J Korean Surg Soc.  2012 Aug;83(2):115-118. 10.4174/jkss.2012.83.2.115.

Successful aspiration and thrombolytic therapy for acute superior mesenteric artery occlusion

• Byun SJ
• So BJ

• KMID: 1820098
• DOI: http://doi.org/10.4174/jkss.2012.83.2.115

Abstract

To report a case of acute superior mesenteric artery (SMA) embolism successfully treated with aspiration and pharmacological thrombolysis. A 74-year-old female was admitted to the hospital with acute abdominal pain 5 hours in duration. Computed tomography angiography revealed a complete embolic occlusion distal to the first jejunal branch of the SMA. Aspiration and local continuous thrombolysis with urokinase resulted in near complete revascularization of the mesenteric flow after 4 hours and almost complete restoration after 20 hours. The patient made a complete recovery and continues to do well on warfarin therapy after treatment. Aspiration and thrombolytic therapy can be an alternative treatment modality in surgical high risk patient.

Keyword

Superior mesenteric artery embolism; Aspiration; Thrombolysis

MeSH Terms

Abdominal Pain
Aged
Angiography
Embolism
Female
Humans
Mesenteric Artery, Superior
Thrombolytic Therapy
Urokinase-Type Plasminogen Activator
Warfarin
Urokinase-Type Plasminogen Activator
Warfarin

Figure

• 

  Fig. 1 CT angiography (A) and angiography (B) showed a filling defect at middle to distal portion of SMA (arrow).

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  Fig. 2 (A) Angiography showed a partial recanalization after aspiration and thrombolysis for 20 minutes. (B) Angiography after 4 hours showed distal migration after aspiration and thrombolysis. (C) Angiography after 4 hours showed a 5 Fr multi-side hole catheter was inserted at the occluded branch by distal migration. (D, E) Angiography after 20 hours showed the occluded branch by distal migration was clearly delineated through thrombolytic therapy by selection of 5 Fr multi-side hole catheter and a near complete restoration of SMA.

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