Published in:
01-10-2011 | Clinical Investigation
Acute Thrombotic Mesenteric Ischemia: Primary Endovascular Treatment in Eight Patients
Published in: CardioVascular and Interventional Radiology | Issue 5/2011
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Introduction
The purpose of this study was to evaluate our experience with initial percutaneous transluminal angioplasty (PTA) ± stenting as valuable options in the acute setting.
Methods
Between 2003 and 2008, eight patients with abdominal angio-MDCT-scan proven thrombotic AMI benefited from initial PTA ± stenting. We retrospectively assessed clinical and radiological findings and their management. Seven patients presented thrombosis of the superior mesenteric artery, and in one patient both mesenteric arteries were occluded. All patients underwent initial PTA and stenting, except one who had balloon PTA alone. One patient was treated by additional in situ thrombolysis.
Results
Technical success was obtained in all patients. Three patients required subsequent surgery (37.5%), two of whom had severe radiological findings (pneumatosis intestinalis and/or portal venous gas). Two patients (25%) died: both had NIDD, an ASA score ≥4, and severe radiologic findings. Satisfactory arterial patency was observed after a follow-up of 15 (range, 11–17) months in five patients who did not require subsequent surgery, four of whom had abdominal guarding but no severe CT scan findings. One patient had an ileocecal stenosis 60 days after the procedure.
Conclusions
Initial PTA ± stenting is a valuable alternative to surgery for patients with thrombotic AMI even for those with clinical peritoneal irritation signs and/or severe radiologic findings. Early surgery is indicated if clinical condition does not improve after PTA. The decision of a subsequent surgery must be lead by early clinical status reevaluation. In case of underlying atherosclerotic lesion, stenting should be performed after initial balloon dilatation.