Abstract：
BACKGROUND: This study was performed to summarize our experience in treating acute superior mesenteric artery embolism (SMAE) by percutaneous mechanical thrombectomy (PMT).
METHODS: Between January 2023 and October 2023, 18 patients presenting with acute mesenteric ischemia were admitted to our center, including 11 cases of SMAE, 3 cases of superior mesenteric artery thrombosis, and 4 cases of superior mesenteric vein thrombosis. We retrospectively reviewed 8 patients (4 males and 4 females; range, 51-79 years; mean, 62.50 ± 9.67 years) who underwent treatment of acute SMAE using the AcoStream system. The patients had no obvious evidence of intestinal necrosis as shown by peritoneal puncture or computed tomography. Thrombectomy was performed on the superior mesenteric artery (SMA) using an 8F AcoStream thrombus aspiration system (Acotec, China). The demographics, risk factors, therapeutic effect, complications, mortality, and follow-up of the study population were assessed.
RESULTS: The technical success rate was 100%. After 1-3 passes (2.38 ± 0.92) and aspiration thrombectomy, complete thrombus removal was achieved in 7 (87.50%) patients. One patient received an adjunctive catheter-directed thrombolysis due to partial thrombus removal. Thrombolysis was conducted for 2 days, resulting in complete resolution of the thrombus. The other 7 patients did not receive adjunctive endovascular intervention due to complete thrombus removal and no residual stenosis. No distal embolization or device-related complications were noted during the procedure. After the procedure, sufficient clinical improvement was seen in 6 patients within 1-2 days. Two patients showed no significant improvement of their symptoms. Laparotomy was performed on day 1 and day 2 after thrombectomy in patients 3 and 7, respectively. Intestinal necrosis was diagnosed operatively and intestinal resection was performed. All patients were discharged 6-15 days (9.50 ± 3.07) after admission without perioperative complication or death. The mean follow-up period was 5.00 ± 3.30 months (range, 1-10 months), and the follow-up rate was 100%. During the follow-up, all patients remained symptom-free. Computed tomography angiography images showed good flow in the trunk and branches of the SMA in all patients.
CONCLUSIONS: PMT using the AcoStream system is a minimally invasive, safe, and effective technique for acute SMAE. Early application of PMT can achieve immediate revascularization of the SMA and have the potential advantage of avoiding laparotomy or reducing the extension of enterectomy, as it could theoretically restore intestinal perfusion in less time than open revascularization. If the symptoms do not improve after PMT, exploratory laparotomy should be scheduled as soon as possible. Further studies are necessary on this field to confirm these findings.
METHODS: Between January 2023 and October 2023, 18 patients presenting with acute mesenteric ischemia were admitted to our center, including 11 cases of SMAE, 3 cases of superior mesenteric artery thrombosis, and 4 cases of superior mesenteric vein thrombosis. We retrospectively reviewed 8 patients (4 males and 4 females; range, 51-79 years; mean, 62.50 ± 9.67 years) who underwent treatment of acute SMAE using the AcoStream system. The patients had no obvious evidence of intestinal necrosis as shown by peritoneal puncture or computed tomography. Thrombectomy was performed on the superior mesenteric artery (SMA) using an 8F AcoStream thrombus aspiration system (Acotec, China). The demographics, risk factors, therapeutic effect, complications, mortality, and follow-up of the study population were assessed.
RESULTS: The technical success rate was 100%. After 1-3 passes (2.38 ± 0.92) and aspiration thrombectomy, complete thrombus removal was achieved in 7 (87.50%) patients. One patient received an adjunctive catheter-directed thrombolysis due to partial thrombus removal. Thrombolysis was conducted for 2 days, resulting in complete resolution of the thrombus. The other 7 patients did not receive adjunctive endovascular intervention due to complete thrombus removal and no residual stenosis. No distal embolization or device-related complications were noted during the procedure. After the procedure, sufficient clinical improvement was seen in 6 patients within 1-2 days. Two patients showed no significant improvement of their symptoms. Laparotomy was performed on day 1 and day 2 after thrombectomy in patients 3 and 7, respectively. Intestinal necrosis was diagnosed operatively and intestinal resection was performed. All patients were discharged 6-15 days (9.50 ± 3.07) after admission without perioperative complication or death. The mean follow-up period was 5.00 ± 3.30 months (range, 1-10 months), and the follow-up rate was 100%. During the follow-up, all patients remained symptom-free. Computed tomography angiography images showed good flow in the trunk and branches of the SMA in all patients.
CONCLUSIONS: PMT using the AcoStream system is a minimally invasive, safe, and effective technique for acute SMAE. Early application of PMT can achieve immediate revascularization of the SMA and have the potential advantage of avoiding laparotomy or reducing the extension of enterectomy, as it could theoretically restore intestinal perfusion in less time than open revascularization. If the symptoms do not improve after PMT, exploratory laparotomy should be scheduled as soon as possible. Further studies are necessary on this field to confirm these findings.
摘要：
背景：本研究旨在总结我们通过经皮机械血栓切除术（PMT）治疗急性肠系膜上动脉栓塞（SMAE）的经验。
方法：在2023年1月至2023年10月之间，我们中心收治了18例急性肠系膜缺血（AMI）患者，肠系膜上动脉栓塞(SAME)11例,肠系膜上动脉血栓形成(SMAT)3例,肠系膜上静脉血栓形成(SMVT)4例。我们回顾性分析了8例患者（4例男性和4例女性；范围，51-79岁；意思是，62.50±9.67岁）使用AcoStream系统接受急性SMAE治疗的患者。如腹膜穿刺或计算机断层扫描（CT）所示，患者没有明显的肠坏死证据。使用8FAcoStream血栓抽吸系统（Acotec，中国）。人口统计，危险因素，治疗效果,并发症,死亡率,并对研究人群的随访情况进行了评估。
结果：技术成功率为100％。经过1-3次（2.38±0.92）和抽吸血栓切除术后，7例(87.50%)患者实现了血栓完全清除.1例患者由于部分血栓清除而接受了辅助导管溶栓（CDT）。溶栓2天,导致血栓完全消退。其他7例患者由于完全清除血栓且无残余狭窄而未接受辅助血管内介入治疗。术中没有发现远端栓塞或装置相关并发症。手术后,6例患者在1-2天内有足够的临床改善.2例患者症状无显著改善。分别在患者3和7的血栓切除术后第1天和第2天进行剖腹手术。手术诊断为肠坏死，并进行肠切除术。所有患者均于入院后6～15天(9.50±3.07)出院,无围手术期并发症或死亡。平均随访时间为5.00±3.30个月(范围，1-10个月),随访率为100%。在后续行动中,所有患者均保持无症状.CTA图像显示所有患者的SMA主干和分支中的良好流量。
结论：使用AcoStream系统的PMT是一种微创，安全,和急性SMAE的有效技术。早期应用PMT可以实现SMA的立即血运重建，并具有避免剖腹手术或减少扩张的潜在优势。因为它理论上可以在比开放血运重建更短的时间内恢复肠道灌注。如果PMT后症状没有改善，应尽快安排剖腹探查术。在这一领域需要进一步的研究来证实这些发现。
方法：在2023年1月至2023年10月之间，我们中心收治了18例急性肠系膜缺血（AMI）患者，肠系膜上动脉栓塞(SAME)11例,肠系膜上动脉血栓形成(SMAT)3例,肠系膜上静脉血栓形成(SMVT)4例。我们回顾性分析了8例患者（4例男性和4例女性；范围，51-79岁；意思是，62.50±9.67岁）使用AcoStream系统接受急性SMAE治疗的患者。如腹膜穿刺或计算机断层扫描（CT）所示，患者没有明显的肠坏死证据。使用8FAcoStream血栓抽吸系统（Acotec，中国）。人口统计，危险因素，治疗效果,并发症,死亡率,并对研究人群的随访情况进行了评估。
结果：技术成功率为100％。经过1-3次（2.38±0.92）和抽吸血栓切除术后，7例(87.50%)患者实现了血栓完全清除.1例患者由于部分血栓清除而接受了辅助导管溶栓（CDT）。溶栓2天,导致血栓完全消退。其他7例患者由于完全清除血栓且无残余狭窄而未接受辅助血管内介入治疗。术中没有发现远端栓塞或装置相关并发症。手术后,6例患者在1-2天内有足够的临床改善.2例患者症状无显著改善。分别在患者3和7的血栓切除术后第1天和第2天进行剖腹手术。手术诊断为肠坏死，并进行肠切除术。所有患者均于入院后6～15天(9.50±3.07)出院,无围手术期并发症或死亡。平均随访时间为5.00±3.30个月(范围，1-10个月),随访率为100%。在后续行动中,所有患者均保持无症状.CTA图像显示所有患者的SMA主干和分支中的良好流量。
结论：使用AcoStream系统的PMT是一种微创，安全,和急性SMAE的有效技术。早期应用PMT可以实现SMA的立即血运重建，并具有避免剖腹手术或减少扩张的潜在优势。因为它理论上可以在比开放血运重建更短的时间内恢复肠道灌注。如果PMT后症状没有改善，应尽快安排剖腹探查术。在这一领域需要进一步的研究来证实这些发现。
