Endovascular Treatment of an Acute Superior Mesenteric Artery Occlusion following Failed Surgical Embolectomy

Purpose: To present the successful primary stenting of a superior mesenteric artery (SMA) occlusion following failed surgical embolectomy. Case Report: A 65-year-old woman with a history of atrial fibrillation underwent surgical embolectomy of an acute embolic occlusion of the superior mesenteric artery (SMA). The following day, symptom recurrence suggested reocclusion, which was confirmed with emergent arteriography. Two balloon-expandable stents were deployed primarily, which ameliorated the patient's symptoms. Follow-up angiography at 3 months showed continued SMA patency, with no evidence of distal embolization or restenosis. The patient remains asymptomatic at 9 months after the stent procedure. Conclusions: Although more experience is required, primary stenting may be a valuable alternative in the treatment of acute SMA occlusions, in particular, for reocclusions after failed surgery.

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Endovascular Treatment of Multiple Visceral Artery Paradoxical Emboli with Mechanical and Pharmacological Thrombolysis

Journal of Endovascular Therapy ◽

10.1177/152660280000700212 ◽

2000 ◽

Vol 7 (2) ◽

pp. 155-160 ◽

Cited By ~ 12

Author(s):

W. Charles Sternbergh ◽

Stephen R. Ramee ◽

Daniel A. DeVun ◽

Samuel R. Money

Keyword(s):

Endovascular Treatment ◽

Mesenteric Artery ◽

Left Kidney ◽

Visceral Artery ◽

Attractive Alternative ◽

Paradoxical Emboli ◽

History Of ◽

Surgical Embolectomy ◽

Urokinase Infusion

Purpose: To report a case of paradoxical emboli to multiple visceral vessels treated with both mechanical (AngioJet device) and pharmacological (urokinase) thrombolysis. Methods and Results: A 72-year-old man presented with a 48-hour history of symptomatic right renal ischemia, which was treated with heparinization. Five days later, an abrupt creatinine elevation prompted arteriography, which demonstrated thromboembolism of the superior mesenteric artery (SMA) and both renal arteries. The AngioJet aspiration device was employed to successfully remove the clot from the SMA; urokinase infusion restored flow to the left kidney. At the 16-month follow-up evaluation, the patient was normotensive without medication and had a stable creatinine (1.4 mg/dL). Conclusions: Because of its speed and minimal morbidity, the AngioJet device may be an attractive alternative to surgical embolectomy or pharmacological thrombolysis in highly selected cases of acute visceral artery thromboembolism.

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Long-term Outcomes of Conservative Treatment and Endovascular Treatment in Patients with Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection: A Single-center Experience

10.21203/rs.2.17427/v2 ◽

2020 ◽

Author(s):

Leyin Xu ◽

Jiang Shao ◽

Daming Zhang ◽

Chenyang Qiu ◽

Jingjing Wang ◽

...

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Artery Dissection ◽

Single Center ◽

Long Term Outcomes ◽

Conservative Group ◽

Superior Mesenteric Artery Dissection ◽

Symptom Recurrence

Abstract Background: Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare vascular disorder, and the treatment strategies remain controversial. This study aimed to compare outcomes of conservative and endovascular treatments in symptomatic patients with SISMAD. Methods: Forty-two consecutive SISMAD patients who were admitted to a single center between October 2009 and May 2018 were enrolled in this study. Based on their symptoms, 15 had conservative treatment, and 27 had endovascular treatment. The baseline characteristics, treatments, and follow-up results of the conservative group and endovascular group were analysed. Results: The rates of symptom relief were 93.3% in the conservative group and 96.3% in the endovascular group. The procedure-related complications in the endovascular group included one case of pseudoaneurysm formation in the left brachial artery. During the follow-up period (median 28.5 months), a higher proportion of patients in the conservative group had symptom recurrence (42.9% in the conservative group versus 4.8% in the endovascular group, p < 0.001). Four patients in the conservative group and one patient in the endovascular group had additional endovascular intervention during follow-up. Compared with the conservative group, patients in the endovascular group had statistically significantly longer symptom-free survival ( p = 0.014) and a higher rate of superior mesenteric artery (SMA) remodeling ( p < 0.001). Conclusions: For symptomatic SISMAD, endovascularly treated patients had a lower rate of symptom recurrence and a higher rate of SMA remodeling in the long term. Prospective, multi-center studies are needed to confirm the long-term outcomes of both treatments.

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Superior Mesenteric Artery occlusion presenting with severe acute abdomen and subsequent gangrenous small gut

Bangladesh Critical Care Journal ◽

10.3329/bccj.v5i2.34399 ◽

2017 ◽

Vol 5 (2) ◽

pp. 141-142

Author(s):

Chishti Tanhar Bakth Choudhury ◽

Jamal Ahmed Chowdhury ◽

Mrigen Kumar Das Chowdhury

Keyword(s):

Differential Diagnosis ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Artery Occlusion ◽

Clinical Scenario ◽

Male Smoker ◽

Clinical Ground ◽

Superior Mesenteric Artery Occlusion ◽

History Of ◽

Mesenteric Artery Occlusion

Superior Mesenteric Artery occlusion is not very uncommon in developing world . It mimic clinically with many differential diagnosis.2 There is a clinical scenario of 60 yrs male, smoker presented in Accident & Emergency (A&E) department with history of central abdominal pain for two days associated with vomiting. Pain was gradually increasing, abdomen became tense, tender and patient developed restlessness. Even after all sorts of conservative management, pain was not subsiding. Following day of admission laparotomy attempted with clinical vision of burst appendix and peritonitis. After exploration of abdomen the finding was thundering. The almost whole small gut was gangrenous , resection anastomosis had done. In this case the differential diagnosis was burst appendix and Intestinal obstruction . Possibility of Superior Mesenteric Artery occlusion should be kept in mind by this clinical ground .Bangladesh Crit Care J September 2017; 5(2): 141-142

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Long-term Outcomes of Conservative Treatment and Endovascular Treatment in Patients with Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection: A Single-center Experience

10.21203/rs.2.17427/v1 ◽

2019 ◽

Author(s):

Leyin Xu ◽

Daming Zhang ◽

Chenyang Qiu ◽

Jingjing Wang ◽

Kang Li ◽

...

Keyword(s):

Endovascular Treatment ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Artery Dissection ◽

Single Center ◽

Conservative Group ◽

Superior Mesenteric Artery Dissection ◽

Symptom Recurrence

Abstract Background: Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare vascular disorder and the treatment strategies remain controversial. This study aimed to compare outcomes of conservative and endovascular treatments in symptomatic patients with SISMAD. Methods: Forty-two consecutive SISMAD patients between October 2009 and May 2018 in a single center were enrolled in the study. Based on their symptoms, 15 had conservative treatment and 27 had endovascular treatment. The baseline characteristics, treatments, and follow-up results of the conservative group and endovascular group were analyzed. Results: The rate of symptom relief was 93.3% in the conservative group and 96.3% in the endovascular group, respectively. The procedure-related complications in the endovascular group included one case of pseudoaneurysm formation in the left brachial artery. During the follow-up period (median 28.5 months), a higher proportion of patients in the conservative group had symptom recurrence (42.9% in the conservative group versus 4.8% in the endovascular group, p < 0.001). Four patients in the conservative group and one patient in the endovascular group had additional endovascular intervention during follow-up. Compared with the conservative group, patients in the endovascular group had statistically significantly longer symptom-free survival ( p = 0.014) and a higher rate of superior mesenteric artery (SMA) remodeling ( p < 0.001). Conclusions: For symptomatic SISMAD, endovascularly treated patients had a lower rate of symptom recurrence and a higher rate of SMA remodeling in the long term. Endovascular treatment should be considered as the first-line treatment of SISMAD.

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Endovascular Treatment of an Acute Superior Mesenteric Artery Occlusion Following Failed Surgical Embolectomy

Journal of Endovascular Therapy ◽

10.1583/1545-1550(2003)010<0386:etoaas>2.0.co;2 ◽

2003 ◽

Vol 10 (2) ◽

pp. 386-391 ◽

Cited By ~ 1

Author(s):

Saim Yilmaz ◽

Alihan Gürkan ◽

Okan Erdoğan ◽

Timur Sindel ◽

Kağan Çeken ◽

...

Keyword(s):

Endovascular Treatment ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Artery Occlusion ◽

Superior Mesenteric Artery Occlusion ◽

Surgical Embolectomy ◽

Mesenteric Artery Occlusion

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Natural history of spontaneous isolated superior mesenteric artery dissection derived from follow-up after conservative treatment

Journal of Vascular Surgery ◽

10.1016/j.jvs.2011.07.052 ◽

2011 ◽

Vol 54 (6) ◽

pp. 1727-1733 ◽

Cited By ~ 89

Author(s):

Yang Jin Park ◽

Kwang Bo Park ◽

Dong-Ik Kim ◽

Young Soo Do ◽

Duk-Kyung Kim ◽

...

Keyword(s):

Natural History ◽

Conservative Treatment ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Artery Dissection ◽

History Of ◽

Superior Mesenteric Artery Dissection

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Antibiotic Therapy Did Not Prevent the Rupture of Mycotic Aneurysm of the Superior Mesenteric Artery

The Heart Surgery Forum ◽

10.1532/hsf.1322 ◽

2015 ◽

Vol 18 (3) ◽

pp. 088

Author(s):

Ye-tao Li ◽

Xiao-bin Liu ◽

Tao Wang

Keyword(s):

Abdominal Pain ◽

Infective Endocarditis ◽

Aortic Valve ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Mycotic Aneurysm ◽

Acute Abdominal Pain ◽

Rare Complication ◽

Emergency Operation ◽

History Of

Mycotic aneurysm of the superior mesenteric artery (SMA) is a rare complication of infective endocarditis. We report a case with infective endocarditis involving the aortic valve complicated by multiple septic embolisms. The patient was treated with antibiotics for 6 weeks. During preparation for surgical treatment, the patient developed acute abdominal pain and was diagnosed with a ruptured SMA aneurysm, which was successfully treated with an emergency operation of aneurysm ligation. The aortic valve was replaced 17 days later and the patient recovered uneventfully. In conclusion, we present a rare case with infective endocarditis (IE) complicated by SMA aneurysm. Antibiotic treatment did not prevent the rupture of SMA aneurysm. Abdominal pain in a patient with a recent history of IE should be excluded with ruptured aneurysm.

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Visceral Mycotic Aneurysm: Superior Mesenteric Artery Aneurysm Caused by K. pneumoniae

Dubai Medical Journal ◽

10.1159/000517222 ◽

2021 ◽

pp. 1-4

Author(s):

Reham Almasoud ◽

Alaaeddin Nwilati ◽

Saeb Bayazid ◽

Mamoun Shafaamri

Keyword(s):

Infectious Disease ◽

Antibiotic Therapy ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Mycotic Aneurysm ◽

Artery Aneurysm ◽

Management Plan ◽

Resected Tissue ◽

Infectious Disease Specialists

We herein report a rare case of mycotic aneurysm of the superior mesenteric artery caused by Klebsiella pneumoniae. A 66-year-old man, a known case of hypertension and aorto-oesophageal fistula with stented aorta in 2010 and 2018, presented to the emergency department multiple times over 2 months with severe postprandial abdominal pain associated with vomiting and fever. On his last presentation, the obtained blood cultures grew ESBL positive K. pneumoniae and a repeated computed tomography (CT) showed a growing aneurysm at the origin of the ileocecal branch of the superior mesenteric artery measuring 17 × 10 mm (the aneurysm was 8 × 7.5 mm in the CT angiography on the previous admission). Extensive workup did not reveal the underlying cause of the mycotic aneurysm, thus we believe the cause to be the infected aortic stent, leading to bacteraemia and vegetations to the mesenteric artery causing the aneurysm. The management plan was placed by a multidisciplinary team consisting of vascular surgeons and infectious disease specialists along with review from a dietician to evaluate the patient’s nutritional status. The patient was started on total parenteral nutrition due to his postprandial pain and on antibiotic therapy according to the infectious disease team’s recommendation. He underwent surgical resection of the mycotic aneurysm, which showed a thrombosed aneurysm in the jejunoileal mesenteric area. The histopathology of the resected tissue demonstrated inflammatory aneurysm of the mesenteric artery. Following the surgery, the patient continued his antibiotic therapy and was discharged on the 13th post-operative day with follow-up appointments in the vascular surgery and infectious disease clinic.

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