Endovascular Treatment for Acute Mesenteric Ischaemia in a Young Woman with Polyarterial Disease.
BACKGROUND
Acute mesenteric ischaemia is a condition with a grim prognosis on conservative treatment. Endovascular revascularisation is a promising approach for some of these patients.


METHODS
We present the case of a 44-year-old woman with a history of severe arterial hypertension, left leg claudication, and overlooked symptoms of chronic mesenteric ischaemia for one year, who was admitted for severe abdominal pain for one week. Computed tomographic angiography (CTA) showed acute mesenteric ischaemia by occlusion of the coeliac trunk and the superior mesenteric artery (SMA), without bowel perforation. In addition, CTA showed tight left renal stenosis and left external iliac stenosis. We performed angioplasty with a stent of the SMA, followed by revascularisation of the left renal artery. On control injection, the SMA appeared re-occluded, requiring a second stent implantation and a loading dose of dual antiplatelet therapy, with a good final result. Subsequently, the clinical course was uneventful, with no need of surgical exploration; a second procedure was planned, aiming at iliac revascularisation. At one month, the patient was asymptomatic, with normal Doppler flow in the SMA. Angiographic control during iliac revascularisation procedure showed a permeable SMA with a good filling of the coeliac trunk territory. Because of the suspicion of fibro-muscular dysplasia as aetiology, coronary angiography and cerebral CTA were performed, in order to exclude other potential lesions.


CONCLUSIONS
Endovascular revascularisation in AMI is a promising alternative to the surgical approach in patients presenting without bowel perforation. Nevertheless, its safety and many tactical details remain to be clarified. Existing networks for revascularisation in acute myocardial infarction may be useful for the implementation of this approach.
County Emergency Clinical Hospital, Cluj-Napoca, Romania.
Mihai C
MC
Ober
County Emergency Clinical Hospital; Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. chomorodean@yahoo.com.
Calin
C
Homorodean
County Emergency Clinical Hospital; Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Dan A
DA
Tataru
Iuliu Haţieganu University of Medicine and Pharmacy;Municipal Clinical Hospital, Cluj-Napoca, Romania.
Antonia E
AE
Macarie
N. Stăncioiu Heart Institute, Cluj-Napoca, Romania.
Camelia D
CD
Ober
County Emergency Clinical Hospital; Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Dan M
DM
Olinic
D000208:Acute Disease; D000328:Adult; D000792:Angiography / Q000379:methods; D017130:Angioplasty / Q000379:methods*; D002445:Celiac Artery / Q000000981:diagnostic imaging; D000072226:Computed Tomography Angiography / Q000379:methods; D005260:Female; D006801:Humans; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D065666:Mesenteric Ischemia / Q000000981:diagnostic imaging / Q000628:therapy*; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000628:therapy