Hybrid recanalization of superior mesenteric artery occlusion in acute mesenteric ischemia

Purpose: To describe an alternative hybrid endovascular/open approach to revascularizing the occluded superior mesenteric artery (SMA) in patients with acute ischemia. Technique: A laparotomy is performed to assess any visceral ischemia. The SMA is exposed, clamped distally, and cannulated proximally. The SMA occlusion is crossed in a retrograde fashion. Balloon embolectomy or stent implantation may be performed if required. This technique has been used in 6 patients: 2 with acute atherosclerotic occlusion, 1 with thrombotic occlusion and distal emboli, and another 3 in whom the SMA ostium had been covered during placement of a fenestrated stent-graft. Conclusion: A hybrid approach to SIMA occlusions with retrograde recanalization is feasible. It is of particular use in patients with acute or iatrogenic occlusion and allows assessment of visceral ischemia.