title: Outcome of endovascular revascularisation in patients with acute obstructive mesenteric ischaemia - a single-centre experience.
abstract: BACKGROUND
  Acute embolic or thrombotic mesenteric ischaemia (AMI) is a rare but life-threatening clinical condition. Despite diagnostic and therapeutic advances, the mortality rate remains high, between 60 % and 90 %. Over the last years revascularisation was increasingly performed by endovascular techniques. The aim of this study was to retrospectively analyse the clinical outcome of catheter-directed thrombolysis (CDT) and aspiration thrombectomy (AT) in patients with AMI with regard to technical success, intervention-related complication rate, need for secondary abdominal surgery, clinical course and 30-day mortality rate.
  
  
  METHODS
  Thirteen patients (4 men, 9 women; mean age 74.5 ± 17 years) with 12 embolic and one thrombotic occlusion of the superior mesenteric artery (SMA) underwent emergent endovascular revascularisation of SMA. Clinical data including all imaging reports, laboratory analysis and follow-up data were derived from the electronic patient file and images were reviewed on a Picture Archiving and Communication System.
  
  
  RESULTS
  Eleven patients (n = 11; 84.6 %) underwent CDT and AT, and two patients (n = 2; 15.4 %) had AT alone. Technical success with complete restoration of SMA perfusion was achieved in 38.5 % (n = 5). Adjunctive angioplasty ± stenting was mandatory in 2 patients. Overall, the intervention-related complication rate was 38.5 %. In total, 46.2 % (n = 6) clinically improved following the intervention, while 38.5 % required explorative laparotomy after the intervention, with 2 colectomies and 2 small bowel resections. Overall, the 30-day mortality rate was 30.8 %.
  
  
  CONCLUSIONS
  Endovascular revascularisation with CDT in combination with AT is feasible, with a technical success rate of 38.5 % (n = 5). Endovascular revascularisation was beneficial for 46.2 % (n = 6) of the patients, who clinically improved following the intervention. The need for secondary explorative laparotomy was rather low, with 38.5 % (n = 5) of the patients. The 30-day-mortality remains high with 30.8 %.
authors: 1 Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland.
authors: Gilbert Dominique
authors: GD
authors: Puippe
authors: Julian
authors: J
authors: Suesstrunk
authors: Antonio
authors: A
authors: Nocito
authors: Roger
authors: R
authors: Pfiffner
authors: Michael
authors: M
authors: Glenck
authors: Thomas
authors: T
authors: Pfammatter
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000601:surgery*; D065666:Mesenteric Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008641:Mesenteric Vascular Occlusion / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Endovascular acute mesenteric ischaemia thrombectomy