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A single institutional experience with suction thrombectomy in acute mesenteric ischemia
Allison K Mak1, Elizabeth A Andraska2, Katherine M Reitz2
1University of Pittsburgh School of Medicine, United States.
Abstract:
Acute mesenteric ischemia (AMI) is typically treated by open surgery or hybrid techniques. Catheter-based aspiration thrombectomy represents another minimally invasive alternative with a potential additional safety benefit of minimizing the bleeding risk associated with thrombolytics. In this institutional case series, we present five clinical cases of aspiration thrombectomy for high-risk AMI using the Penumbra aspiration system. All patients underwent technically successful endovascular thrombectomy as demonstrated by intraoperative angiography results. However, bowel necrosis and sepsis adversely affected postoperative outcomes. Lack of intraoperative bowel assessment is a limitation of endovascular methods, highlighting the importance of patient selection.
Insights
Catheter-based aspiration thrombectomy offers a minimally invasive option for acute mesenteric ischemia (AMI), potentially reducing bleeding risks. However, careful patient selection is crucial due to risks of bowel necrosis and sepsis.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Acute mesenteric ischemia (AMI) traditionally requires open surgery or hybrid approaches.
- Minimally invasive catheter-based aspiration thrombectomy is an emerging alternative.
- This technique may reduce bleeding complications associated with thrombolytics.
Purpose of the Study:
- To evaluate the feasibility and outcomes of catheter-based aspiration thrombectomy for high-risk AMI.
- To assess the safety and efficacy of the Penumbra aspiration system in treating AMI.
Main Methods:
- An institutional case series of five patients with high-risk AMI.
- Treatment involved catheter-based aspiration thrombectomy using the Penumbra system.
- Technical success was confirmed by intraoperative angiography.
Main Results:
- All five cases demonstrated technically successful endovascular thrombectomy.
- Postoperative complications included bowel necrosis and sepsis in some patients.
- Intraoperative assessment of bowel viability was not performed.
Conclusions:
- Catheter-based aspiration thrombectomy is technically feasible for high-risk AMI.
- Patient selection is critical to mitigate risks of postoperative bowel necrosis and sepsis.
- The lack of intraoperative bowel assessment is a limitation of current endovascular techniques.
