J Korean Soc Radiol.  2011 Oct;65(4):345-356. 10.3348/jksr.2011.65.4.345.

Proper Treatment of Acute Mesenteric Ischemia

• Kim SK
• Han YM
• Kwak HS
• Yu HC

• KMID: 2002935
• DOI: http://doi.org/10.3348/jksr.2011.65.4.345

Abstract

PURPOSE
To evaluate the effectiveness of treatment options for Acute Mesenteric Ischemia and establish proper treatment guidelines.
MATERIALS AND METHODS
From January 2007 to May 2010, 14 patients (13 men and 1 woman, mean age: 52.1 years) with acute mesenteric ischemia were enrolled in this study. All of the lesions were detected by CT scan and angiography. Initially, 4 patients underwent conservative treatment. Eleven patients were managed by endovascular treatment. We evaluated the therapeutic success and survival rate of each patient.
RESULTS
The causes of ischemia included thromboembolism in 6 patients and dissection in 8 patients. Nine patients showed bowel ischemia on CT scans, 4 dissection patients underwent conservative treatment, 3 patients had recurring symptoms, and 5 dissection patients underwent endovascular treatment. Overall success and survival rate was 100%. However, overall success was 83% and survival rate was 40% in the 6 thromboembolism patients. The choice of 20 hours as the critical time in which the procedure is ideally performed was statistically significant (p = 0.0476).
CONCLUSION
A percutaneous endovascular procedure is an effective treatment for acute mesenteric ischemia, especially in patients who underwent treatment within 20 hours. However, further study and a long term follow-up are needed.

MeSH Terms

Angiography
Endovascular Procedures
Female
Follow-Up Studies
Humans
Ischemia
Male
Mesenteric Artery, Superior
Survival Rate
Thromboembolism
Vascular Diseases
Ischemia
Vascular Diseases

Figure

• 

  Fig. 1 71-year-old man suddenly experienced periumbilical pain. The symptom duration time was 18.5 hours. A. Contrast-enhanced CT scan shows free flap (arrow) in superior mesenteric artery with decreased small bowel enhancement (open arrow). B. On digital subtraction angiogram, there were narrowed true lumen of the superior mesenteric artery and a clearly visible dissection flap from 2 cm distal to the ostium (arrow). C. A 6 × 36-mm self-expandable Wallstent was placed in the true lumen. Final angiogram shows a patent true lumen with good blood flow in all the branches of the superior mesenteric artery. D. Contrast-enhanced CT at 1 month after the procedure shows good patency through the fully expanded stents with complete occlusion of the false lumen. The patient remained completely asymptomatic for 740 days.

• 

  Fig. 2 72-year-old who visited ER due to epigastric pain. The symptom duration time was 4 hours. A. Contrast-enhanced CT scan shows filling defect (open arrow) at the proximal portion of the SMA with decreased bowel enhancement. B. SMA arteriogram demonstrated thrombotic occlusion a few centimeters distal to the orifice. C. After continuous infusion of urokinase into the SMA, arteriogram revealed improved distal flow but, residual stenosis was seen (arrow). D. A 6 × 48-mm self-expandable Wallstent was placed in the stenotic segment. Final angiogram shows completely restored blood flow in the major branches of the SMA. E. CT scan showed ongoing patency of the SMA after 1 year. At 741 days follow-up period, the patient has not experienced recurrence of abdominal pain. Note.-ER = Emergency Room, SMA = superior mesenteric artery

• 

  Fig. 3 79-year-old man who visited ER due to epigastric pain. His medical history included atrial fibrillation and hypertension. The symptom duration time was 31.5 hours. A. Contrast-enhanced CT scan shows filling defect (open arrow) at the proximal portion of the SMA without definitely decreased bowel enhancement. B. SMA arteriogram shows a complete thrombotic occlusion of the proximal portion of the main stem. C. A 6 × 29-mm self-expandable Wallstent was placed in the occlusive segment. But, Rt. colic artery was not visualized after procedure (arrow). D. We performed multiple courses of aspiration thrombectomy using a 6.0 Fr aspiration catheter after intra-arterial thrombolysis. Final angiogram shows a recanalized Rt. colic artery (arrow). E. Contrast-enhanced CT at 34 days after the procedure shows no filling defect in the SMA, but decreased small bowel enhancement and multifocal perfusion defect in both kidneys. He expired due to multi-organ failure. Note.-ER = Emergency Room, SMA = superior mesenteric artery

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