Endovascular treatment of multiple visceral artery paradoxical emboli with mechanical and pharmacological thrombolysis.
OBJECTIVE
To report a case of paradoxical emboli to multiple visceral vessels treated with both mechanical (AngioJet device) and pharmacological (urokinase) thrombolysis.


RESULTS
A 72-year-old man presented with a 48-hour history of symptomatic right renal ischemia, which was treated with heparinization. Five days later, an abrupt creatinine elevation prompted arteriography, which demonstrated thromboembolism of the superior mesenteric artery (SMA) and both renal arteries. The AngioJet aspiration device was employed to successfully remove the clot from the SMA; urokinase infusion restored flow to the left kidney. At the 16-month follow-up evaluation, the patient was normotensive without medication and had a stable creatinine (1.4 mg/dL).


CONCLUSIONS
Because of its speed and minimal morbidity, the AngioJet device may be an attractive alternative to surgical embolectomy or pharmacological thrombolysis in highly selected cases of acute visceral artery thromboembolism.
Sternbergh
W C
WC
Department of Surgery, Ochsner Clinic and Foundation, New Orleans, Louisiana 70115, USA. csternbergh@ochsner.org
Ramee
S R
SR
DeVun
D A
DA
Money
S R
SR
D000368:Aged; D017128:Embolectomy / Q000379:methods*; D019320:Embolism, Paradoxical / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D017538:Mesenteric Artery, Superior; D010960:Plasminogen Activators / Q000008:administration & dosage; D011859:Radiography; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*; D014781:Viscera / Q000098:blood supply*
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator