Acute superior mesenteric artery embolism: rapid reperfusion with hydrodynamic thrombectomy and pharmacological thrombolysis.
OBJECTIVE
To report a case of acute superior mesenteric artery (SMA) embolism successfully treated with hydrodynamic thrombectomy and pharmacological thrombolysis.


METHODS
A 67-year-old man was admitted to the hospital with acute severe abdominal pain. Selective angiography via a femoral puncture revealed a complete embolic occlusion distal to the first jejunal branch of the SMA. Hydrodynamic thrombectomy resolved the severe abdominal pain of the patient in approximately 10 minutes after the start of thrombectomy. Local continuous thrombolysis with urokinase resulted in near complete restoration of the mesenteric flow after 24 hours. The patient made an uneventful recovery and continues to do well on warfarin therapy 8 months after treatment; he has shown no evidence of malabsorption.


CONCLUSIONS
Although insertion of the device into the SMA via a femoral puncture is a difficult approach, we propose that hydrodynamic thrombectomy followed by local thrombolysis is a useful treatment for acute superior mesenteric artery embolism.
Tsuda
Masashi
M
Department of Radiology, Sendai National Hospital, Sendai, Japan. mtsuda@rad.med.tohoku.ac.jp
Nakamura
Mamoru
M
Yamada
Yasuo
Y
Saito
Haruo
H
Ishibashi
Tadashi
T
Takahashi
Shoki
S
D000208:Acute Disease; D000368:Aged; D003131:Combined Modality Therapy; D004617:Embolism / Q000628:therapy*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior; D008641:Mesenteric Vascular Occlusion / Q000628:therapy*; D015424:Reperfusion; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy; D013997:Time Factors; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator