Journal List > Korean J Gastroenterol > v.57(4) > 1006797

Jung, Jo, Ahn, Son, Kim, Park, Bae, and Cho: Clinical Effectiveness of Percutaneous Angioplasty for Acute and Chronic Mesenteric Ischemia: A Six Case Series

Abstract

Intestinal ischemia is divided into three categories, namely, acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI), and colonic ischemia. AMI can result from arterial or venous thrombi, emboli, and vasoconstriction secondary to low-flow states. It is an urgent condition which can result in high mortality rate. The predominant causative factor of CMI is stenosis or occlusion of the mesenteric arterial circulation, and it is characterized by postprandial abdominal pain and weight loss. Surgery is the treatment of choice for intestinal ischemia. However, it has been recently reported that percutaneous transluminal angioplasty with stent placement and/or thrombolysis is an effective therapy in various types of mesenteric ischemia. We report six cases of mesenteric ischemia which were successfully treated by percutaneous angioplasty, and review the literature from South Korea.

References

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Fig. 1.
Abdominal CT and percutaneous angiography in case 2. (A) A filling defect was revealed in the ostium of the SMA and proximal portion in the abdominal computed tomography. Arrow indicates a thrombotic stenosis. (B) Severe stenosis (arrow) is shown in the proximal portion of the SMA in the percutaneous angiography. CT, computed tomography; SMA, superior mesenteric artery.
kjg-57-243f1.tif
Fig. 2.
Percutaneous angiographic findings in case 2. A stent was placed in the stenotic portion of the SMA. The balloon expanded fully (arrow) in the most stenotic lesion. SMA, superior mesenteric artery.
kjg-57-243f2.tif
Fig. 3.
Percutaneous angioplasty for the reoccluded lesion with previously implanted stent in case 3. (A) Severe stenosis (arrow) is visible in the distal portion of the stent placed in the celiac artery. (B) A new stent was inserted (arrow) in the restenotic lesion.
kjg-57-243f3.tif
Fig. 4.
Percutaneous angiographic finding. Total occlusion of SMA due to thromboembolism (arrow) is shown in the mesenteric angiography in case 6.
kjg-57-243f4.tif
Table 1.
Clinical Characteristics of Cases with Mesenteric Ischemia
Case Sex/ Age (yr) Symptoms Duration of symptom Past history Involved vessels Stenosis (%) Urokinase Procedure Follow up (months) Recurrence Improvement of abdomianl pain (visual scale score)
1 F/84 Epigastric pain 7 months DM CA 75 No Stent 12 No 60–80%
    Anorexia   HTN SMA            
    Weight loss   DM              
2 F/59 Epigastric pain 6 months HTN SMA 90 No Stent 24 No 70–80%
        AF              
        ESRD              
        CVA              
3 M/78 Epigastric pain 12 months   CA 95 No Stent 13 8 months 70–80%
    Constipation                  
    Weight loss                  
4 M/49 Periumbilical pain 24 months DM SMA 75 No Balloon 10 No 90%
    Weight loss   HTN       dilatation      
        ESRD              
5 M/72 Abdominal pain 1 day HTN SMA 100 Yes Stent 17 No 100%
        Myocardial              
        infarction              
6 M/67 Abdominal pain 1 day DM SMA 100 Yes Stent 9 No 100%
        HTN              
        AF              
7 M/46 Abdominal pain NA NA CA 80 Yes Stent 23 8 months NA
          SMA 90          
8 M/58 Hematochezia NA NA CA 90 Yes Stent 25 No NA
          SMA 90          
9 M/57 Abdominal pain NA NA SMA 90 No Stent 17 No NA
10 F/43 Abdominal pain NA NA SMA 100 No Stent 5 No NA
11 M/48 Abdominal pain NA NA CA 100 Yes Stent 6 6 months NA
          SMA 80          
12 M/66 Abdominal pain NA NA SMA 70 No Stent 8 No NA
13 F/65 Abdominal pain NA NA SMA 80 No Stent 1 No NA
14 M/63 Epigastric pain 2 months RA SMA 80 No Stent NA No NA
    Weight loss                  
15 M/69 Abdominal pain 12 months HTN SMA 80 No Stent NA No NA
    Chronic diarrhea   AMI              
16 M/46 Chronic diarrhea Epigastric pain 1 month AMI HTN CA 80 Yes Stent NA No NA
          SMA 100          
17 F/60 Dyspnea NA ESRD CA 80 No Stent 18 No NA
    Abdominal pain   MI SMA 100          
18 M/78 Abdominal pain 3 days HTN IMA 90 No Stent 5 No NA
    Bloody stool                  

M, male; F, female; NA, not available; CA, celiac artery; SMA, superior mesenteric artery; IMA, inferior mesenteric artery; DM, diabetes mellitus; AMI, acute mesenteric ischemia; HTN, hypertension; ESRD, end stage renal disease; AF, atrial fibrillation; CVA, cerebrovascular accident; RA, rheumatoid arthritis.

Case 1–6 from our cases; Cases 7–13 from reference8; Case 14 from reference9; Case 15 from reference10; Case 16 from reference11

Case 17 from reference12; Case 18 from reference13.

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