Superior mesenteric artery emboli during renal PTA: successful surgical treatment after fibrinolysis failure.
The paper presents a rare case of iatrogenic embolization of the superior mesenteric artery which required an emergency operation after an unsuccessful fibrinolytic treatment. An old woman, who had undergone renal percutaneous angioplasty (r-PTA), presented sudden but transient abdominal pain. Angiographic control of the angioplasty showed the goal of r-PTA but also an embolic occlusion of the main trunk of the superior mesenteric artery that did not respond to a selective fibrinolytic treatment. Within a few hours, the abdominal pain appeared again and induced an exploratory laparotomy which showed an extensive ischaemia of the whole jejunum. A successful embolectomy was performed associated with the resection of about 20 cm of necrotic jejunum. The postoperative period was uncomplicated. The case underlines several topics: close collaboration is necessary between interventional radiologists and surgeons in order to get a surgical "stand-by" during PTA procedures; the embolic occlusion of the superior mesenteric artery can produce irreversible, even if segmentary intestinal damage, also within a very short time after onset and, therefore, it seems to be at high risk for a fibrinolytic approach.
Bonardelli
S
S
Department of General Surgery, University of Brescia, Italy.
Cangiotti
L
L
Pinelli
D
D
Pouchè
A
A
Giulini
S M
SM
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D004617:Embolism / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D017538:Mesenteric Artery, Superior; D008641:Mesenteric Vascular Occlusion / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000628:therapy; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D014568:Urokinase-Type Plasminogen Activator