Management of acute superior mesenteric artery occlusion.
BACKGROUND
This review examines the surgical management of acute superior mesenteric artery (SMA) occlusion and the impact of interventional radiology techniques.


METHODS
Eight consecutive patients with SMA occlusion were treated at the Lismore Base Hospital, Lismore, NSW, Australia, from 1996 through to 2001 and of these, one patient was managed successfully with catheter-directed lytic therapy. The study group included five male and three female patients with a mean age of 71.3 (range 57-88) years. The records of these patients were reviewed to determine demographic characteristics, clinical features, predisposing factors and the duration of symptoms before intervention, management details and final outcome.


RESULTS
Embolic phenomena due to atrial fibrillation were the most frequently identifiable cause of acute SMA occlusion, present in six of eight patients. Seven patients were managed with open surgery in the first instance and of these, four died. Three patients remain alive and well at a mean 2.8 years follow-up. Patient number eight developed acute SMA occlusion from embolism secondary to atrial fibrillation and was managed initially with SMA urokinase thrombolysis. This patient's pain was relieved 1 h after initiation of the procedure. Delayed films after 18 h from initiation of thrombolysis demonstrated re-opening of all the ileo-colic branches and at 6 weeks' follow-up the patient remains well with normal bowel function.


CONCLUSIONS
There is a role for selective SMA cannulation and urokinase thrombolysis in the management of patients with acute SMA thrombosis.
Barakate
Michael S
MS
University of Sydney, Departments of Surgery and Interventional Radiology, University of Sydney, Lismore Base Hospital, Lismore, New South Wales, Australia. msbarakate@hotmail.com
Cappe
Ian
I
Curtin
Austin
A
Engel
Karen D
KD
Li-Kim-Moy
Jean
J
Poon
Michael S F
MS
Sandeman
Matthew D
MD
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior; D008875:Middle Aged; D013923:Thromboembolism / Q000601:surgery*