Mechanical Recanalization for Acute Embolic Occlusion at the Origin of the Superior Mesenteric Artery

Miura, Yoichi; Araki, Toshimitsu; Terashima, Mio; Tsuboi, Junya; Saito, Yasuhiro; Kanamaru, Kenji; Suzuki, Hiroyoshi

doi:10.1177/1538574416689425

Cited by 13 publications

(6 citation statements)

References 12 publications

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“…In patients with no likelihood of infarcted bowel but features in keeping with AMI, the treatment options for revascularization are open or endovascular in nature. Open vascular revascularization has traditionally been the optimal treatment option [ 301 , 373 , 374 , 375 , 376 , 377 ]. More recently, endovascular treatments have gained traction [ 373 , 384 ].…”

Section: Introductionmentioning

confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

et al. 2021

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Aim There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence‐based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. Methods Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology‐based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence‐based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. Results All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. Conclusion These guidelines provide an up to date and evidence‐based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.

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Section: Introductionmentioning

confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

et al. 2021

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“…Some scholars have attempted to use thrombectomy devices for SMAE and have achieved good results; however, these retrospective series were small ( 17 , 20 ). Thrombectomy devices, such as the Rotarex debulking Device (Straub Medical, Wangs, Switzerland), AngioJet thrombectomy catheter (Solent Omni; Boston Scientific, Marlborough, MA, USA), and Solitaire FR revascularization device (Covidien, Irvine, CA, USA), are used for such treatments ( 16 , 21 , 22 ). In our cohort, mechanical thrombectomy performed with the Rotarex system was the first choice.…”

Section: Discussionmentioning

confidence: 99%

Outcome Comparison of Endovascular and Open Surgery for the Treatment of Acute Superior Mesenteric Artery Embolism: A Retrospective Study

Cao

Zhang

et al. 2022

Front. Surg.

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BackgroundFew centers have adopted endovascular revascularization for the treatment of superior mesenteric artery embolism (SMAE). We sought to evaluate the efficacy of endovascular therapy for the treatment of SMAE and identify post-treatment prognostic factors.MethodsThe clinical data of 41 patients with acute SMA embolism between 2013 and 2021 were retrospectively reviewed. Patients with mesenteric artery thrombosis, mesenteric venous thrombosis, and who had only conservative treatment were excluded.ResultsForty-one consecutive patients were identified with SMAE (median age, [range] 35–86 years). Endovascular therapy was initiated in 14 patients with no clinical evidence of bowel necrosis, with mainly mechanical thrombectomy, and technical success was achieved in 93%. Endovascular therapy had advantages in duration surgery time, blood loss, bowel rest time, ICU time, and ventilator use. There was no difference in bowel necrosis, length of necrotic bowel resected, or in-hospital mortality between the two groups. An initial white blood cell (WBC) count >15 × 103/dl and neutrophil count >13 × 103/dl were associated with an increased risk of bowel necrosis, and an initial WBC count, renal function, American Society of Anesthesiologists (ASA >3) and necrotic bowel >2 m were associated with increased mortality.ConclusionsEndovascular treatment has altered the management of SMAE, and it may be adopted in selected patients who are not at risk for bowel necrosis. Avoidance of bowel necrosis patients and close monitoring for bowel necrosis are important.

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“…With the increasing use of endovascular treatment in recent years, new endovascular tools have become available, and more clinicians understand how to use them in most fields of vascular surgery. [14][15][16][17] Thus, endovascular treatment is becoming the first choice for early-stage AS-MAE, which has no obvious intestinal necrosis. 18 In particular, with the popularization of mechanical thrombectomy devices such as the AngioJet system, some scholars have achieved good outcomes of SMA thrombus removal using these devices.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous mechanical thrombectomy in the management of early acute superior mesenteric artery embolism

Wang

Lang

et al. 2022

Vascular

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Purpose This study was performed to summarize our experience in the management of early-stage acute superior mesenteric artery embolism (ASMAE) by percutaneous mechanical thrombectomy (PMT). Methods The clinical data of 12 patients with early-stage ASMAE treated by PMT in our institution from November 2019 to September 2021 were retrospectively analyzed. The patients had no obvious evidence of bowel infarction as shown by peritoneal puncture and computed tomography angiography. Thrombectomy of the superior mesenteric artery was performed using a 6F AngioJet catheter. Results The emboli were completely removed in 10 (83.3%) patients. Six patients were treated only by the AngioJet device. The other six patients underwent combined treatment with a 6F multipurpose drainage catheter after PMT, including one patient who underwent simultaneous stent implantation. Two patients showed no significant improvement in their symptoms after the operation; one was found to have intestinal necrosis and underwent resection by exploratory laparotomy, and the other died of septic shock 3 days after PMT (further intervention had been discontinued because of complications with multiple underlying diseases). No other PMT-related complications occurred. Only one patient was found to have a pseudoaneurysm of the superior mesenteric artery 1 week after PMT and underwent resection by exploratory laparotomy. The 11 surviving patients were smoothly discharged from the hospital after their symptoms were relieved. At a mean follow-up of 13.2 months, computed tomography angiography showed smooth patency of the superior mesenteric artery. No patients developed serious symptoms during follow-up. Conclusions PMT by the AngioJet device is a minimally invasive, safe, and effective technique to remove ASMAE. Early application of PMT can avoid acute intestinal necrosis. Combining the AngioJet device with a 6F multipurpose drainage catheter might be more helpful to remove residual emboli.

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Mechanical Recanalization for Acute Embolic Occlusion at the Origin of the Superior Mesenteric Artery

Abstract: Combined endovascular procedures of mechanical thrombectomy using the Solitaire FR with thromboaspiration may allow prompt recanalization, clot removal, and prevention of distal embolism and therefore would be a new therapy for acute embolic occlusion at the origin of the SMA.

Cited by 13 publications

References 12 publications

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

Outcome Comparison of Endovascular and Open Surgery for the Treatment of Acute Superior Mesenteric Artery Embolism: A Retrospective Study

Percutaneous mechanical thrombectomy in the management of early acute superior mesenteric artery embolism

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