Hybrid open and endovascular retrograde suction thrombectomy and stenting for acute proximal superior mesenteric artery thrombosis

We describe hybrid retrograde suction thrombectomy and stenting via open mesenteric exposure for acute proximal superior mesenteric artery thrombosis. A 74-year-old female with multiple comorbidities presented with 12 hours of severe abdominal pain, nausea, vomiting, and diarrhea. Imaging revealed proximal superior mesenteric artery thrombosis with complete occlusion and distal reconstitution. Emergent hybrid laparotomy with retrograde suction thrombectomy achieved complete clot extraction, with subsequent stenting. At 6-week follow-up, the patient was asymptomatic with a patent stent on mesenteric duplex. This hybrid approach combines direct bowel assessment with minimally invasive endovascular revascularization, offering an alternative when antegrade access fails or is not an option.