Akútna končatinová ischémia v dôsledku paradoxnej embolizácie liečená systémovou trombolýzou

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Autori: Veronika Pokorná ¹; Svetlana Bodíková ¹; Jozef Kaluzay ¹; Zuzana Liskova ²; Olga Jurkovicova ¹
Pôsobisko autorov: Rádiológia, s. r. o., University Hospital Bratislava, St. Cyril and Method Hospital, Slovak Republic ²; th Department of Internal Medicine, Faculty of Medicine, Comenius University in Bratislava and University, Hospital Bratislava, St. Cyril and Method Hospital, Slovak republic ¹⁴
Vyšlo v časopise: Vnitř Lék 2020; 66(5): 76-79
Kategória: Kazuistika

Súhrn

Predstavujeme prípad pacientky s akútnou ischémiou na hornej aj dolnej končatine v dôsledku paradoxnej embolizácie. 67-ročná žena bez anamnézy venózneho tromboembolizmu utrpela v novembri 2017 dislokovanú fraktúru pately s potrebou operačného riešenia. Dva mesiace po operácii bola rehospitalizovaná pre obojstrannú embóliu do arteria pulmonalis, oklúziu ľavej arteria subclavia, ľavej arteria femoralis communis a arteria mesenterica superior. Transezofageálna echokardiografia zistila prítomnosť foramen ovale patens. Cievny chirurg neindikoval embolektómiu a intervenčný rádiológ neindikoval farmakomechanickú trombolýzu z dôvodu veľkého rozsahu oklúzie. Následne bola úspešne podaná systémová trombolýza (altepláza) s rozpustením embolov v ľavej arteria subclavia, v ľavej arteria femoralis communis a v arteria mesenterica supeior.

Klíčová slova:

akútna končatinová ischémia – ortopedická operácia – paradoxná embolizácia – foramen ovale patens – systémová trombolýza – venózny tromboembolizmus

Zdroje

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