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Percutaneous Aspiration Embolectomy Using Guiding Catheter for the Superior Mesenteric Artery Embolism.

Choi KS, Kim JD, Kim HC, Min SI, Min SK, Jae HJ, Chung JW - Korean J Radiol (2015)

Bottom Line: In 3 patients who received primary thrombolysis, percutaneous aspiration was undertaken because the emboli were resistant to urokinase.Complete angiographic success was achieved in 6 patients and partial angiographic success was accomplished in 3 patients.One patient died of whole bowel necrosis and sepsis, and 8 patients survived without complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea.

ABSTRACT

Objective: To evaluate the technical feasibility and clinical outcome of percutaneous aspiration embolectomy for embolic occlusion of the superior mesenteric artery (SMA).

Materials and methods: Between January 2010 and December 2013, 9 patients with embolic occlusion of the SMA were treated by percutaneous aspiration embolectomy in 2 academic teaching hospitals. The aspiration embolectomy procedure was performed with the 6-Fr and 7-Fr guiding catheter. Thrombolysis was performed with urokinase using a multiple-sidehole infusion catheter. The clinical outcome was investigated retrospectively.

Results: Superior mesenteric artery occlusion was initially diagnosed by computed tomography (CT) in all patients, and all patients had no obvious evidence of bowel infarction on CT scan. Percutaneous aspiration embolectomy was primarily performed in 6 patients, and thrombolysis was initially performed in 3 patients. In 3 patients who received primary thrombolysis, percutaneous aspiration was undertaken because the emboli were resistant to urokinase. Complete angiographic success was achieved in 6 patients and partial angiographic success was accomplished in 3 patients. One patient underwent bowel resection. One patient died of whole bowel necrosis and sepsis, and 8 patients survived without complications.

Conclusion: Percutaneous aspiration embolectomy is a useful tool in recanalization of embolic occlusion of the SMA in select patients.

No MeSH data available.


Related in: MedlinePlus

88-year-old female presented with abdominal pain and hematochezia.A. Three-dimensional-volume rendered image of abdominal CT angiograph shows segmental occlusion of proximal superior mesenteric artery (SMA) (arrowheads) with calcified plaque. B. Initial angiography shows complete occlusion of SMA (arrowhead) with sluggish flow through distal jejunal branches. Convex meniscus suggests embolic occlusion. C. 7-Fr sheath (arrow) was introduced into proximal segment of SMA, and 7-Fr guiding catheter (arrowhead) was advanced into main trunk of SMA. D. Angiography after aspiration shows partial recanalized SMA and residual blood clot (arrowheads). E. 6-Fr guiding catheter was advanced into distal branch of SMA. F. Final angiography shows complete recanalized SMA. G. Emboli were removed by guiding catheter. Note fresh thrombotic clots (arrowheads) and old embolic clots (arrows).
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Figure 1: 88-year-old female presented with abdominal pain and hematochezia.A. Three-dimensional-volume rendered image of abdominal CT angiograph shows segmental occlusion of proximal superior mesenteric artery (SMA) (arrowheads) with calcified plaque. B. Initial angiography shows complete occlusion of SMA (arrowhead) with sluggish flow through distal jejunal branches. Convex meniscus suggests embolic occlusion. C. 7-Fr sheath (arrow) was introduced into proximal segment of SMA, and 7-Fr guiding catheter (arrowhead) was advanced into main trunk of SMA. D. Angiography after aspiration shows partial recanalized SMA and residual blood clot (arrowheads). E. 6-Fr guiding catheter was advanced into distal branch of SMA. F. Final angiography shows complete recanalized SMA. G. Emboli were removed by guiding catheter. Note fresh thrombotic clots (arrowheads) and old embolic clots (arrows).

Mentions: Percutaneous aspiration embolectomy was performed in all 9 patients. It was initially undertaken in 6 patients (No. 2-7), and thrombolysis was initially performed in 3 patients (No. 1, 8, 9). Thrombolysis was initially tried in the early study period, and primary aspiration embolectomy was preferentially performed in the late study period. In 5 patients (No. 2, 3, 5-7) primary percutaneous aspiration embolectomy alone, was applied. In 1 patient (No. 4), primary percutaneous aspiration embolectomy was attempted, but residual emboli were noted in the ileal branches. Thrombolysis was conducted for 10 hours, resulting in complete resolution of the emboli. In 3 patients (No. 1, 8, 9) who received primary thrombolysis, percutaneous aspiration embolectomy was undertaken because the emboli were resistant to urokinase. Aspirated emboli consisted of white and red clots (Fig. 1).


Percutaneous Aspiration Embolectomy Using Guiding Catheter for the Superior Mesenteric Artery Embolism.

Choi KS, Kim JD, Kim HC, Min SI, Min SK, Jae HJ, Chung JW - Korean J Radiol (2015)

88-year-old female presented with abdominal pain and hematochezia.A. Three-dimensional-volume rendered image of abdominal CT angiograph shows segmental occlusion of proximal superior mesenteric artery (SMA) (arrowheads) with calcified plaque. B. Initial angiography shows complete occlusion of SMA (arrowhead) with sluggish flow through distal jejunal branches. Convex meniscus suggests embolic occlusion. C. 7-Fr sheath (arrow) was introduced into proximal segment of SMA, and 7-Fr guiding catheter (arrowhead) was advanced into main trunk of SMA. D. Angiography after aspiration shows partial recanalized SMA and residual blood clot (arrowheads). E. 6-Fr guiding catheter was advanced into distal branch of SMA. F. Final angiography shows complete recanalized SMA. G. Emboli were removed by guiding catheter. Note fresh thrombotic clots (arrowheads) and old embolic clots (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499537&req=5

Figure 1: 88-year-old female presented with abdominal pain and hematochezia.A. Three-dimensional-volume rendered image of abdominal CT angiograph shows segmental occlusion of proximal superior mesenteric artery (SMA) (arrowheads) with calcified plaque. B. Initial angiography shows complete occlusion of SMA (arrowhead) with sluggish flow through distal jejunal branches. Convex meniscus suggests embolic occlusion. C. 7-Fr sheath (arrow) was introduced into proximal segment of SMA, and 7-Fr guiding catheter (arrowhead) was advanced into main trunk of SMA. D. Angiography after aspiration shows partial recanalized SMA and residual blood clot (arrowheads). E. 6-Fr guiding catheter was advanced into distal branch of SMA. F. Final angiography shows complete recanalized SMA. G. Emboli were removed by guiding catheter. Note fresh thrombotic clots (arrowheads) and old embolic clots (arrows).
Mentions: Percutaneous aspiration embolectomy was performed in all 9 patients. It was initially undertaken in 6 patients (No. 2-7), and thrombolysis was initially performed in 3 patients (No. 1, 8, 9). Thrombolysis was initially tried in the early study period, and primary aspiration embolectomy was preferentially performed in the late study period. In 5 patients (No. 2, 3, 5-7) primary percutaneous aspiration embolectomy alone, was applied. In 1 patient (No. 4), primary percutaneous aspiration embolectomy was attempted, but residual emboli were noted in the ileal branches. Thrombolysis was conducted for 10 hours, resulting in complete resolution of the emboli. In 3 patients (No. 1, 8, 9) who received primary thrombolysis, percutaneous aspiration embolectomy was undertaken because the emboli were resistant to urokinase. Aspirated emboli consisted of white and red clots (Fig. 1).

Bottom Line: In 3 patients who received primary thrombolysis, percutaneous aspiration was undertaken because the emboli were resistant to urokinase.Complete angiographic success was achieved in 6 patients and partial angiographic success was accomplished in 3 patients.One patient died of whole bowel necrosis and sepsis, and 8 patients survived without complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea.

ABSTRACT

Objective: To evaluate the technical feasibility and clinical outcome of percutaneous aspiration embolectomy for embolic occlusion of the superior mesenteric artery (SMA).

Materials and methods: Between January 2010 and December 2013, 9 patients with embolic occlusion of the SMA were treated by percutaneous aspiration embolectomy in 2 academic teaching hospitals. The aspiration embolectomy procedure was performed with the 6-Fr and 7-Fr guiding catheter. Thrombolysis was performed with urokinase using a multiple-sidehole infusion catheter. The clinical outcome was investigated retrospectively.

Results: Superior mesenteric artery occlusion was initially diagnosed by computed tomography (CT) in all patients, and all patients had no obvious evidence of bowel infarction on CT scan. Percutaneous aspiration embolectomy was primarily performed in 6 patients, and thrombolysis was initially performed in 3 patients. In 3 patients who received primary thrombolysis, percutaneous aspiration was undertaken because the emboli were resistant to urokinase. Complete angiographic success was achieved in 6 patients and partial angiographic success was accomplished in 3 patients. One patient underwent bowel resection. One patient died of whole bowel necrosis and sepsis, and 8 patients survived without complications.

Conclusion: Percutaneous aspiration embolectomy is a useful tool in recanalization of embolic occlusion of the SMA in select patients.

No MeSH data available.


Related in: MedlinePlus