Safety, Efficacy and Outcome of Rotational Thrombectomy assisted Endovascular Revascularisation of the Superior Mesenteric Artery in Acute Thromboembolic Mesenteric Ischaemia

Purpose To evaluate the efficacy and safety of percutaneousrotational thrombectomy-assisted endovascular revascularization of acute thromboembolic superior mesenteric arteryocclusions in acute mesenteric ischemia Materials and Methods Fifteen cases of percutaneous rotational thrombectomy- assisted (Rotarex S, BD, USA) revascularization were retrospectively analyzed. The etiology was embolicin 40% of cases and thrombotic in 60%. A"Thrombectomy inVisceral Ischemia"(TIVI) 5-point score determined vessel patency at presentation, after percutaneous rotational thrombectomy, and after adjunctive technologies. TIVI 3 indicated nearly complete revascularization (minimal residual side branch thrombus). TIVI 4 indicated complete revascularization. Technical success was defined as successful device application and a final TIVI score of 3/4 after adjunctive technologies. Safe-ty and outcome were also analyzed. Results Device application via femoral access was feasible in100 % of cases and improved flow in 86.7 % of cases (1 x TIVI0 -> 1, 11 x TIVI 0 -> 2, 1x TIVI 1 -> 2). There was no change in13.3% of cases (2 x TIVI 2 -> 2). Additional devices resulted in further flow improvement in 93.3% of cases (8x TIVI 3, 6xTIVI 4). One recanalization failed (TIVI 2 -> 2 -> 2). After adjunctive technologies (10x manual aspiration, 11x angioplasty,9x stenting), the technical success rate was 93.3%. The mean procedure time was 40.5(+/- 14) minutes for embolism and 72.1(+/- 20) minutes for thrombosis. There was one device-related major complication (catheter tip fracture) resulting in a device-related safety rate of 93.3 %. The overall major complication rate was 20 %. Surgical exploration (13 x), bowel resection (9 x) and Fogarty embolectomy/bypass (3 x) were also performed. The 30-day mortality rate was 40 %. Conclusion Percutaneous rotational thrombectomy is an effective adjunct for rapid endovascular recanalization of acute thromboembolic superior mesenteric artery occlusions with an acceptable rate of major procedural complications.