Percutaneous Aspiration Embolectomy Using Guiding Catheter for the Superior Mesenteric Artery Embolism

Abstract

Objective: To evaluate the technical feasibility and clinical outcome of percutaneous aspiration embolectomy for embolic occlusion of the superior mesenteric artery (SMA).

Materials and methods: Between January 2010 and December 2013, 9 patients with embolic occlusion of the SMA were treated by percutaneous aspiration embolectomy in 2 academic teaching hospitals. The aspiration embolectomy procedure was performed with the 6-Fr and 7-Fr guiding catheter. Thrombolysis was performed with urokinase using a multiple-sidehole infusion catheter. The clinical outcome was investigated retrospectively.

Results: Superior mesenteric artery occlusion was initially diagnosed by computed tomography (CT) in all patients, and all patients had no obvious evidence of bowel infarction on CT scan. Percutaneous aspiration embolectomy was primarily performed in 6 patients, and thrombolysis was initially performed in 3 patients. In 3 patients who received primary thrombolysis, percutaneous aspiration was undertaken because the emboli were resistant to urokinase. Complete angiographic success was achieved in 6 patients and partial angiographic success was accomplished in 3 patients. One patient underwent bowel resection. One patient died of whole bowel necrosis and sepsis, and 8 patients survived without complications.

Conclusion: Percutaneous aspiration embolectomy is a useful tool in recanalization of embolic occlusion of the SMA in select patients.

Keywords: Aspiration embolectomy; Embolism; Superior mesenteric artery.

Fig. 1. 88-year-old female presented with abdominal pain and hematochezia.

A. Three-dimensional-volume rendered image of abdominal CT angiograph shows segmental occlusion of proximal superior mesenteric artery (SMA) (arrowheads) with calcified plaque. B. Initial angiography shows complete occlusion of SMA (arrowhead) with sluggish flow through distal jejunal branches. Convex meniscus suggests embolic occlusion. C. 7-Fr sheath (arrow) was introduced into proximal segment of SMA, and 7-Fr guiding catheter (arrowhead) was advanced into main trunk of SMA. D. Angiography after aspiration shows partial recanalized SMA and residual blood clot (arrowheads). E. 6-Fr guiding catheter was advanced into distal branch of SMA. F. Final angiography shows complete recanalized SMA. G. Emboli were removed by guiding catheter. Note fresh thrombotic clots (arrowheads) and old embolic clots (arrows).