Pancreatitis caused by rheolytic thrombolysis: an unexpected complication.
Two patients developed acute pancreatitis after mechanical thrombolysis with use of the AngioJet system. Patient 1 had undergone a remote complex revascularization of the lower extremities and presented with acute ischemia after thrombosis of his composite distal bypass. Patient 2 presented with superior vena cava (SVC) syndrome and had thrombosis of the SVC and innominate veins. Despite dissimilar presentations, both patients had renal insufficiency, were treated with mechanical and chemical thrombolysis, and had extensive thrombus burden. The pathophysiology of acute pancreatitis in this setting is believed to be secondary to massive hemolysis in the presence of chronic renal insufficiency. This phenomenon should be considered in patients whom develop abdominal pain after mechanical thrombolysis.
Division of Peripheral Vascular Surgery, Department of Surgery, Southern Illinois University School of Medicine, PO Box 19638, Springfield, Illinois 62794-9638, USA.
Jeffrey S
JS
Danetz
Robert B
RB
McLafferty
Juan
J
Ayerdi
Lori A
LA
Rolando
Zachary C
ZC
Schmittling
Don E
DE
Ramsey
Kim J
KJ
Hodgson
D000208:Acute Disease; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy; D035002:Lower Extremity / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology*; D011994:Recombinant Proteins / Q000009:adverse effects; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D013479:Superior Vena Cava Syndrome / Q000000981:diagnostic imaging / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects; D014057:Tomography, X-Ray Computed
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; C087896:reteplase; D010959:Tissue Plasminogen Activator