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[Intra-arterial fibrinolytic therapy for acute mesenteric ischemia]
1Service de Radiologie Cardio-Vasculaire, Centre Médico-Chirurgical de l'Europe, 9 bis, rue de Saint Germain, 78560 Le Port Marly.
Abstract:
We report a case of mesenteric ischemia secondary to embolic occlusion treated by percutaneous intra-arterial thrombolysis. Early initial radiographic evaluation included abdominal plain film, ultrasonography, abdominal CT, and arteriography. Only selective superior mesenteric artery angiography provided definite diagnosis. The duration of ischemic symptoms before thrombolysis was 6 hours. Post procedure angiogram at 12 hours showed complete resolution of the mesenteric arterial thrombus with clinical improvement. The most important criteria for patient survival is early diagnosis and immediate treatment. Direct infusion of urokinase into the superior mesentric artery may be an alternative to surgery in selected patients and particularly in patients without evidence of frank bowel necrosis.
Insights
Percutaneous intra-arterial thrombolysis effectively treated mesenteric ischemia caused by embolic occlusion. This minimally invasive approach offers a viable alternative to surgery for selected patients, improving outcomes with prompt intervention.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Mesenteric ischemia, often caused by embolic occlusion, is a critical condition requiring timely diagnosis and intervention.
- Traditional management may involve surgical exploration, carrying significant risks.
- Minimally invasive techniques are increasingly explored for complex vascular conditions.
Observation:
- A patient presented with acute mesenteric ischemia due to embolic occlusion.
- Initial diagnostic imaging included plain film, ultrasound, CT, and arteriography.
- Selective superior mesenteric artery angiography confirmed the diagnosis.
Findings:
- Percutaneous intra-arterial thrombolysis was performed within 6 hours of symptom onset.
- Post-procedure angiography at 12 hours demonstrated complete resolution of the arterial thrombus.
- The patient showed significant clinical improvement following the procedure.
Implications:
- Early diagnosis and immediate treatment are crucial for patient survival in mesenteric ischemia.
- Intra-arterial thrombolysis with agents like urokinase can be a safe and effective alternative to surgery.
- This approach is particularly beneficial for patients without signs of bowel necrosis, offering a less invasive treatment option.