Superior mesentery artery embolization as a complication of the primary angioplasty solved by local thrombolysis

Česká verzia

Authors: R. Miklík ¹; J. Maňoušek ¹; P. Kala ¹; J. Sedmík ²; J. Pařenica ¹; M. Poloczek ¹; O. Toman ¹; J. Špinar ¹
Authors place of work: Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC ¹; Radiodiagnostická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Vlastimil A. Válek, CSc. ²
Published in the journal: Vnitř Lék 2008; 54(9): 871-875
Category: Case Report

Summary

Acute mesentery artery embolization is a rare complication of invasive catheterizations. The incidence is unknown. In case of late diagnosis the mortality may reach up to 93%. Acute abdominal pain, vomitus, rapid and sudden bowel evacuation with or without blood are the typical symptoms of the disease. Plain X-Rays of abdomen or CT tomography may show no signs of intestinal ischaemia. The diagnostic method to choose is either spiral CT angiography or contrast angiography, respectively. The most common therapeutical approach is surgical revascularization but in selected cases it is feasible to perform local thrombolysis with a microcatheter placed directly into the artery with embolus. We report a case of a man who was admitted with an acute myocardial infarction who underwent primary angioplasty with implantation of a bare-metal stent. After the procedure he developed severe and progressive abdominal pain as a result of acute superior mesentery artery embolization. In this patient we performed a local thrombolysis with rt-PA (alteplase) with a great technical success and immediate pain relief, with no need of surgical revision. Our approach was concordant to recommendations cited in this article.

Key words:
embolization – superior mesentery artery – catheterization – local thrombolysis – myocardial infarction

Zdroje

1. Kala P, Želízko M, Vojáček J. PS Intervenční kardiologie ČKS a Národní registr kardiovaskulárních intervencí (NRKI). Interv Akut Kardiologie 2007; 6: 152–153.

2. Georgiev G. Acute obstruction of the mesenteric vessels: a diagnostic and therapeutic problem. Khirurgiia (Sofiia) 1989; 42: 23–29.

3. Brandt LJ, Boley SC. AGA Technical Review on Intestinal Ischemia. Gastroenterology 2000; 118: 954–968.

4. ACC/AHA 2005 practice Guidelines for the management of patients with peripheral arterial disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic). Circulation 2006; 113: e463–e465.

5. Ujiki M, Kibbe MR. Mesenteric ischemia. Perspect Vasc Surg Endovasc Ther 2005; 17: 309–318.

6. Schoots IG, Levi MM, Reekers JA et al. Thrombolytic therapy for acute superior mesenteric artery occlusion. J Vasc Interv Radiol 2005; 16: 317–329.

7. Kougias P, Lau D, El Sayed HF et al. Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J Vasc Surg 2007; 46: 467–474.

8. Edwards MS, Cherr GS, Craven TE et al. Acute occlusive mesenteric ischemia: surgical management and outcomes. Ann Vasc Surg 2003; 17: 72–79.

9. Simo G, Echenagusia AJ, Camunez F et al. Superior mesenteric arterial embolism: local fibrinolytic treatment with urokinase. Radiology 1997; 20: 775–779.

10. Schoenbaum SW, Pena C, Koenigs-berg P et al. Superior mesenteric artery embolism: treatment with intraarterial urokinase. J Vasc Interv Radiol 1992; 3: 485–490.

11. Clavien PA. Diagnosis and management of mesenteric infarction. Br J Surg 1990; 77: 601–603.

12. Batellier J, Kieny R. Superior mesenteric artery embolism: eighty-two cases. Ann Vasc Surg 1990; 4: 112–116.