Korean J Gastroenterol.  2011 Apr;57(4):243-248. 10.4166/kjg.2011.57.4.243.

Clinical Effectiveness of Percutaneous Angioplasty for Acute and Chronic Mesenteric Ischemia: A Six Case Series

• Jung YM
• Jo Y
• Ahn SB
• Son BK
• Kim SH
• Park YS
• Bae JH
• Cho YK

• KMID: 1718405
• DOI: http://doi.org/10.4166/kjg.2011.57.4.243

Abstract

Intestinal ischemia is divided into three categories, namely, acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI), and colonic ischemia. AMI can result from arterial or venous thrombi, emboli, and vasoconstriction secondary to low-flow states. It is an urgent condition which can result in high mortality rate. The predominant causative factor of CMI is stenosis or occlusion of the mesenteric arterial circulation, and it is characterized by postprandial abdominal pain and weight loss. Surgery is the treatment of choice for intestinal ischemia. However, it has been recently reported that percutaneous transluminal angioplasty with stent placement and/or thrombolysis is an effective therapy in various types of mesenteric ischemia. We report six cases of mesenteric ischemia which were successfully treated by percutaneous angioplasty, and review the literature from South Korea.

Keyword

Ischemia; Mesenteric arteries; Mesenteric vascular occlusion; Thrombolytic therapy; Angioplasty

MeSH Terms

Acute Disease
Aged
Aged, 80 and over
*Angioplasty, Balloon
Chronic Disease
Female
Humans
Intestines/*blood supply
Ischemia/surgery/*therapy
Male
Mesenteric Artery, Superior
Mesenteric Vascular Occlusion/surgery
Middle Aged
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Abdominal CT and percutaneous angiography in case 2. (A) A filling defect was revealed in the ostium of the SMA and proximal portion in the abdominal computed tomography. Arrow indicates a thrombotic stenosis. (B) Severe stenosis (arrow) is shown in the proximal portion of the SMA in the percutaneous angiography. CT, computed tomography; SMA, superior mesenteric artery.

• 

  Fig. 2. Percutaneous angiographic findings in case 2. A stent was placed in the stenotic portion of the SMA. The balloon expanded fully (arrow) in the most stenotic lesion. SMA, superior mesenteric artery.

• 

  Fig. 3. Percutaneous angioplasty for the reoccluded lesion with previously implanted stent in case 3. (A) Severe stenosis (arrow) is visible in the distal portion of the stent placed in the celiac artery. (B) A new stent was inserted (arrow) in the restenotic lesion.

• 

  Fig. 4. Percutaneous angiographic finding. Total occlusion of SMA due to thromboembolism (arrow) is shown in the mesenteric angiography in case 6.

Reference

References

1. Lim RP, Dowling RJ, Thomson KR. Angioplasty and stenting of the superior mesenteric artery in acute mesenteric ischaemia. Australas Radiol. 2004; 48:426–429.

2. Howard TJ, Plaskon LA, Wiebke EA, Wilcox MG, Madura JA. Nonocclusive mesenteric ischemia remains a diagnostic dilemma. Am J Surg. 1996; 171:405–408.

3. Chandra A, Quinones-Baldrich WJ. Chronic mesenteric ischemia: how to select patients for invasive treatment. Semin Vasc Surg. 2010; 23:21–28.

4. Kougias P, Lau D, El Sayed HF, Zhou W, Huynh TT, Lin PH. Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J Vasc Surg. 2007; 46:467–474.

5. Gupta R, Chimpiri AR, Saucedo JF. Superior mesenteric artery thrombosis managed percutaneously by timely combining aspiration thrombectomy with angioplasty and stents. J Thromb Thrombolysis. 2010; 29:105–107.

6. Schermerhorn ML, Giles KA, Hamdan AD, Wyers MC, Pomposelli FB. Mesenteric revascularization: management and outcomes in the United States, 1988–2006. J Vasc Surg. 2009; 50:341–348. e1.

7. Zacho HD, Abrahamsen J. Functional versus radiological assessment of chronic intestinal ischaemia. Clin Physiol Funct Imaging. 2010; 30:116–121.

8. Gweon HM, Suh SH, Won JY, Lee DY, Kim SS. Percutaneous stenting of the superior mesenteric artery for the treatment of chronic mesenteric ischemia. J Korean Radiol Soc. 2008; 58:571–578.

9. Moon IS, Kwon OS, Jung HS, et al. A case of chronic mesenteric ischemia treated with percutaneous transluminal angioplasty. Korean J Gastroenterol. 2003; 41:499–503.

10. Kim JH, Ahn S, Shim WH. A case report of percutaneous transluminal angioplasty with stenting in treatment of superior me-genteric artery stenosis. Korean Circ J. 1997; 27:228–233.

11. Kim MH, Lee DY, Han KH, et al. A case of superior mesenteric artery thrombosis treated with intraarterial urokinase infusion and intraluminal stent insertion. Korean J Gastroenterol. 2001; 37:132–136.

12. Go BS, Lee JH, Nam HK, et al. A case of mesenteric ischemia in a patient who was on continuous ambulatory peritoneal dialysis. Korean J Med. 2006; 71(Suppl 3):S1073–S1078.

13. Kim JH, Cheon GJ, Choi TH, et al. Successful treatment of acute ischemic colitis with stent insertion. Korean J Med. 2005; 69:686–691.

14. Cluzel P, Auguste M, Galvez V. Traitement endovasculaire des arteres digestives. Kieffer E, Parc EA, editors. Chirurgie des arteres digestives. Paris: 1999. p. 145–153.

15. Mateo RB, O'Hara PJ, Hertzer NR, Mascha EJ, Beven EG, Krajewski LP. Elective surgical treatment of symptomatic chronic mesenteric occlusive disease: early results and late outcomes. J Vasc Surg. 1999; 29:821–831.

16. Johnston KW, Lindsay TF, Walker PM, Kalman PG. Mesenteric arterial bypass grafts: early and late results and suggested surgical approach for chronic and acute mesenteric ischemia. Surgery. 1995; 118:1–7.

17. Oderich GS, Gloviczki P, Bower TC. Open surgical treatment for chronic mesenteric ischemia in the endovascular era: when it is necessary and what is the preferred technique? Semin Vasc Surg. 2010; 23:36–46.

18. Dias NV, Acosta S, Resch T, et al. Midterm outcome of endovascular revascularization for chronic mesenteric ischaemia. Br J Surg. 2010; 97:195–201.

19. Edwards MS, Cherr GS, Craven TE, et al. Acute occlusive mesenteric ischemia: surgical management and outcomes. Ann Vasc Surg. 2003; 17:72–79.

20. Wyers MC. Acute mesenteric ischemia: diagnostic approach and surgical treatment. Semin Vasc Surg. 2010; 23:9–20.