Vnitr Lek 2008, 54(9):871-875

Superior mesentery artery embolization as a complication of the primary angioplasty solved by local thrombolysis

R. Miklík^1,*, J. Maňoušek¹, P. Kala¹, J. Sedmík², J. Pařenica¹, M. Poloczek¹, O. Toman¹, J. Špinar¹

¹ Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC

² Radiodiagnostická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Vlastimil A. Válek, CSc.

Acute mesentery artery embolization is a rare complication of invasive catheterizations. The incidence is unknown. In case of late diagnosis the mortality may reach up to 93%. Acute abdominal pain, vomitus, rapid and sudden bowel evacuation with or without blood are the typical symptoms of the disease. Plain X-Rays of abdomen or CT tomography may show no signs of intestinal ischaemia. The diagnostic method to choose is either spiral CT angiography or contrast angiography, respectively. The most common therapeutical approach is surgical revascularization but in selected cases it is feasible to perform local thrombolysis with a microcatheter placed directly into the artery with embolus. We report a case of a man who was admitted with an acute myocardial infarction who underwent primary angioplasty with implantation of a bare-metal stent. After the procedure he developed severe and progressive abdominal pain as a result of acute superior mesentery artery embolization. In this patient we performed a local thrombolysis with rt-PA (alteplase) with a great technical success and immediate pain relief, with no need of surgical revision. Our approach was concordant to recommendations cited in this article.

Keywords: embolization; superior mesentery artery; catheterization; local thrombolysis; myocardial infarction

Received: March 2, 2008; Accepted: May 15, 2008; Published: September 1, 2008  Show citation