Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2019; 25(7): 848-858
Published online Feb 21, 2019. doi: 10.3748/wjg.v25.i7.848
Aspiration therapy for acute embolic occlusion of the superior mesenteric artery
Yi-Ren Liu, Zhu Tong, Cheng-Bei Hou, Shi-Jun Cui, Lian-Rui Guo, Yi-Xia Qi, Li-Xing Qi, Jian-Ming Guo, Yong-Quan Gu
Yi-Ren Liu, Zhu Tong, Shi-Jun Cui, Lian-Rui Guo, Yi-Xia Qi, Li-Xing Qi, Jian-Ming Guo, Yong-Quan Gu, Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Cheng-Bei Hou, Center of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Author contributions: Gu YQ designed the research and wrote the paper; Liu YR performed the research and wrote the paper; Hou CB contributed to analytic tools and analyzed the data; Tong Z and Cui SJ edited the manuscript; Guo LR, Qi LX, Qi YX, and Guo JM collected the human samples.
Supported by the National Key Research and Development Program of China, No. 2017YFC1104100; the Capital Health Research and Development of Special, No. 2016-1-2012; Beijing Hospital Authority Clinical Technological Innovation Project, No. XMLX201610; and Beijing Hospital Authority "Climb Peak" Talent Training Scheme, No. DFL20150801.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Xuanwu Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yong-Quan Gu, MD, Chief Doctor, Professor, Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100053, China. 15901598209@163.com
Telephone: +86-15901598209 Fax: +86-10-83125113
Received: December 2, 2018
Peer-review started: December 3, 2018
First decision: January 11, 2019
Revised: January 20, 2019
Accepted: January 26, 2019
Article in press: January 26, 2019
Published online: February 21, 2019
Abstract
BACKGROUND

Embolic superior mesenteric artery (SMA) occlusion is associated with high mortality rates. Delayed treatment often leads to serious consequences, including intestinal necrosis, resection, and even patient death. Endovascular repair is being introduced, which can improve clinical symptoms and prognosis and decrease the incidence of exploratory laparotomy. Many reports have described successful endovascular revascularization of embolic SMA occlusion. However, most of those reports are case reports, and there are few reports on Chinese patients. In this paper, we describe the technical and clinical outcomes of aspiration therapy using a guiding catheter and long sheath technique which facilitates the endovascular repair procedure.

AIM

To evaluate the complications, feasibility, effectiveness, and safety of endovascular treatment for the acute embolic occlusion of the SMA.

METHODS

This retrospective study reviewed eight patients (six males and two females) from August 2013 to October 2018 at Xuanwu Hospital, Capital Medical University. The patients presented with acute embolic occlusion of the SMA on admission and were initially diagnosed by computed tomography angiography (CTA). The patients who underwent endovascular treatment with a guiding catheter had no obvious evidence of bowel infarct. No intestinal necrosis was identified by gastrointestinal surgeons through peritoneal puncture or CTA. The complications, feasibility, effectiveness, safety, and mortality were assessed.

RESULTS

Six (75%) patients were male, and the mean patient age was 70.00 ± 8.43 years (range, 60-84 years). The acute embolic occlusion of the SMA was initially diagnosed by CTA. All patients had undertaken anticoagulation primarily, and percutaneous aspiration using a guiding catheter was then undertaken because the emboli had large amounts of thrombus residue. No death occurred among the patients. Complete patency of the suffering artery trunk was achieved in six patients, and defect filling was accomplished in two patients. The in-hospital mortality was 0%. The overall 12-mo survival rate was 100%. All patients survived, and two of the eight patients had complications (the clot broke off during aspiration).

CONCLUSION

Aspiration therapy is feasible, safe, and beneficial for acute embolic SMA occlusion. Aspiration therapy has many benefits for reducing patients’ death, resolving thrombi, and improving symptoms.

Keywords: Superior mesenteric artery, Acute embolic occlusion, Aspiration embolectomy, Transcatheter thrombolysis, Endovascular repair

Core tip: Percutaneous aspiration embolectomy was recently used to treat embolic superior mesenteric artery (SMA) occlusion. The aim of this study was to assess the utility of endovascular revascularization. Eight patients with acute embolic SMA occlusion underwent aspiration therapy using a guiding catheter. The rate of technical success, clinical success, and adverse events was 100%, 100%, and 25%, respectively. Recurrence was not observed. The median follow-up period after aspiration was 328 d. Aspiration using a guiding catheter achieved immediate revascularization of emboli of the SMA trunk and is a useful tool in the recanalization of embolic occlusion of the SMA in select patients.