Results ASA score: Epidemiological data: 8 patients: 7 men and 1 woman

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Presentation transcript:

Results ASA score: Epidemiological data: 8 patients: 7 men and 1 woman Mean age: 62 years (50 - 75) Cardiovascular risk factors: Hypertension: 75% (6), Smoking 62.5% (5), Diabetes: 37.5% (3) Dyslipidemia: 37.5% (3), Obesity: 25% (2) History of chronic mesenteric ischemia: 50% (4) Associated atheromatous disease: Lower Limb arteritis: 62.5% (5), Coronary: 25% (2) ASA score: Score 4: 25% (2), Score 3: 62.5% (5) Score 2: 12.5% (1)

Results Clinical data: Biological Data: Abdominal pain: 100% (8) Defense: 75% (6) Circulatory collapse: 12.5% (1) Biological Data: Leukocytosis: 100% (8) Inflammatory syndrome: 100% (8) The venous lactate was assessed in only one patient (increased).

Results Abdominal AngioCT data: Pneumatosis intestinalis: 25% (2) Portal venous gas: 12.5% (1) Arterial occlusion SMA occlusion alone: 87.5% (7) Occlusion SMA and IMA: 12.5% (1)

Results Endovascular treatment: Technical success: 100% Balloon angioplasty + stenting: 75% (6), including 1 patient with SMA and IMA stenting Balloon angioplasty SMA: 12.5% (1) Balloon angioplasty + stenting + Fibrinolysis in situ: 12.5% (1) Heparin in situ : 100% (3000 IU) Technical success: 100% Endovascular procedure-related complication: 0%

Male, 62 years old, occlusive syndrome Department of Radiology, CHU Gabriel Montpied, Clermont-Ferrand 2010 Bowel distension, arcuate ligament, proximal occlusion of the SMA

Angioplasty and Stenting SMA Department of Radiology, CHU Gabriel Montpied, Clermont-Ferrand 2010 SMA Oclusion CT arcuate ligament Final control after stenting SMA Catheterization

Results Secondary surgery: 37.5% (3) 66.7% (2 / 3) for initial adbominal guarding, severe sepsis and severe CT findings (pneumatosis intestinalis) In 2 patients: extensive resection of the small bowel Third patient: ileo-caecal resection with colostomy at D0 for bowel necrosis depicted on second look laparoscopy Additional medical treatment recommended: Heparin for 72 hours Antiplatelet agent for 6 months Death: 25% (2) These were the same 2 patients with pneumatosis intestinalis on CT scan Day 4 and Day 26 By multiorgan failure

Results Delay onset of pain/revascularisation procedure: 14 hours (4-48) Delay CT scan / revascularization: 2 hours (2-12) The 2 patients with pneumatosis intestinalis on CT severity died and had a revascularization delay superior to 24 hours Hospital stay: Patients treated with angioplasty alone, 8 days Angioplasty + surgery : 26 days Complication: 1 ileocecal stenosis with occlusive syndrome, treated medically, 60 days after percutaneous revascularization without surgery

Results Follow-up CT D30: 100% (6) Splanchnic arterial permeability : 100% No reccurrence until August 2009 (end of study) Mean follow up of 6 patients: 24.5 months (12-68 months)

50 years old man with abdominal pain for 4 hours Initial CT Department of Radiology, CHU Gabriel Montpied, Clermont-Ferrand 2010 SMA oclusion

SMA Angioplasty & Stenting 2 hours after CT scan Department of Radiology, CHU Gabriel Montpied, Clermont-Ferrand 2010 Final control after stenting SMA oclusion SMA catheterism

6 months follow-up Department of Radiology, CHU Gabriel Montpied, Clermont-Ferrand 2010