Local thrombolytic therapy for superior mesenteric artery embolism: complications and long-term clinical follow-up.
OBJECTIVE
To evaluate the effectiveness and complications of local intraarterial fibrinolysis in selected patients with superior mesenteric artery (SMA) embolism.


METHODS
Intraarterial thrombolytic therapy was performed for acute SMA embolism in eight patients. Patients were selected for thrombolytic therapy on the basis of absence of peritoneal signs of intestinal necrosis at physical examination and absent findings of bowel infarction by CT.


RESULTS
Clinical success was achieved in five patients and technical success in six. Complications included death due to massive shower emboli from the left ventricle in one patient and extravasation in one patient, who required surgery on the following day. Within one month after thrombolytic therapy, one patient each died of myocardial infarction and cerebral infarction due to emboli, and one patient underwent aorto-SMA bypass surgery due to residual stenosis. In the long-term follow-up period (2-7 years), four patients were still alive, with another embolic episode of a lower limb in one patient. One patient died of an unrelated cause without experiencing another embolic episode.


CONCLUSIONS
Intraarterial fibrinolysis may be a therapeutic alternative in the management of SMA embolism in selected patients in whom an early diagnosis can be made. The long-term results depend on the occurrence of another embolic event.
Yamaguchi
T
T
Department of Radiology, St. Marianna University Yokohama Seibu Hospital, Japan.
Saeki
M
M
Iwasaki
Y
Y
Ishikawa
M
M
Hayakawa
M
M
Sakuyama
K
K
Ishikawa
T
T
Ashida
H
H
D004617:Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D017538:Mesenteric Artery, Superior; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology; D008875:Middle Aged; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use*; D011859:Radiography; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator