Aspiration Thrombectomy for Acute SMA Thrombosis: A Minimally Invasive lifesaving procedure

History:

This was a 55 years male patient with mild abdominal pain for 24 hours which became severe and unbearable for about 8-10 hours before presenting to us. CT scan abdomen done in outside hospital revealed Superior Mesenteric Artery(SMA) occlusion with early ischemic changes in the small intestine. Acute mesenteric ischemia was diagnosed and taken up for the emergency endovascular mechanical thrombectomy.

Procedure: Mechanical Thrombectomy for acute SMA thrombosis

Diagnostic abdominal angiogram confirmed complete occlusion of SMA about 2cms after its origin with no forward flow. Using left brachial artery access, large bore soft long sheath was advanced into the SMA and multiple passes of thrombectomy done by engaged the catheter within the clot. Final check angiogram revealed complete recanalization of SMA with few of the small distal branches showing residual fragmented clots, which were left untreated as there was good collateralization after recanalizing the main stem of SMA. Patient gradually improved over next 3 days and discharged home on 4th day without any complaints.

Discussion:

Acute mesenteric ischemia is one of the rarer conditions; however, it carries significantly higher mortality and morbidity if not managed appropriately in time. In the older literature, reported mortality is up to 60 per cent. Now with better understand of the anticoagulants and prompt diagnosis and initiation of anticoagulant therapy, the mortality has reduced to 10 to 15 per cent. The management of such patient include prompt diagnosis and initiation of anticoagulant therapy and further interventions including open surgical or minimally invasive endovascular thrombectomy based on the CT scan findings. Left untreated in time, these patients invariably require long segment small bowel resection with associated high mortality and morbidity. In the index case, we have done successful minimally invasive mechanical thrombectomy with excellent clinical outcome.

Conclusion:

Acute mesenteric ischemia is one of the rare clinical conditions; however, it requires prompt diagnosis and management as it carries very high mortality if not attended in time. Mechanical thrombectomy is a safe minimally invasive procedure highly effective for such patients. Our team with experienced intervention radiologist, vascular surgeon and gastroenterologist is highly efficient in managing such cases.

• SMA Angiogram - Complete occlusion
• Aspirated clot from SMA
• SMA final angiogram - Early
• SMA final angiogram - Delayed