and non-specific laboratory findings.Methods:Relevant studies published were identified by searching the PubMed, Embase and Cochrane Library databases. This review presented the literatures to introduce the research progress of ASMAE in recent years.Results:Patients with the history of atrial fibrillation, heart valve disease and atherosclerosis should be considered as ASMAE. Laboratory findings are insensitive and unspecific, however, angiography and Computed tomography angiography (CTA) can provide a clear diagnosis sensitively and specifically. Endovascular approaches have been increasingly reported in multiple case series. The key to successful treatment of AMI involves early clinical recognition and early intervention to move the embolus, which can reduce the rate of misdiagnosis and save the precious time and lives of patients.Conclusions:Loss of time eventually leads to progression of ischemia to transmural bowel necrosis with peritonitis and septicemia, which may further worsen patients’ outcomes. It is important for physicians to make a timely and accurate diagnosis, which can save precious time and reduce the mortality.

Effect of Clinical Suspicion by Referral Physician and Early Outcomes in Patients with Acute Superior Mesenteric Artery Embolism.

PurposeTo investigate the pattern of referral of patients with superior mesenteric artery embolism (SMAE) and its effect on outcomes, and to evaluate the risk factors for bowel infarction.Materials and MethodsThis retrospective study included 66 consecutive patients diagnosed with acute SMAE between January 2001 and June 2016. Appropriate diagnosis by the referring physician was defined if the referral letter indicated that acute mesenteric ischemia was suspected or had been diagnosed at the referral center. Surgical delay was defined as the interval between symptom onset and surgery for definitive treatment.ResultsAmong 54 patients transferred from other centers, 26 patients (48.1%) were diagnosed appropriately by the referring physician. The rate of appropriate diagnosis was differed significantly by the use of computed tomography (CT) scan at referral center (25/35 with CT and 1/19 without CT, P=0.00). The surgical delay was significantly longer in patients without appropriate diagnosis compared with the patients with appropriate diagnosis (53.5±52.3 hours vs. 28.8±23.6 hours, P=0.04). Initially, 56 patients received surgical treatment with 31 underwent bowel resection due to infarction, 6 received conservative treatment, and the remaining 4 patients refused any treatment. The surgical delay, abdominal distension, tenderness, rebound tenderness, and level of C-reactive protein were associated with bowel infarction at initial operation. Overall in-hospital mortality was 32%.ConclusionA high index of suspicion with appropriate diagnostic modality, such as CT scan is crucial in patients with SMAE for reducing surgical delay as a risk factor of bowel infarction.

Diagnosis and treatment of acute superior artery embolism: analysis of 10 cases

Objective To explore the early diagnosis, surgical treatment and clinical effect of acute superior mesenteric artery embolism. Methods Base on the retrospectively study of the clinical data of 10 patients with acute superior mesenteric artery embolism, all the patients were treated with routine blood test, D-dimer, abdominal ultrasound, abdominal CT examination.At the same time, partial selective superior mesenteric artery angiography was performed.Patients with definite or highly suspected of mesenteric artery embolism, such as no absolute surgical procedure, were treated by immediate surgical fixation.Superior mesenteric artery embolism was confirmed in the surgery.Then Operation was decided according to intestinal necrosis.Fogaty catheter removal was applied to the main trunk of the superior mesenteric artery.At the same time, such as the discovery of branches of vascular embolism, the therapy using direct injection of urokinase in local embolism was performed because of difficulty in embolectomy for narrow vessels.Then anticoagulation therapy was performed after surgery. Results Among them, 1 case gave up treatment from the hospital, 2 cases died of multiple organ failure after operation, and 7 cases recovered well after operation. Conclusion Early diagnosis of acute superior mesenteric artery embolization combined with early surgical treatment is the key to the treatment of acute superior mesenteric artery embolism.The cure rate can be significantly improved and the mortality rate can be reduced.Fogaty catheter was applied to treat acute superior mesenteric artery embolism with the therapy using direct injection of urokinase in local embolism has the characteristics of quick effect and curative effect. Key words: Embolism; Mesenteric artery, Superior; Thrombolytic therapy

Aspiration Therapy for Acute Superior Mesenteric Artery Embolism with an Angled Guiding Sheath and Guiding Catheter

Seven patients with superior mesenteric artery embolism were treated by aspiration with the use of a 6-F angled guiding sheath and a 6-F guiding catheter through an 8-F short sheath by direct advancement using a telescopic and “biting-off” technique. Aspiration of the trunk took between 30 and 60 minutes (median, 44.0 min), and total procedure time ranged from 34 to 94 minutes (median, 60 min). Five of six trunk lesions and six of nine branch lesions were successfully aspirated. One dissection was observed. Six patients underwent bowel resection. Two patients died and the remaining five survived for a median of 868.2 days without complications.

Percutaneous mechanical thrombectomy of superior mesenteric artery embolism

BackgroundThe present series present three consecutive cases of successful percutaneous mechanical embolectomy in acute superior mesenteric artery ischemia. Superior mesenteric artery embolism is a rare abdominal emergency that commonly leads to bowel infarction and has a very high mortality rate. Prompt recognition and treatment are crucial for successful outcome. Endovascular therapeutic approach in patients with acute SMA embolism in median portion of its stem is proposed.Case reports.Three male patients had experienced a sudden abdominal pain and acute superior mesenteric artery embolism in median portion of its stem was revealed on computed tomography angiography. No signs of intestinal infarction were present. The decision for endovascular treatment was made in concordance with the surgeons. In one patient 6 French gauge Rotarex® device was used while in others 6 French gauge Aspirex® device were used. All patients experienced sudden relief of pain after the procedure with no signs of intestinal infarction. Minor procedural complication – rupture of a smaller branch of SMA during Aspirex® treatment was successfully managed by coiling while transient paralytic ileus presented in one patient resolved spontaneously. All three patients remained symptom-free with patent superior mesenteric artery during the follow-up period.ConclusionsPercutaneous mechanical thrombectomy seems to be a rapid and effective treatment of acute superior mesenteric artery embolism in median portion of its stem in absence of bowel necrosis. Follow-up of our patients showed excellent short- and long-term results.

Treatment Outcome in Patients With Acute Superior Mesenteric Artery Embolism

The goals of this study were to investigate the treatment outcomes of acute mesenteric ischemia caused by superior mesenteric artery (SMA) embolism and identify the posttreatment prognostic factors. The clinical data of 32 episodes of acute SMA embolism in 30 patients, including 2 recurrent cases, between April 2003 and March 2011 were retrospectively reviewed. Median patient age was 74 years (range, 39-89 years), and 50% were male. Conservative treatment, including bowel rest, nasogastric drainage, intravenous fluid therapy, parenteral nutritional support, and anticoagulation therapy, was undertaken in 5 patients with no clinical evidence of bowel gangrene, including 1 with recurrent ischemia. No deaths occurred among patients treated conservatively. A total of 27 patients were treated with open surgical repair (25 embolectomies and 2 bowel resections alone). Among 25 patients treated with embolectomy, 14 required bowel resection. Most bowel resections (94%, 15/16) were limited, with the remaining length of small bowel greater than 150 cm, which could not cause short bowel syndrome. In-hospital mortality of surgery was 30%. No variables were associated with mortality after surgical intervention, including, age, gender, presence of bowel gangrene, and symptom duration. The overall 1-, 3-, and 5-year survival rates after initial successful treatment were 96%, 73%, and 44%, respectively, regardless of treatment type. Prompt diagnosis and treatment before extensive irreversible gangrene is the mainstay in the treatment of SMA embolism. Limited bowel gangrene was not associated with mortality.