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. 2019 Sep 3;2(1):31.
doi: 10.1186/s42155-019-0074-0.

Case report: direct revascularization in acute mesenteric ischemia by an endovascular approach

P Genzel  1 , L C van Dijk  2 , H T C Veger  2 , J J Wever  2 , R G S van Eps  2 , R M E Slangen  2 , H van Overhagen  2
Affiliations

Case report: direct revascularization in acute mesenteric ischemia by an endovascular approach

P Genzel et al. CVIR Endovasc. .

Abstract

Background: Acute mesenteric ischemia is a relatively rare but life-threatening clinical condition. Outcome depends on early diagnosis and prompt intervention.

Case presentation: A 85-year-old man and a 75-year-old woman developed acute mesenteric ischemia due to cardiac embolism. The first patient received an insufficient dose of anticoagulants for atrial fibrillation and the second patient dicontinued her anticoagulantia to avoid bleeding during a routine colonoscopy. Both patients presented with severe abdominal pain and computed tomography showed thrombus in de superior mesenteric artery. Successfulrevascularization with good clinical outcome was achieved by means of an endovascular first approach.

Conclusion: This case report shows that an endovascular approach - in contrast to open surgery - not only enables to revascularize main trunk lesions but can also facilitate revascularization of side branches. Endovascular treatment used to be limited to a selected group of patients without signs of bowel necrosis, but there is a tendency to initiate endovascular revascularization in all patients because it is associated with a reduced mortality, a reduced laparotomy rate and reduction in the resected length of bowel.

Keywords: Acute mesenteric ischemia; Revascularization; Superior mesenteric artery; Thrombosuction.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
SMA embolism, occlusion main trunk and ileicolic artery (a) Sagittal CT image, arterial phase, main stem occlusion. b Lateral view DSA acute stop proximal in the SMA. c Selective SMA angiography after thrombosuction shows improved patency but residual thrombus in main stem SMA and ileocolic artery. d After PTA of ileocolic artery and main stem SMA followed by stent placement in main stem SMA shows patent SMA and side branches
Fig. 2
Fig. 2
SMA embolism in proximal side branches. a CT image, coronal view, arterial phase. b An-giography showing disrupted blood supply particularly to the ileocolic artery and branches. c Restored blood supply in affected segments after thrombosuction, thrombolysis and PTA
See this image and copyright information in PMC

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