Radiology, Vol 204, 775-779, Copyright © 1997 by Radiological Society of North America
Superior mesenteric arterial embolism: local fibrinolytic treatment with urokinase
G Simo, AJ Echenagusia, F Camunez, F Turegano, A Cabrera and J Urbano
Department of Radiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.
PURPOSE: To evaluate the efficacy of intraarterial urokinase in the
treatment of superior mesenteric arterial (SMA) embolism. MATERIALS AND
METHODS: Within 3 years, 10 patients (six men, four women; aged 62-82
years) with angiographically proved SMA emboli were selected on the basis
of absence of peritoneal signs of intestinal necrosis at physical
examination and normal abdominal plain radiographs to undergo local lysis
with urokinase. RESULTS: The procedure was performed without complications
in all 10 patients. The embolus was successfully lysed in nine patients
(90%). Clinical success was achieved in seven patients (70%); however, in
one patient laparotomy was required to confirm the clinical finding. None
of these patients had recurrent embolism or postischemic intestinal
stenosis during follow-up (mean, 11.2 months). The three remaining patients
(30%) underwent laparotomy subsequent to failure of intraarterial treatment
with urokinase. CONCLUSION: Fibrinolytic treatment with urokinase may be an
effective alternative to surgical embolectomy in patients with SMA embolism
without clinical or radiologic signs of intestinal infarction. In this
small series, abatement of abdominal pain in the 1st hour of fibrinolytic
treatment was the best indicator of clinical success. Pain persisted in
patients with intestinal infarction.
