Multi-center Registry For Vacuum-Assisted Thrombectomy of Acute Superior Mesenteric Artery Thrombosis

Abstract

Objectives: The aim of our study was to evaluate safety and efficacy of percutaneous vacuum-assisted thrombectomy (VAT) fortreatment of acute thrombosis or thromboemboli of the superior mesenteric artery (SMA).Methods: This study is a retrospective review of data from a multi-national registry, including consecutive patients with acute thrombosis or thromboemboli of the SMA who underwent VAT at 11 international study centers. Technical success was defined as successful removal of acute thrombus material without the need for alternative thrombectomy devices, systemic thrombolysis, or other revascularization strategies such as vascular surgery. Safety endpoints were in-hospital major adverse events e.g. intestinal gangrene or death. Mean follow-up period was 9.5 (3-16) months.Results: A total of 98 patients (53 females; mean age 73 years; range 55-93 years) were included. Symptom onset defined as initial occurrence of abdominal pain to treatment time ranged from 8 hours to 7 days. Thromboemboli affected a native SMA vessel in all cases. Mean occlusion length was 20 mm (Range 18 to 22 mm). Technical success was achieved in 100% of cases. There was no relevant dissection, vessel rupture or peripheral embolization reported. Provisional stenting was required in 5 cases to treat underlying atherosclerotic stenosis. Mortality in the first 24 hours was 0%. Two deaths on day 27 and 28, following cardiac arrest from other co-morbidities were reported. Bowel resection was performed in 4 cases due to delayed intestinal gangrene.Conclusions: Endovascular management using vacuum-assisted thrombectomy proved to be a safe and effective option for acute thrombotic SMA occlusion