Use of ICG imaging to confirm bowel viability after upper mesenteric stenting in patient with acute mesenteric ischemia: Case report
| Autor: | Murlychev Alexander, Miziev Ismail, Voronova Olga, Golovina Anastasiya, Khitaryan Аlexander, Taranov Ivan, Shatov Dmitry, Melnikov Denis |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Abdominal pain medicine.medical_treatment Ischemia Revascularization Article Acute mesenteric ischemia 03 medical and health sciences 0302 clinical medicine medicine.artery Case report medicine cardiovascular diseases Myocardial infarction Thrombus Indocyanine green imaging Endovascular intervention medicine.diagnostic_test business.industry Abdominal aorta medicine.disease Thrombosis Surgery 030220 oncology & carcinogenesis Angiography 030211 gastroenterology & hepatology medicine.symptom business |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| Popis: | Highlights • A 70-year-old man with NSTEMI was diagnosed with AMI on the 3rd day after primary coronary intervention. • Acute mesenteric ischemia is a life-threatening disease with high mortality rate, varying from 40% to 69%. • The man underwent thoracoscopic SMA angiography with aspiration thrombectomy and stenting. • On the next day a diagnostic laparoscopy with ICG fluorescence was implemented to access bowel viability. • The patient is alive at 4 months after operative treatment of AMI. Introduction Acute mesenteric ischemia (AMI) is a rare and life-threatening disease. Despite modern advances in open and endovascular treatments it has unacceptably high mortality rate. Presentation of case A 70-year-old man with NSTEMI was diagnosed with acute mesenteric ischemia on the 3rd day after primary coronary intervention. CT with intravenous contrast revealed a generalized abdominal aorta atherosclerosis and a circular thrombus in SMA. Then a superior mesenteric angiography with aspiration thrombectomy, percutaneous transluminal angioplasty and stenting was performed. The next day abdominal pain still persisted. A diagnostic laparoscopy with ICG fluorescence was implemented. There were no ischemia and necrotic changes. The patient was alive at 4 months after the operative treatment of AMI. Discussion In patients with myocardial infarction, atrial fibrillation, accompanied by any invasive procedure, especially endovascular, the incidence of thrombosis and thromboembolic complications is high. This is the key to the suspicion of such a serious complication as AMI. It can be assumed that in some cases, with adequate revascularization of the small intestine, reperfusion syndrome may occur and cause ischemic necrosis of the intestinal wall. In this case it is necessary to perform control laparoscopy in 24–48 h. Conclusion In patients with suspected AMI timely applying of MDCT, angiography, endovascular revascularization and ICG quality control of perfusion after revascularization are expedient to improve the results of treatment. These patients should be treated by a multidisciplinary team consisting of a cardiologist, a cardiovascular and endovascular surgeon, a general surgeon with experience in working with such patients. |
| Databáze: | OpenAIRE |
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