Local thrombolytic therapy for superior mesenteric artery embolism: complications and long-term clinical follow-up

To evaluate the effectiveness and complications of local intraarterial fibrinolysis in selected patients with superior mesenteric artery (SMA) embolism.

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.

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.

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.