Endovascular surgery in treatment of patients with acute impairment of mesenteric circulation in the stage of intestinal ischaemia

Chernookov A.I.¹, Kuznetsov M.R.^2,3, Atayan A.A.^1,2, Yarkov S.A.⁴, Ivanova M.I.², Khachatryan E.O.⁴

1) First Moscow State Medical University named after I.M. Sechenov under the RF Ministry of Public Health (Sechenov University),
2) Municipal Clinical Hospital №29 named after N.E. Bauman,
3) Pirogov Russian National Research Medical University (RNRMU),
4) Municipal Clinical Hospital named after S.S. Yudin, Moscow, Russia

Analysed herein are the results of endovascular revascularization of the superior mesenteric artery (SMA). The study included a total of 18 patients with acute impairment of mesenteric circulation in the stage of intestinal ischaemia. The patients underwent multispiral computed tomography (MSCT) and once impairments of blood flow in the SMA were revealed, we performed endovascular revascularization of the artery. Patency of the SMA was assessed by repeat contrast-enhanced MSCT.

Thirteen (72.2%) patients were found to have occlusion in the system of the SMA and five (27.8%) were diagnosed as having significant stenoses of the SMA. All 13 patients with occlusion of the SMA underwent vacuum thrombextraction followed by transluminal balloon angioplasty (TBA). Of these, thrombotic masses were obtained in 11 (84.6%) patients. Stents were implanted in 3 cases wherein TBA turned out inefficient.

The patients with haemodynamically significant stenoses of the SMA were subjected to TBA followed by stent implantation. Good roentgenoendovascular results of restoration of blood flow through the SMA and its branches were obtained in 83.4% of cases.

Assessing blood parameters and patients’ condition severity revealed positive dynamics or a tendency towards improvement. The mortality rate amounted to 16.6%.

A conclusion drawn is that this technique is efficient and appropriate for SMA lesions of any localization.

KEY WORDS: mesenteric thrombosis, acute impairment of mesenteric circulation, superior mesenteric artery, computed tomography, mesentericography, endovascular intervention.

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