Clinical Effectiveness of Percutaneous Angioplasty for Acute and Chronic Mesenteric Ischemia: A Six Case Series

Yu Min Jung; Yunju Jo; Sang Bong Ahn; Byoung Kwan Son; Seong Hwan Kim; Young Sook Park; June Ho Bae; Young Kwon Cho

doi:10.4166/kjg.2011.57.4.243

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

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

Case Report

Korean J Gastroenterol 2011;57(4):243-248.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.57.4.243

Clinical Effectiveness of Percutaneous Angioplasty for Acute and Chronic Mesenteric Ischemia: A Six Case Series

Yu Min Jung, Yunju Jo, Sang Bong Ahn, Byoung Kwan Son, Seong Hwan Kim, Young Sook Park, June Ho Bae, Young Kwon Cho¹

Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea

¹Department of Radiology, Eulji University School of Medicine, Seoul, Korea

Correspondence to: Yunju Jo, Division of Gastroenterology, Department of Internal Medicine, Eulji University School of Medicine, Eulji General Hospital, 280-1, Hagye-dong, Nowon-gu, Seoul 139-711, Korea. Tel: +82-2-970-8209, Fax: +82-2-970-8621, E-mail: jyj1138@eulji.ac.kr

Received 6 August 2010 Revised 14 October 2010 Accepted 18 October 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Ischemia, Mesenteric arteries, Mesenteric vascular occlusion, Thrombolytic therapy, Angioplasty

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.

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.

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.

Fig. 4.

Percutaneous angiographic finding. Total occlusion of SMA due to thromboembolism (arrow) is shown in the mesenteric angiography in case 6.

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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