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Catheter-directed thrombolysis in inflammatory bowel diseases: report of a case

Péter Ilonczai1, Judit Tóth, László Tóth

  • 12nd Department of Medicine, Medical and Health Science Centre, University of Debrecen, 4032 Debrecen, Hungary.

World Journal of Gastroenterology
|September 25, 2012
PubMed

Insights

Thrombosis risk is elevated in inflammatory bowel disease (IBD). This case study shows successful catheter-directed thrombolysis (CDT) for acute arterial occlusion in an active IBD patient, offering a potential treatment option.

Area of Science:

  • Vascular Surgery
  • Gastroenterology
  • Hematology

Background:

  • Thromboembolism (TE) is a significant extraintestinal complication of inflammatory bowel diseases (IBD), occurring 3.6 times more frequently than in the general population.
  • The management of TE in active IBD patients, particularly with anticoagulant and thrombolytic therapies, remains an unresolved clinical challenge.

Observation:

  • A 46-year-old male with a 10-year history of Crohn's disease presented with sudden coldness and pain in his right hand.
  • Angiography revealed acute occlusion of the brachial and radial arteries, rendering vascular surgery non-applicable.
  • Endoscopy confirmed severe, extensive colonic inflammation, frequent bloody stools, and moderate anemia, indicating active IBD.

Findings:

  • Catheter-directed thrombolysis (CDT) using recombinant tissue plasminogen activator was successfully performed.
  • Follow-up angiography demonstrated improved arterial flow, with the reappearance of the radial artery pulse.
  • No bleeding complications were observed post-procedure.

Implications:

  • This case suggests that CDT can be a safe and effective treatment for severe or life-threatening TE in active IBD patients.
  • Careful assessment of bleeding risk is crucial before considering CDT in this patient population.
  • This approach may offer a viable therapeutic option when traditional interventions are not feasible.

Keywords:
Catheter-directed thrombolysisCrohn’s diseaseGastrointestinal haemorrhageInflammatory bowel diseaseThromboembolism

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