PMC10365118_01
Pre-treatment arterial phase CTA:maximum intensity projection reconstruction showing multiple filling defects in the mid-distal part of the superior mesenteric artery (SMA) and in the proximal part of jejunal branches.
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F1
Due to the persistence of symptomatology 36 h after the admission in emergency room a contrast-enhanced computed tomography scan of the abdomen was performed, and the arterial phase revealed multiple filling defects in the mid-distal part of the superior mesenteric artery (SMA) and in the proximal part of jejunal branches with no evidence of atherosclerosis, associated in portal phase with small intestine walls thickening without intramural or extramural air, suggestive for SMA thromboembolism and initial intestinal ischemia (Figure 1).
(A) Pre-treatment DSA images showing multiple filling defects in the mid-distal part of the superior mesenteric artery (SMA) and obstruction of at least two jejunal branches with still a perfusion of intestine loops by collateralization. (B) EKOS catheter 18 cm positioned in SMA.
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F2
An angiographic study was done which showed the presence of subtotal thrombotic occlusion of the SMA with multiple emboli in jejunal branches and still a hemodynamic compensation by collateralization (Figure 2).
Post-treatment DSA images showing complete dissolution of the emboli with an improvement of the blood flow into the intestine wall.
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F3
The SMA angiographic study confirmed the absence of vessel stenosis and revealed a complete dissolution of the multiple emboli with an improvement of the blood flow into the intestine wall (Figure 3).
Post-treatment arterial phase CTA:maximum intensity projection reconstruction showing superior mesenteric artery without any filling defects of thrombotic nature.
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F4
CT scan that confirmed the previous angiogram images without any filling defects of thrombotic nature of the upper mesenteric artery, thoracic aorta, and large splanchnic vessels (Figure 4). Compared to the CT exam before the treatment, there was also an important reduction in the parietal thickening of the multiple intestinal loops.