Use of Indocyanine Green Angiography at the Arteriotomy Site to Avoid Intestinal Resection in a Case of Superior Mesenteric Artery Embolism

Abstract

An 80-year-old woman was transferred to our hospital with the chief complaint of epigastric discomfort. Abdominal contrast computed tomography revealed a superior mesenteric artery embolism and small bowel ischemia for which emergency surgery was performed. The superior mesenteric artery was dissected, and the red thrombus was removed using a thrombectomy balloon catheter. The blood flow on the central side was normal, but it was lacking on the peripheral side ; therefore, blood flow impairment was suspected. To confirm whether residual thrombus was present, a catheter was inserted into the arteriotomy site and indocyanine green (ICG) fluorescence angiography was performed. Angiogram findings of the superior mesenteric artery trunk and the jejunum to the ileocecal region were normal. Since it was determined that the thrombus was removed, the dissected blood vessel was closed with sutures. The abdomen was temporarily closed at that time and completely closed the next day after confirmation of the patient's intestinal condition. The patient's dietary intake was good, and she was discharged from the hospital on postoperative day 20. We report a case of a superior mesenteric artery embolism in which intestinal resection was avoided using ICG fluorescence angiography performed through a catheter inserted into the arteriotomy site.