title: Colonic necrosis subsequent to catheter-directed thrombin embolization of the inferior mesenteric artery via the superior mesenteric artery: a complication in the management of a type II endoleak.
abstract: The optimal management of endoleaks after endovascular repair of abdominal aortic aneurysms remains to be established. In this report, we describe a persistent side-branch, or type II, endoleak 1 year after endograft implantation treated with catheter-directed embolization of the aneurysm sac and the inferior mesenteric artery via the superior mesenteric artery, with embolization agents including thrombin, lipiodol, and gelfoam powder. Shortly after the embolization procedure, colonic necrosis developed in the patient, manifested by peritonitis, which necessitated a partial colectomy. This case underscores the devastating complication of colonic ischemia as a result of catheter-directed embolization of the inferior mesenteric artery in the management of an endoleak.
authors.affiliation: Joseph B. Whitehead Department of Surgery, Division of Vascular Surgery, Emory University School of Medicine, Emory University Hospital, Atlanta, GA, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Bush
authors.forename: P H
authors.initials: PH
authors.lastname: Lin
authors.forename: R S
authors.initials: RS
authors.lastname: Ronson
authors.forename: B S
authors.initials: BS
authors.lastname: Conklin
authors.forename: L G
authors.initials: LG
authors.lastname: Martin
authors.forename: A B
authors.initials: AB
authors.lastname: Lumsden
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000628:therapy*; D001027:Aortography; D021721:Balloon Occlusion / Q000009:adverse effects* / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D003082:Colectomy; D003097:Collateral Circulation; D004359:Drug Therapy, Combination; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods*; D005781:Gelatin Sponge, Absorbable / Q000009:adverse effects*; D006490:Hemostatics / Q000009:adverse effects*; D006801:Humans; D008297:Male; D017537:Mesenteric Artery, Inferior; D017538:Mesenteric Artery, Superior; D009336:Necrosis; D010538:Peritonitis / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D012008:Recurrence; D012810:Sigmoid Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D015607:Stents; D013917:Thrombin / Q000009:adverse effects*; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D006490:Hemostatics; D013917:Thrombin