Revascularization to prevent postoperative bowel infarction after surgery for acute superior mesenteric artery thromboembolism

Abstract

Purpose: Postoperative bowel infarction is a major contributing factor to the high mortality rate associated with acute thromboembolism of the superior mesenteric artery (SMA). This study was conducted to evaluate the prophylactic role of thrombectomy to prevent postoperative mesenteric infarction.

Methods: An autologous fibrin clot (1 cm3) was implanted into the SMA of beagle dogs. The animals in group I (n = 7) underwent only resection of the ischemic intestine 120 min after insertion of the thrombus. In group IIa (n = 6), the intestine was removed before thrombectomy of the SMA, and revascularization was performed 30 min prior to resection in group IIb (n = 6). The postoperative outcomes were compared among the three groups.

Results: Postoperative bowel infarction developed in four (57.1%) of the group I dogs, three (42.8%) of which died within 5 days postoperatively. The SMA was patent in the group IIa and IIb dogs, none of which died throughout the observation period. Performing thrombectomy before the resection reduced the length of resected intestine.

Conclusion: Arterial revascularization is not only an essential procedure for mesenteric infarction due to SMA thromboembolism, but it also prevents the postoperative bowel infarction caused by the extension of thrombus in the mesentery.