Abstract
Herein, we report 4 cases of superior mesenteric artery (SMA) occlusion in which angiography was effective for determining the appropriate treatment strategies, including interventional radiology (IVR). In 2 patients who were successfully treated by IVR alone, the occlusion site was distal to the origin of the middle colic artery, and angiography showed good visualization of the peripheral branches via collateral circulation. Both received thrombolysis, and the interval from the onset to blood flow resumption was 15 hours in one patient and 3 hours in the other. In the 2 patients who underwent enterectomy following IVR, the occlusion site was proximal to the origin of the middle colic artery and the peripheral branches were poorly visualized: In one patient, aspiration thrombectomy failed to restore blood flow, and in the other, thrombolysis plus aspiration thrombectomy restored good blood flow, although it took as long as 5.5 hours from the onset of occlusion. The viability of the intestines in cases of SMA occlusion may depend on the collateral circulation. If angiography shows poor development of collateral circulation and poor visualization of branches, the possibility of intestinal necrosis should be borne in mind, even if IVR restores the blood flow in the SMA stem and branches.
