Aspiration therapy for acute embolic occlusion of the superior mesenteric artery

Table 1 Characteristics of the patients

Patient No.	Sex	Age (yr)	Basal disease	Symptoms	Signs (tenderness)	Signs (re-bound tenderness)	WBC count (×103/μL)	Echocardiography (LA τhrombus)
1	M	60	HBP	Abdominal pain, vomiting, dark stool	Present	Present	15.3	Absent
2	M	68	Af, DM	Abdominal pain, diarrhea	Present	Present	17.4	Absent
3	F	71	Af, CAD, HF	Abdominal pain, hematochezia	Present	Present	24.0	Absent
4	M	84	DM	Abdominal pain	Present	Absent	17.8	Absent
5	M	61	Af	Abdominal pain	Present	Absent	15.1	Absent
6	M	66	Af, DM	Abdominal pain, diarrhea	Present	Present	16.9	Absent
7	F	70	HBP	Abdominal pain, dark stool	Present	Present	23.5	Absent
8	M	80	HBP, DM	Abdominal pain, vomiting	Present	Absent	17.1	Absent

Normal range: WBC count = 4.0-10.0 (× 10⁹/L). M: Male; F: Female; WBC: White blood cell; Af: Atrial fibrillation; CAD: Coronary artery disease; HF : Heart failure; HBP: High blood pressure; DM: Diabetes mellitus; LA: Left atrium.

Table 2 Digital subtraction angiography results

Patient No.	CTA	Time from onset totreatment (h)	Occlusion of main SMA trunk	Branch lesion location(s)	Collateral flowto jejunal/ileal branches
1	Filling defect, mild bowel oedema, mild ileus	9	Complete occlusion	None	Good
2	Filling defect, mild bowel oedema, mild ileus	10	Complete occlusion	Jejunal arteries	Slow
3	Filling defect, mild bowel oedema, scanty ascites, mild ileus	30	Complete occlusion	None	Absent
4	Filling defect, mild bowel oedema, mild ileus	7	Complete occlusion; SMA stenosis	None	Good
5	Filling defect, mild bowel oedema, mild ileus	8	Complete occlusion	None	Good
6	Filling defect, mild bowel oedema, mild ileus	11	Complete occlusion	None	Good
7	Filling defect, mild bowel oedema, mild ileus	6	Complete occlusion	None	Good
8	Filling defect, mild bowel oedema, mild ileus	28	Complete occlusion	None	Good

CTA: Computed tomography angiography; SMA: Superior mesenteric artery.

Table 3 Summary of interventions and clinical outcomes

Patient No.	Total procedure time (min)	Trunk lesion	Branch lesion location(s)	Additional treatment	Complications
1	85	Successful	The clot breaking off and ileal arterial embolism, good flow	Thrombolysis with urokinase during the operation	The clot breaking off
2	85	Successful	Multiple residual emboli in jejunal arteries, slow flow	Intra-artery transcatheter thrombolytic therapy with urokinase successful	-
3	50	Partial rec-analization	-	thrombolysis was initially performed before aspiration embolectomy	-
4	75	Successful (PTA)	The clot breaking off and ileocolic artery emboli.	primary thrombolysis with urokinase during the operation	The clot breaking off
5	79	Successful	-	-	-
6	80	Successful	-	-	-
7	53	Successful	-	-	-
8	69	Partial recanalization	-	-	-

PTA: Percutaneous transluminal angioplasty.

Table 4 Postoperative situations

Patient No.	The time of feed (d)	Hospital stay (d)	In-hospital mortality	Symptoms	Signs (tenderness)	Signs (rebound tenderness)
1	2	9	None	Abdominal symptom resolved in 1 d	Present	Present
2	6	12	None	Diarrhoea developed after aspiration but subsided spontaneously; Abdominal symptom resolved in 1 d	Present	Present
3	6	12	None	Haematochezia developed after aspiration but subsided spontaneously; Abdominal symptom resolved in 1 d	Present	Present
4	17	17	None	Abdominal symptom resolved in 1 d	Present	Absent
5	5	8	None	Abdominal symptom resolved in 1 d	Present	Absent
6	16	11	None	Diarrhoea lasted 2 d	Present	Present
7	7	13	None	Abdominal symptom resolved in 2 d; Dark stool lasted 3 d	Present	Present
8	3	16	None	Abdominal symptom resolved in 2 d	Present	Absent