Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2019; 25(7): 848-858
Published online Feb 21, 2019. doi: 10.3748/wjg.v25.i7.848
Aspiration therapy for acute embolic occlusion of the superior mesenteric artery
Yi-Ren Liu, Zhu Tong, Cheng-Bei Hou, Shi-Jun Cui, Lian-Rui Guo, Yi-Xia Qi, Li-Xing Qi, Jian-Ming Guo, Yong-Quan Gu
Yi-Ren Liu, Zhu Tong, Shi-Jun Cui, Lian-Rui Guo, Yi-Xia Qi, Li-Xing Qi, Jian-Ming Guo, Yong-Quan Gu, Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Cheng-Bei Hou, Center of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Author contributions: Gu YQ designed the research and wrote the paper; Liu YR performed the research and wrote the paper; Hou CB contributed to analytic tools and analyzed the data; Tong Z and Cui SJ edited the manuscript; Guo LR, Qi LX, Qi YX, and Guo JM collected the human samples.
Supported by the National Key Research and Development Program of China, No. 2017YFC1104100; the Capital Health Research and Development of Special, No. 2016-1-2012; Beijing Hospital Authority Clinical Technological Innovation Project, No. XMLX201610; and Beijing Hospital Authority "Climb Peak" Talent Training Scheme, No. DFL20150801.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Xuanwu Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yong-Quan Gu, MD, Chief Doctor, Professor, Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100053, China. 15901598209@163.com
Telephone: +86-15901598209 Fax: +86-10-83125113
Received: December 2, 2018
Peer-review started: December 3, 2018
First decision: January 11, 2019
Revised: January 20, 2019
Accepted: January 26, 2019
Article in press: January 26, 2019
Published online: February 21, 2019
ARTICLE HIGHLIGHTS
Research background

Embolic superior mesenteric artery (SMA) occlusion is associated with high mortality rates. Delayed treatment often leads to serious consequences, including intestinal necrosis, resection, and even patient death. Endovascular repair is being introduced, which can improve clinical symptoms and prognosis and decrease the incidence of exploratory laparotomy. Many reports have described successful endovascular revascularization of embolic SMA occlusion. However, most of those reports are case reports, and there are few reports on Chinese patients. In this paper, we describe the technical and clinical outcomes of aspiration therapy using a guiding catheter and long sheath technique which facilitates the endovascular repair procedure.

Research motivation

To evaluate the complications, feasibility, effectiveness, and safety of endovascular treatment using a guiding catheter for the acute embolic occlusion of the SMA.

Research objectives

Many reports have described successful endovascular revascularization of embolic SMA occlusion by several endovascular techniques. However, most of those reports are case reports. There are few reports on Chinese patients. In this paper, we describe the technical and clinical outcomes of aspiration therapy using a guiding catheter and long sheath technique which facilitates the endovascular repair procedure.

Research methods

This retrospective study reviewed patients with acute embolic occlusion of the SMA. All patients were treated by aspiration therapy with a guiding catheter. The complications, feasibility, effectiveness, safety, and mortality were assessed.

Research results

All patients had successfully undertaken percutaneous aspiration using a guiding catheter. No death occurred among the patients. Most of the clots were removed and patency of the suffering artery trunk was achieved. Although the complication of the clot breaking off was detected in partial patients, blood perfusion was not affected.

We need a large number of enrolled patients and conduct a comparative study between open surgery treatment and endovascular treatment. Furthermore, thrombolysis can deal with fresh blood clots. However, with regard to old thrombi, which cannot be cleared by aspiration, further studies are needed.

Research conclusions

Aspiration therapy is feasible, safe, and beneficial for acute embolic SMA occlusion. Aspiration therapy using a guiding catheter and long sheath technique facilitates the endovascular repair procedure. Aspiration therapy has many benefits for reducing patients’ death, resolving thrombi, and improving symptoms.

Research perspectives

Aspiration therapy using a guiding catheter and long sheath technique is feasible, safe and beneficial for acute SMA embolic occlusion, which should be applied and popularized. Especially, auxiliary applications of a long sheath technique facilitate operation procedure. Tender operation is needed to avoid the clot breaking off. However, with regard to old thrombi, which cannot be cleared by aspiration, further studies are needed. A randomized controlled trial comparing open surgery treatment and endovascular treatment is needed to be conducted in the future.