PERCUTANEOUS MECHANICAL THROMBECTOMY: A NEW TOOL IN THE TREATMENT OF ACUTE MESENTERIC ISCHEMIA.

Abstract

Introduction: The diagnosis of acute mesenteric ischemia (AMI) remains challenging due to nonspecific symptoms and signs that lead to a high mortality rate. Common causes include cardiac emboli and thrombosis of a mesenteric plaque.

Objective: To present a clinical case of acute mesenteric ischemia that underwent successful endovascular revascularization.

Case report: 82-year-old female patient with a history of atrioventricular block, hypertension, and dementia. She was admitted to the emergency department for acute abdominal pain with onset 3 days before. Diagnosis of ischemic colitis secondary to acute superior mesenteric artery occlusion was confirmed by angioCT scan. Endovascular treatment was performed: percutaneous mechanical thrombectomy through left brachial access using the Rotarex® system (Straub Medical). She improved from her previous symptoms and was discharged at day 6, with no need of exploratory laparotomy.

Discussion/conclusion: AMI is a vascular emergency that requires rapid identification and treatment. There are two courses of action for mesenteric revascularization: open or endovascular. Some authors have demonstrated an advantage in the endovascular approach, with reduced morbidity and mortality, especially in an often aging and frail group of patients. The Rotarex® (Straub Medical) system fragments the thrombus and aspirates it at the same time, thus avoiding embolic phenomena at distance. Despite being a new technology, it has shown to be a very promising tool for AMI treatment due to its fast restoration of blood flow with minimal invasiveness.