Emergent Treatment of Acute Embolic Superior Mesenteric Ischemia with Combination of Thrombolysis and Angioplasty: Report of Two Cases
Journal Article
·
· Cardiovascular and Interventional Radiology
- Tsuyama Central Hospital, Radiology (Japan)
- Tsuyama Central Hospital, Surgery (Japan)
- Tsuyama Central Hospital, Department of Internal Medicine (Japan)
- Tsuyama Central Hospital, Emergency Medicine (Japan)
- Okayama University Medical School, Department of Medical Technology, Faculty of Health Sciences (Japan)
We successfully revascularized the acutely occluded superior mesenteric artery (SMA), caused by a thromboembolus, with a combination of thrombolysis and percutaneous transluminal angioplasty (PTA) in 2 patients. Considerable percent luminal reduction (>90%) was still observed after thrombolysis in both patients. Subsequent adjunctive balloon angioplasty produced sufficient luminal diameter of the SMA (<20% luminal reduction). No serious acute procedural complication occurred. The time from onset to partial reperfusion by thrombolysis was approximately 4.5 and 5.5 hours. Approximately 1 week after the combination therapy, colonoscopy and a small bowel radiocontrast series showed localized mucosal ischemia with mild erosions and ulcerations in the terminal ileum and ascending colon in 1 patient. Subsequent bowel resection was required but the resection was short (<20 cm). The other patient's bowel condition was good and did not require any surgical treatment. The present cases suggest that combination therapy is useful for achieving rapid and sufficient revascularization of acute proximal thromboembolic SMA occlusion, and prevents the considerably broad bowel necrosis that requires surgical bowel resection, resulting in short bowel syndrome.
- OSTI ID:
- 21088242
- Journal Information:
- Cardiovascular and Interventional Radiology, Journal Name: Cardiovascular and Interventional Radiology Journal Issue: 4 Vol. 27; ISSN 0174-1551; ISSN CAIRDG
- Country of Publication:
- United States
- Language:
- English
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