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Massive intestinal mesenteric portal vein ischemia: Percutaneous endovascular thrombolysis as minimally invasive
Carlos Augusto Gomes1, Thaiza de Souza Filgueiras2, Alice M Carvalho3
1Department of Surgery, Hospital Universitário Therezinha De Jesus, Faculdade De Ciências Médicas E Da Saúde, Juiz de Fora, Brazil.
Abstract:
Acute mesenteric ischemia represents a group of diseases, which lead to an abrupt interruption of blood flow to the small intestine resulting in intestinal necrosis. Its first symptoms are vague and in the majority of cases nonspecific, so the diagnostic suspicion is of the utmost importance to establish the correct diagnostic and prompt treatment. It is a complex and difficult event, that needs a multidisciplinary approach involving different specialties such as gastrointestinal and vascular surgeons, interventional radiologists, and expertise from the acute care unit team. The fundamental aspect is the precocity of diagnostic based on abdominal computed angio-tomography and the immediate re-establishment of blood supply to the affected areas. In this report, we introduce a case of a patient with mesenteric venous thrombosis, who has beenundergone a percutaneous endovascular treatment (portal-mesenteric mechanical thrombectomy, besides an intravenous thrombolytic infusion), due to poor clinical response after anticoagulation approach that needed mechanical ventilation.
Insights
Acute mesenteric ischemia, a critical condition causing intestinal necrosis, requires prompt diagnosis and multidisciplinary care. This case highlights successful endovascular treatment for mesenteric venous thrombosis unresponsive to anticoagulation.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Acute mesenteric ischemia (AMI) is a life-threatening condition characterized by interrupted blood flow to the small intestine, leading to intestinal necrosis.
- Nonspecific initial symptoms of AMI necessitate high diagnostic suspicion for timely intervention.
- Management of AMI requires a multidisciplinary approach involving surgeons, interventional radiologists, and acute care teams.
Purpose of the Study:
- To report a case of mesenteric venous thrombosis (MVT) treated with percutaneous endovascular methods.
- To illustrate the challenges in diagnosing and managing AMI, particularly MVT.
- To demonstrate an alternative treatment strategy for MVT when anticoagulation fails.
Main Methods:
- Diagnostic workup included abdominal computed angio-tomography (CTA) for rapid diagnosis.
- Initial treatment involved anticoagulation.
- Percutaneous endovascular treatment, including mechanical thrombectomy and thrombolytic infusion, was employed due to poor clinical response.
Main Results:
- The patient presented with mesenteric venous thrombosis.
- Anticoagulation alone was insufficient, leading to poor clinical response.
- Successful endovascular intervention re-established blood flow, although mechanical ventilation was required.
Conclusions:
- Early diagnosis via CTA is crucial for managing acute mesenteric ischemia.
- Endovascular treatment offers a viable option for mesenteric venous thrombosis refractory to anticoagulation.
- Multidisciplinary collaboration is essential for optimizing outcomes in complex cases of mesenteric ischemia.
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