Korean Journal of Radiology

  • 제16권4호
  • /
  • Pages.736-743
  • /
  • 2015
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

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

  • Choi, Kyu Sung (Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital) ;
  • Kim, Ji Dae (Department of Radiology, Eulji University Hospital) ;
  • Kim, Hyo-Cheol (Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital) ;
  • Min, Sang-Il (Department of Surgery, Seoul National University Hospital) ;
  • Min, Seung-Kee (Department of Surgery, Seoul National University Hospital) ;
  • Jae, Hwan Jun (Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital) ;
  • Chung, Jin Wook (Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital)
  • 투고 : 2015.02.22
  • 심사 : 2015.03.04
  • 발행 : 2015.08.01
⟨ 이전 논문 다음 논문 ⟩

초록

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.

키워드

참고문헌

  1. Bjorck M, Acosta S, Lindberg F, Troeng T, Bergqvist D. Revascularization of the superior mesenteric artery after acute thromboembolic occlusion. Br J Surg 2002;89:923-927 https://doi.org/10.1046/j.1365-2168.2002.02150.x
  2. Gupta PK, Natarajan B, Gupta H, Fang X, Fitzgibbons RJ Jr. Morbidity and mortality after bowel resection for acute mesenteric ischemia. Surgery 2011;150:779-787 https://doi.org/10.1016/j.surg.2011.07.079
  3. Wong YC, Wu CH, Wang LJ, Chen HW, Lin BC, Huang CC. Mesenteric vascular occlusion: comparison of ancillary CT findings between arterial and venous occlusions and independent CT findings suggesting life-threatening events. Korean J Radiol 2013;14:38-44 https://doi.org/10.3348/kjr.2013.14.1.38
  4. Park WM, Gloviczki P, Cherry KJ Jr, Hallett JW Jr, Bower TC, Panneton JM, et al. Contemporary management of acute mesenteric ischemia: factors associated with survival. J Vasc Surg 2002;35:445-452 https://doi.org/10.1067/mva.2002.120373
  5. Endean ED, Barnes SL, Kwolek CJ, Minion DJ, Schwarcz TH, Mentzer RM Jr. Surgical management of thrombotic acute intestinal ischemia. Ann Surg 2001;233:801-808 https://doi.org/10.1097/00000658-200106000-00010
  6. Acosta S, Sonesson B, Resch T. Endovascular therapeutic approaches for acute superior mesenteric artery occlusion. Cardiovasc Intervent Radiol 2009;32:896-905 https://doi.org/10.1007/s00270-009-9559-x
  7. Resch TA, Acosta S, Sonesson B. Endovascular techniques in acute arterial mesenteric ischemia. Semin Vasc Surg 2010;23:29-35 https://doi.org/10.1053/j.semvascsurg.2009.12.004
  8. Heiss P, Loewenhardt B, Manke C, Hellinger A, Dietl KH, Schlitt HJ, et al. Primary percutaneous aspiration and thrombolysis for the treatment of acute embolic superior mesenteric artery occlusion. Eur Radiol 2010;20:2948-2958 https://doi.org/10.1007/s00330-010-1859-7
  9. Kawasaki R, Miyamoto N, Oki H, Yamaguchi M, Okada T, Sugimura K, et al. Aspiration therapy for acute superior mesenteric artery embolism with an angled guiding sheath and guiding catheter. J Vasc Interv Radiol 2014;25:635-639 https://doi.org/10.1016/j.jvir.2013.11.015
  10. Shah SN, Sacks D, Chavali R. Mechanical embolectomy and recanalization of superior mesenteric artery embolism using the MERCI retrieval device. J Vasc Interv Radiol 2011;22:1638-1640 https://doi.org/10.1016/j.jvir.2011.08.007
  11. Goltz JP, Petritsch B, Spor L, Hahn D, Kickuth R. Acute thromboembolic occlusion of the superior mesenteric artery following covered stent occlusion in the superior mesenteric artery: endovascular therapy using mechanical rotational thrombectomy. Vasa 2012;41:375-379 https://doi.org/10.1024/0301-1526/a000225
  12. Zelenak K, Sinak I, Janik J, Mikolajcik A, Mistuna D. Successful recanalization of acute superior mesenteric artery thromboembolic occlusion by a combination of intraarterial thrombolysis and mechanical thrombectomy with a carotid filter. Cardiovasc Intervent Radiol 2013;36:844-847 https://doi.org/10.1007/s00270-012-0486-x
  13. Kim SK, Kwak HS, Chung GH, Han YM. Acute upper limb ischemia due to cardiac origin thromboembolism: the usefulness of percutaneous aspiration thromboembolectomy via a transbrachial approach. Korean J Radiol 2011;12:595-601 https://doi.org/10.3348/kjr.2011.12.5.595

피인용 문헌

  1. Percutaneous aspiration embolectomy of superior mesenteric artery using a 5MAX ACE reperfusion catheter vol.2, pp.4, 2015, https://doi.org/10.1259/bjrcr.20160039
  2. Endovascular Renal Artery Stent Retriever Embolectomy in a Young Patient With Cardiac Myxoma: Case Report and Review of the Literature vol.52, pp.1, 2015, https://doi.org/10.1177/1538574417739746
  3. Aspiration therapy for acute embolic occlusion of the superior mesenteric artery vol.25, pp.7, 2015, https://doi.org/10.3748/wjg.v25.i7.848
  4. Analysis of the Risk Factors of Acute Mesenteric Artery Embolism Patients with Surgical Treatment vol.10, pp.10, 2020, https://doi.org/10.12677/acm.2020.1010362
  5. Endovascular therapy in acute mesenteric ischemia after coronary artery bypass grafting: a case report and literature review vol.20, pp.3, 2021, https://doi.org/10.15829/1728-8800-2021-2586