#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Acute embolization into the veins in the splanchnic bed – an overview of current methods of diagnosis and therapies


Authors: R. Miklík;  P. Kala;  J. Maňoušek;  M. Poloczek;  J. Pařenica;  P. Lokaj;  J. Špinar
Authors‘ workplace: Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC
Published in: Vnitř Lék 2008; 54(11): 1081-1086
Category: Review

Overview

Acute mesentery artery embolization is a rare diagnosis. In case of late recognition the mortality may reach up to 93%. Acute abdominal pain, vomitus, rapid and sudden bowel evacuation with or without blood are the typical symptoms of the disease. Unfortunately, the symptoms do not often correlate with clinical findings. Plain X‑ray of abdomen or CT tomography may show no signs of intestinal ischaemia. The diagnostic method to choose is either spiral CT angiography or contrast angiography, respectively. The most common therapeutical approach is surgical revascularization but in selected cases it is feasible to perform local thrombolysis with a microcatheter placed directly into the occluded artery. Papaverin vasodilatation and intravenous anticoagulation are also justifiable, catheter aspiration and stent implantation have also been challenged. Our review is to provide a detailed up-to-date information about the issue and is an extensive follow‑up of our recently published case report [Superior mesentery artery embolization as a complication of the primary angioplasty solved by local thrombolysis. Vnitř Lék 2008; 54(9): 871–875].

Key words:
acute occlusion – superior mesentery artery – embolization – catheterization – thrombolysis – angiography


Sources

1. Miklík R, Maňoušek J, Kala P et al. Embolizace větví arteria mesenterica superior jako komplikace direktní angioplastiky řešená lokální trombolýzou. Vnitř Lék 2008; 54: 871–875.

2. Kala P, Želízko M, Vojáček J. PS Intervenční kardiologie ČKS a Národní registr kardiovaskulárních intervencí (NRKI). Interv Akut Kardiologie 2007; 6: 152–153.

3. Georgiev G. Acute obstruction of the mesenteric vessels: a diagnostic and therapeutic problem. Khirurgiia (Sofiia) 1989; 42: 23–29.

4. Schoots IG, Levi MM, Reekers JA et al. Thrombolytic Therapy for Acute Superior Mesenteric Artery Occlusion. J Vasc Interv Radiol 2005; 16: 317–329.

5. Stoney RJ, Cunningham CG. Acute mesenteric ischemia. Surgery 1993; 114: 489–490.

6. Acosta S, Ogren M, Sternby NH et al. Incidence of acute thrombo-embolic occlusion of the superior mesenteric artery – A population‑based study. Eur J Vasc Endovasc Surg 2004; 27: 145–150.

7. ACC/AHA 2005 practice Guidelines for the Management of Patients with Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic). Circulation 2006; 113: e463–e465.

8. Brandt LJ, Boley SC. AGA Technical Review on Intestinal Ischemia. Gastroenterology 2000; 118: 954–968.

9. American Gastroenterological Association Medical Position Statement: Guidelines on Intestinal Ischemia. Gastroenterology 2000; 118: 951–953.

10. Kibbe MR, Tassoun HT. Acute mesenteric ischemia: Diagnosis and management of acute bowel ischemia. ACS Surgery Online 2002. www.medscape.com.

11. Brandt LJ. Ischemic bowel: how often is it misdiagnosed? In: Barin J, Rogers A (eds). Difficult decisions in digestive diseases. Chicago: Year Book Medical Publi-shers 1989: 359–361.

12. Kasirajan K, Mascha EJ, Heffernan D et al. Determinants of in‑hospital mortality and length of stay for acute intestinal gangrene. Am J Surg 2004; 187: 482–485.

13. Kougias P, Lau D, El Sayed HF et al. Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J Vasc Surg, 2007; 46: 467–474.

14. Edwards MS, Cherr GS, Craven TE et al. Acute Occlusive Mesenteric Ischemia: Surgical Management and Outcomes. Ann Vasc Surg 2003; 17: 72–79.

15. Geboes K, Geboes KP, Maleux G. Vascular anatomy of the gastrointestinal tract. Best Pract Res Clin Gastroenterol 2001; 15: 1–14.

16. Smerud MJ, Johnson CD, Stephens DH. Diagnosis of bowel infarction: a comparison of plain films and CT scans in 23 cases. Am J Radiol 1990; 154: 99–103.

17. Ritz JP, Runkel N, Berger G et al. Prognosefactoren des mesenterialinfarktes. Zentralblatt Chir 1997; 122: 332–338.

18. Bowersox JC, Zwolak RM, Walsh DB at al. Duplex ultrasonography in the diagnosis of celiac and mesenteric artery occlusive disease. J Vasc Surg 1991; 14: 780–786.

19. Moneta GL, Yeager RA, Dalman R at al. Duplex ultrasound criteria for the diagnosis of splanchnic artery stenosis or occlusion. J Vasc Surg 1991; 14: 511–518.

20. Meaney JF, Prince MR, Nostrant TT et al. Gadoliniumenhanced MR angiography of visceral vessels in patients with suspected chronic mesenteric ischemia. J Magn Reson Imaging 1997; 7: 171–176.

21. Alpern MB, Glazer GM, Francis IR. Ischemic or infarcted bowel: CT findings. Radiology 1988; 166: 149–152.

22. Taourel PG, Deneuville M, Pradel JA et al. Acute mesenteric ischemia: diagnosis with contrast‑enhanced CT. Radiology 1996; 199: 632–636.

23. Clark RA, Gallant TE. Acute mesenteric ischemia: angiographic spectrum. Am J Radiol 1984; 142: 555–562.

24. Boley SJ, Sprayregan S, Siegelman SS at al. Initial results from an aggressive approach to acute mesenteric ischemia. Surgery 1977; 82: 848–855.

25. Czerny M, Trubel W, Claeys L et al. Die akute mesenteriale ischamie. Zentralbl Chir 1997; 122: 538–544.

26. Kaufman SL, Harrington DP, Siegelman S. Superior mesenteric artery embolization. Radiology 1977; 124: 625–630.

27. Boos S. Angiography of the mesenteric artery 1976 to 1991. A change in the indications during mesenteric circulatory disorders? Radiology 1992; 32: 154–157.

28. Bradbury AW, Brittenden J, McBride K et al. Mesenteric ischaemia: a multidisciplinary approach. Br J Surg 1995; 82: 1446–1459.

29. Sicard C, Brenot R, Galtier R et al. Superior mesenteric embolism. Apropos of 2 patients treated successfully with streptokinase. J Mal Vasc 1984; 9: 155–158.

30. Simo G, Echenagusia AJ, Camunez F et al. Superior mesenteric arterial embolism: local fibrinolytic treatment with urokinase. Radiology 1997; 20: 775–779.

31. Turegano FF, Simo MG, Echenagusia BA et al. Successful intraarterial fragmentation and urokinase therapy in superior mesenteric artery embolism. Surgery 1995; 117: 712–714.

32. Gallego AM, Ramirez P, Rodriguez JM et al. Role of urokinase in the superior mesenteric artery embolism. Surgery 1996; 120: 111–113.

33. Schoenbaum SW, Pena C, Koenigsberg P et al. Superior mesenteric artery embolism: treatment with intraarterial urokinase. J Vasc Interv Radiol 1992; 3: 485–490.

34. Makino J, Saito Y, Nishiyama Y et al. A case of superior mesenteric artery embolism which was effectively treated by aspiration of embolus. Jpn J Gastroenterol 1999; 1: 49–52.

35. Ogihara S, Yamamura S, Tomono H et al. Superior mesenteric arterial embolism: treatment by trans‑catheter thrombo-aspiration. J Gastroenterol 2003; 38: 272–277.

36. Kawarada O, Sonomura T, Yokoi Y. Direct aspiration using rapid-exchange and low-profile device for acute thrombo-embolic occlusion of the superior mesenteric artery. Catheter Cardiovasc Interv 2006; 68: 862–866.

37. Yilmaz S, Gurkan A, Erdogan O et al. Endovascular treatment of an acute supe-rior mesenteric artery occlusion following failed surgical embolectomy. J Endovasc Ther 2003; 10: 386–391.

38. Clavien PA. Diagnosis and management of mesenteric infarction. Br J Surg 1990; 77: 601–603.

39. Murano JU, Harrison RB. Mesenteric ischemia: angiographic diagnosis and intervention. Clin Imaging 1991; 15: 91–98.

40. Boley SJ, Feinstein FR, Sammartano R et al. New concepts in the management of emboli of the superior mesenteric artery. Surg Gynecol Obstet 1981; 153: 561–569.

41. Rhee RY, Gloviczki P, Mendonca CT et al. Mesenteric venous thrombosis: still a lethal disease in the 1990 s. J Vasc Surg 1994; 20: 688–697.

42. Batellier J, Kieny R. Superior mesenteric artery embolism: eighty-two cases. Ann Vasc Surg 1990; 4: 112–116.

43. Bergan JJ. Acute mesenteric ischemia. In: Haimovici H (ed). Vascular emergencies. New York: Appleton-Century Crofts 1982: 553–561.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 11

2008 Issue 11

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#