LOCAL FIBRINOLYSIS FOR SUPERIOR MESENTERIC-ARTERY THROMBOEMBOLISM

A 66-year-old man with atrial fibrillation was referred soon after dev eloping left lower limb and abdominal pain with rectal bleeding. An im mediate flush aortogram showed embolic occlusion of the left distal su perficial femoral artery and superior mesenteric artery (SMA), 3 cm fr om its ostium. Recombinant tissue plasminogen activitor (rtPA) 40 mg w as selectively instilled in the SMA in two boluses. Abdominal symptoms resolved within 48 h, and complete recanalization of the SMA was show n on angiography. Exploratory laparotomy after 72 h showed a normal sm all bowel and right colon, and was completed by femoropopliteal embole ctomy. Six months later, the patient remained asymptomatic.