Mert DUMANTEPE, Osman FAZLIOĞULLARI, Süha KÜÇÜKAKSU, İbrahim UYAR, Mustafa SEREN

Successful recanalization of a superior mesenteric artery thromboticocclusion via a percutaneous rotational thrombectomy

Akut mezenterik iskemi, bağırsak kan akımının anikesilmesine bağlı, sıklıkla bağırsak enfarktüsüne yolaçan ciddi bir abdominal acilidir. Bağırsakta yaygın,geri dönüşsüz kangren gelişmeden önce süperiormezenterik arter (SMA) embolisinin erken tanı vetedavisi önemlidir. Altmış üç yaşında bir erkek hastahastanemiz acil servisine ani başlangıçlı ve gittikçekötüleşen karın ağrısı şikayeti ile başvurdu. Hastayaacil olarak uygulanan kontrastlı bilgisayarlı tomografideSMAda emboli gözlendi. İntestinal nekroz bulgusuolmadığından, derhal rotasyonel trombektomiyebaşlandı. Trombüs aspirasyonu 6 French gauge Aspirex® S kateteri kullanılarak uygulandı. Mezenterik akımınreperfüzyonu 20 dakika içerisinde sağlandı. İşlemdendokuz ay sonra, Doppler ultrasonda SMAnın patentolduğu gözlendi. İleri bağırsak iskemisi bulgularıolmayan seçilmiş hastalarda akut SMA tıkanıklığı içinAspirex® S kateteri ile perkütan revaskülarizasyon,cerrahiye karşı hızlı, güvenilir ve umut verici biralternatif olabilir.

Süperior mezente rarter trombotik tıkanıklığının perkütan rotasyo neltrombe ktomi ile başarılı rekanalizasyonu

Acute mesenteric ischemia is a serious abdominal emergencycharacterized by sudden interruption of intestinal bloodflow that commonly leads to bowel infarction. Promptdiagnosis and treatment of superior mesenteric artery (SMA)embolism before extensive irreversible gangrene developsin intestine is important. A 63-year-old male patient wasadmitted to our hospital s emergency department withcomplaint of a sudden onset and worsening abdominalpain. The patient was promptly performed contrast-enhanced computed tomography, which showed an emboluswithin the SMA. As there was no evidence of intestinalnecrosis, rotational thrombectomy was started immediately.Thrombus aspiration was performed using a 6 French gaugeAspirex® S catheter. Reperfusion of the mesenteric flowwas established within 20 minutes. Nine months after theprocedure, Doppler ultrasound showed that SMA was patent.Percutaneous revascularization with Aspirex® S cathetermay be a rapid, safe and promising alternative to surgery foracute SMA occlusion in selected patients who have no signsof advanced bowel ischemia.

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1. Acosta-Merida MA, Marchena-Gomez J, Hemmersbach- Miller M, Roque-Castellano C, Hernandez-Romero JM. Identification of risk factors for perioperative mortality in acute mesenteric ischemia. World J Surg 2006;30:1579-85.
2. Kozuch PL, Brandt LJ. Review article: diagnosis and management of mesenteric ischaemia with an emphasis on pharmacotherapy. Aliment Pharmacol Ther 2005;21:201-15.
3. Schoots IG, Koffeman GI, Legemate DA, Levi M, van Gulik TM. Systematic review of survival after acute mesenteric ischaemia according to disease aetiology. Br J Surg 2004;91:17-27.
4. Yun WS, Lee KK, Cho J, Kim HK, Huh S. Treatment outcome in patients with acute superior mesenteric artery embolism. Ann Vasc Surg 2013;27:613-20.
5. Jamieson AC, Thomas RJ, Cade JF. Lysis of a superior mesenteric artery embolus following local infusion of streptokinase and heparin. Aust N Z J Surg 1979;49:355-6.
6. Iwakura M, Hattori J, Arita Y, Tokushige M, Katsuki H. Studies on regulatory functions of malic enzymes. VI. Purification and molecular properties of NADP-linked malic enzyme from Escherichia coli W. J Biochem 1979;85:1355-65.
7. Stanley JC. Mesenteric arterial occlusive and aneurysmal disease. Cardiol Clin 200;20:611-22.
8. Arthurs ZM, Titus J, Bannazadeh M, Eagleton MJ, Srivastava S, Sarac TP, et al. A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia. J Vasc Surg 2011;53:698-704.
9. Hawkins BM, Khan Z, Abu-Fadel MS, Exaire JE, Saucedo JF, Hennebry TA. Endovascular treatment of mesenteric ischemia. Catheter Cardiovasc Interv 2011;78:948-52.
10. Ballehaninna UK, Hingorani A, Ascher E, Shiferson A, Marks N, Aboian E, et al. Acute superior mesenteric artery embolism: reperfusion with AngioJet hydrodynamic suction thrombectomy and pharmacologic thrombolysis with the EKOS catheter. Vascular 2012;20:166-9.
11. Miyazawa T, Ueki K, Wakakuwa R. A case of acute superior mesenteric artery occlusion treated by intraarterial infusion of urokinase and prostaglandin E1. J Jpn Surg Assoc 2004;65:3293-6.
12. Acosta S, Sonesson B, Resch T. Endovascular therapeutic approaches for acute superior mesenteric artery occlusion. Cardiovasc Intervent Radiol 2009;32:896-905.
13. McNamara TO, Fischer JR. Thrombolysis of peripheral arterial and graft occlusions: improved results using high- dose urokinase. AJR Am J Roentgenol 1985;144:769-75.
14. Barakate MS, Cappe I, Curtin A, Engel KD, Li-Kim-Moy J, Poon MS, et al. Management of acute superior mesenteric artery occlusion. ANZ J Surg 2002;72:25-9.
15. Yamaguchi T, Saeki M, Iwasaki Y, Ishikawa M, Hayakawa M, Sakuyama K, et al. Local thrombolytic therapy for superior mesenteric artery embolism: complications and long-term clinical follow-up. Radiat Med 1999;17:27-33.
16. Kuoppala M, Åkeson J, Svensson P, Lindblad B, Franzen S, Acosta S. Risk factors for haemorrhage during local intra- arterial thrombolysis for lower limb ischaemia. J Thromb Thrombolysis 2011;31:226-32.