D. Trandafir, B. Dorobăţ, S. Condu, L. Malaia, B. Kahlil
Spitalul Universitar de Urgenţă, I.U.B.C.V. “Prof.Dr. C.C. Iliescu”

Cuvinte cheie: EVAR, AMI, complicaţii

Pacient, în vârstă de 57 hipertensiv, fumător şi obez ca factori de risc CV asociați a fost supus unei proceduri hibrid de montare a unei endoproteze Jotec aorto-biiliace pe cale deschisă ca rezolvare a anevrismului aortic infrarenal. Montajul permeabil, bine circulat, fără endoleak.
Peste 5 zile postprocedural pacientul a dezvoltat simptome specifice infarctului mezenteric acut: dureri abdominale brusc instalate, generalizate şi mai intense în zona epigastrică, sensibilitate abdominală spontan şi la palpare, apărare musculară şi meteorism. CT-ul de urgență cu substanţă de contrast a evidențiat: ocluzie proximală de AMS de 22mm, distal de această leziune, lumen permeabil.
Având în vedere imagistică CT cazul este trimis către laboratorul de catheterism pentru confirmare şi tratament angiografic. După catheterizarea selectivă AMS se practică trombaspiraţie şi administrarea pe catheter de Integrilin. Pentru a asigura permeabilitatea arterei şi ramurilor sale se recurge la PTA cu balon şi implantarea de trei stenturi Biotronic AG Assurant Cobalt cu rezultat angiografic optim postprocedural cât şi la 24 de ore. Post-intervenţional simptomatologia se remite, tranzitul intestinal este reluat, fără durere remanentă.
Controlul la 6 luni a confirmat patența endograftului şi o AMS fără leziuni. Pacientul nu era simptomatic. Acest rezultat favorabil s-a datorat în mare parte diagnosticării precoce şi accesului rapid la tratament endovascular.

 

 

A case of AMI post Infrarenal Aortic Aneurysm Endograft repair

D. Trandafir, B. Dorobăţ, S. Condu, L. Malaia, B. Kahlil
Emergency University Hospital, I.U.B.C.V. “Prof.Dr. C.C. Iliescu”

Keywords: EVAR, AMI, complications

57 years old patient with smoking, obesity, hyperlipidemia as associated cv risk factors underwent a mixt procedure for infrarenal aortic aneurysmal with the fitting of a Jotec Aorto-Biiliac prosthesis by bifemoral open access. No endoleak was present, the endograft was well implanted and well circulated.
In five days time, after the procedure, the patient develops symptoms telling of AMI: abdominal pain with a sudden onset, including the entire abdominal area, especially acute in the epigastrium, high sensitivity freely and at palpations, muscular defence as well as meteorism were present. The emergency Contrast-CT revealed: proximal SMA occlusion of 22mm length, distal from this area the artery lumen was empty.
Given the CT scan image the case is referred to the Cath lab for further angiographic confirmation and treatment. After selective catheterization of the SMA it is opted for mechanical thromboaspiration of the cloth and, via catheter, Integrilin administration. To ensure the permeability of the artery and branches, balloon and stent assisted PTA is performed, using three Biotronic AG Assurant Cobalt stents with optimal angiographic results, as confirmed post procedure and as well after 24 hours.  Post-intervention the symptoms of acute mesenteric suffering were remitted, with bowl movement being present and the pain relieved.
The 6 months follow up exam confirmed a patent endograft and SMA without additional lesions. The patient was symptom free. This favourable outcome was due primarily to the early detection of the inner vessel occlusion as well as the prompt access to endovascular treatment.