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Surgical therapy for acute superior mesenteric artery embolism
Hakan Bingol1, Nazif Zeybek, Faruk Cingöz
1Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Etlik 06018 Ankara, Turkey. hbingol@gata.edu.tr
American Journal of Surgery
|June 29, 2004
Summary
Early intervention with tissue-type plasminogen activator (t-PA) during superior mesenteric artery embolectomy improves outcomes. Prompt treatment in acute mesenteric artery embolism cases is crucial for reducing intestinal resection and mortality.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Acute mesenteric artery embolism presents significant morbidity and mortality risks.
- Timely diagnosis and treatment are paramount for improving patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of low-dose tissue-type plasminogen activator (t-PA) as an adjunct to superior mesenteric artery embolectomy.
- To assess the impact of treatment timing on the need for intestinal resection and patient survival.
Main Methods:
- A retrospective analysis of 24 patients undergoing superior mesenteric artery embolectomy between 1997 and 2002.
- Patients were stratified into three groups based on symptom onset to operation time (0-6 hours, 6-12 hours, >12 hours).
- All patients received low-dose (5-10 mg) local t-PA administration directly into the superior mesenteric artery concurrently with embolectomy.
Main Results:
- Normal macroscopic intestinal appearance was observed in 15 patients (62.5%) within 30 minutes post-tPA administration, primarily in the early treatment group (Group I).
- Intestinal resection was required in 4 patients (16.7%) in Group II and 5 patients (20.8%) in Groups II and III.
- Mortality occurred in all patients requiring extended resection (Groups II and III).
Conclusions:
- Early surgical intervention within 6 hours of symptom onset, combined with t-PA, is associated with better intestinal viability.
- Low-dose t-PA administration can reduce the extent of necessary intestinal resection in acute mesenteric artery embolism.
- Exploratory laparotomy is recommended for patients presenting with specific symptoms suggestive of mesenteric ischemia, especially those with cardiac risk factors.