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Upper limb amputation due to a brachial arterial embolism associated with a superior mesenteric arterial embolism: a case report
Tsuyoshi Yamada, Toshitaka Yoshii, Hideya Yoshimura, Koji Suzuki, Atsushi Okawa
BMC Research Notes , 2012, DOI: 10.1186/1756-0500-5-372
Abstract: We present a rare case of a 67-year-old Japanese woman with atrial fibrillation who developed an embolic occlusion of the brachial artery associated with a superior mesenteric arterial embolism. She developed gangrene in her right hand, which had progressed to the point that amputation was necessary by the time the gastrointestinal surgeon had consulted the Department of Orthopedic Surgery. The brachial arterial embolism diagnosis was delayed by the severe abdominal symptoms and shock conditions that followed the emergency enterectomy, resulting in amputation of the upper limb despite anticoagulation therapy. In this case, multiple infarctions of the spleen were also observed, indicating a shower embolism.When treating a superior mesenteric arterial embolism in a patient with atrial fibrillation, the possibility of recurrent or multiple arterial thromboembolic events should be considered, even after the procedure is completed.Acute mesenteric ischemia due to an embolism of the superior mesenteric artery (SMA) is associated with a high mortality rate [1]. Over 20 percent of acute mesenteric embolism cases consist of multiple emboli, and the long-term prognosis depends on the incidence of subsequent embolic events at other sites. An embolic episode in a lower limb following an SMA embolism has been previously reported [2]. However, the incidence of emboli in the upper extremities associated with an SMA embolism has rarely been examined.An embolus in an upper limb is an uncommon event; when diagnosed promptly, however, it can be successfully treated with prompt surgery, such as an embolectomy [3]. Therefore, early amputation of an arm due to an embolism is exceptionally rare [4]. It has been reported that embolisms accounted for approximately 1 percent of upper limb amputations [5]. The signs and symptoms of ischemic changes in the upper limbs can be masked by other circumstances, such as postoperative conditions or complications. In these cases, a late presentation or
Acute mesenteric ischemia due to superior mesenteric artery embolism in a patient with permanent atrial fibrillation  [PDF]
MIROSLAV SIMUNIC,DAMIR FABIJANIC,NIKOLA PERKOVIC,ZORAN BOGDANOVIC
Signa Vitae , 2010,
Abstract: Acute mesenteric ischemia (AMI) is an uncommon disorder with a high mortality rate. Reduction in mortality requires a high index of suspicion and prompt diagnosis. We describe a case of AMI in a 59-year old man with a history of permanent atrial fibrillation. Pathogenesis of AMI, clinical implications, diagnostic and therapeutic options are discussed.
Critical Limb Ischemia in a Young Man: Saddle Embolism or Unusual Presentation of Thromboangiitis Obliterans?  [PDF]
Federico Bucci,Adriano Redler,Leslie Fiengo
Case Reports in Vascular Medicine , 2013, DOI: 10.1155/2013/830540
Abstract: Thromboangiitis obliterans (TAO), also known as Buerger’s disease, is a rare cause of peripheral arterial disease in western countries. Tobacco smoking is strongly correlated to the pathogenesis of this inflammatory vascular disease. We report the case of a 32-year-old tobacco and cannabis consumer presenting with right critical limb ischemia. Computerized tomography angiography revealed a bilateral tibioperoneal arterial occlusion and an aortoiliac saddle embolus. The patient was treated with intravenous heparin, transcatheter thrombolysis, and selective Fogarty embolectomy. Instrumental and laboratory examinations revealed that patient’s most likely diagnosis was TAO. Arterial embolism is uncommon in Buerger’s disease but should be always excluded in these patients. 1. Introduction Thromboangiitis obliterans (TAO), also known as Buerger’s disease (BD), is a rare cause of peripheral arterial disease (PAD) in western countries. Reportedly, annual incidence of TAO is 12.6 per 100,000 representing only 0.5% of all causes of PAD. Tobacco is essential in promoting and maintaining this disease and 95% of patients affected by TAO are smokers [1]. 2. Case Report A 32-year-old man was referred to the emergencies of our hospital because of a right lower limb critical limb ischemia. Past medical history included chronic alcoholism and a three-month history of bilateral intermittent claudication. He did not report any episode of superficial thrombophlebitis. He smoked about 10 cigarettes since the age of ten and 10 cannabis joints daily since the age of twelve. He had no other cardiovascular risk factors. At clinical examination, his right leg was extremely painful and pale. He had absent pedal pulses on both sides, and a mild sensory loss on the right side. Allen’s test of upper extremities was negative. Echo Doppler was suggestive of a bilateral common iliac occlusion and of a three-vessel occlusion on the right leg. A computerized tomography (CT) angiography detected the presence of an intraluminal aortic and iliac clot (Figure 1) and a bilateral distal tibial vessels occlusion (Figure 2). The patient was then fully anticoagulated with intravenous heparin. A transthoracic echocardiogram was also performed and did not detect any proximal source of emboli. The patient was then operated on: under general anesthesia, a right iliofemoral embolectomy associated to a selective right popliteal, tibial, and peroneal embolectomy and intraoperative intraarterial thrombolysis of tibial vessels. During the operation, no thrombus was found in the infrapopliteal vessels, but
Slow-boSUMMARYlus infusion of r-tPA in the treatment of superior mesenteric artery embolism
C. Giavroglou .
Annals of Gastroenterology , 2007,
Abstract: SUMMARY Thromboembolic occlusion of the SMA is an uncommon cause of acute intestinal ischemia that carries a high mortality. We report 2 cases of SMA embolism, treated with slow-bolus infusion of r-tPA. Angiography showed a partially occluded ileiocolic artery in the first patient and a total proximal occlusion of the SMA in the second patient. Thrombolytic drugs were selectively injected in both patients. The clot lysis was complete and the symptoms disappeared in the first patient. In the second patient clot lysis was incomplete and thus an extensive enterectomy was inevitable. Slow-bolus infusion of thrombolytic drugs is an effective method in carefully selected patients with SMA embolism. Key words: Mesenteric ischemia, local fibrinolysis, mesenteric artery, embolism
Slow-bolus infusion of r-tPA in the treatment of superior mesenteric artery embolism
C. Giavroglou .
Annals of Gastroenterology , 2007,
Abstract: SUMMARY Thromboembolic occlusion of the SMA is an uncommon cause of acute intestinal ischemia that carries a high mortality. We report 2 cases of SMA embolism, treated with slow-bolus infusion of r-tPA. Angiography showed a partially occluded ileiocolic artery in the first patient and a total proximal occlusion of the SMA in the second patient. Thrombolytic drugs were selectively injected in both patients. The clot lysis was complete and the symptoms disappeared in the first patient. In the second patient clot lysis was incomplete and thus an extensive enterectomy was inevitable. Slow-bolus infusion of thrombolytic drugs is an effective method in carefully selected patients with SMA embolism. Key words: Mesenteric ischemia, local fibrinolysis, mesenteric artery, embolism
Analysis of associated diseases in patients with acute critical lower limb ischemia  [PDF]
Manojlovi? Vladimir,Popovi? Vladan,Nikoli? Dragan,Milo?evi? ?or?e
Medicinski Pregled , 2013, DOI: 10.2298/mpns1302041m
Abstract: Introduction. Acute critical lower limb ischemia refers to the state of severely impaired vitality of lower limbs due to acute occlusion of arterial blood vessel by a thrombus or emboli. Surgical revascularization in the first 6-12 hours after the onset of symptoms gives the best results. However, a high mortality rate and probability of limb loss make this problem more debatable, and can be related with associated diseases. Material and Methods. This research included 95 patients who had been operated within the first 12 hours after the onset of symptoms of critical limb ischemia. We collected the following data: age and sex of patients, etiology of limb ischemia, type of operation, associated diseases and outcome of treatment. Results and Discussion. Most of the patients were 70 to 80 years old, both sexes being equally represented. There was significantly more arterial embolism (70%) than thrombosis on the prior arterial lesion. Most of the embolizations were treated with Fogarty balloon catheter embolectomy (98%); however, a great number of arterial thrombosis demanded more complex ”inflow” and ”outflow” ensuring procedures such as thromboendarterectomy and bypass (33%). The performed surgical procedures showed no statistical differences when final outcome was analyzed. Amputation had to be performed in about 3% of the patients and all of them were diabetics. Mortality rate in this research was 10.5% and 7/10 with this outcome had severe form of chronic myocardiopathy and metabolic decompensation. Conclusion. Acute critical lower limb ischemia should be treated surgically as soon as possible. Negative outcomes are associated with comorbidity and general condition of the patient.
Superior mesenteric arterial branch occlusion causing partial jejunal ischemia: a case report
Nele Van De Winkel, Avine Cheragwandi, Koenraad Nieboer, Franciscus van Tussenbroek, Kristel De Vogelaere, Georges Delvaux
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-48
Abstract: We report the case of a 68-year-old Caucasian woman who presented with abdominal discomfort, anorexia, melena and fever. A physical examination revealed left lower quadrant tenderness and an irregular pulse. Computed tomography of her abdomen as well as computed tomography enterography, enteroscopy, angiography and small bowel enteroclysis demonstrated an ischemic jejunal segment caused by occlusion of a branch of the superior mesenteric artery. The ischemic segment was resected and an end-to-end anastomosis was performed. The diagnosis of segmental small bowel ischemia was confirmed by histopathological study.Mesenteric ischemia is a pathology well-known by surgeons, gastroenterologists and radiologists. Acute and chronic mesenteric ischemia are two separate entities with their own specific clinical presentation, radiological signs and therapeutic modalities. We present the case of a patient with symptoms and signs of chronic mesenteric ischemia despite an acute etiology. To the best of our knowledge, this is the first report presenting a case of acute mesenteric ischemia with segmental superior mesenteric artery occlusion.Ischemic bowel disease comprises mesenteric ischemia and colonic ischemia. Mesenteric ischemia can be divided into acute and chronic ischemia [1,2]. These are two separate entities, each with their specific clinical presentation and diagnostic and therapeutic modalities. However, diagnosis may be difficult due to the vague symptomatology and subtle signs.A 68-year-old Caucasian woman was admitted to our Department of Gastroenterology for persistent abdominal discomfort, melena, anorexia and fever for several months. She had a history of hypertension, cholecystectomy, hysterectomy and bilateral ovariectomy. Further questioning revealed diarrhea, melena and anxiety to eat (sitophobia) due to severe postprandial abdominal pain. She had lost 5 kg of bodyweight prior to presentation.On physical examination, tender palpation in the left lower quadrant
Isquemia mesentérica aguda por disección espontánea y aislada de la arteria mesentérica superior Mesenteric ischemia caused by a spontaneous and isolated dissection of the superior mesenteric artery  [cached]
Luis Burgos de C,Renato Mertens M,Francisco Valdés E,Albrecht Kr?mer Sch
Revista médica de Chile , 2002,
Abstract: Spontaneous dissection of the superior mesenteric artery is an unusual cause of mesenteric ischemia. Diagnosis can be based on findings of the helicoidal computed tomography or selective angiography of the superior mesenteric artery. We report two male patients, aged 47 and 50 years, who were admitted for abdominal pain. Isolated superior mesenteric artery dissection was confirmed by angiography. Both patients were treated with anticoagulation, conservative measures and recovered uneventfully (Rev Méd Chile 2002; 130: 1282-8).
Idiopathic Superior Mesenteric Vein Thrombosis Resulting in Small Bowel Ischemia in a Pregnant Woman
Hao Lin,Chih-Che Lin,Wan-Ting Huang
Case Reports in Obstetrics and Gynecology , 2011, DOI: 10.1155/2011/687250
Abstract: Background. Small bowel ischemia due to superior mesenteric vein thrombosis (MVT) is rare during pregnancy. However, additional precipitating factors should usually be identified. Case. A 31-year-old woman, pregnant at 34 weeks, was sent to the emergency department because of acute peritonitis. An emergency exploration revealed a segmental gangrene of the small intestine without any mechanical obstruction. Together with the termination of pregnancy, resection of the damaged small bowel was performed, and an end-to-end enterostomy was followed. Based on the operative and pathological findings, small bowel ischemia might be attributed to superior mesenteric vein thrombosis. Conclusion. Hypercoagulation state normally found in pregnant women is believed to lead to this catastrophic condition without other precipitating factors.
Melatonin prevents ischemia - reperfusion injury following superior mesenteric artery occlusion in the rat
Pasbakhsh P.,Saeednia S.,Abolhassani F.,Ghazi Khansari M.
DARU : Journal of Pharmaceutical Sciences , 2008,
Abstract: Background: Free radicals derived from molecular oxygen have been reported to be responsible for changes in motility and mucosal damages observed in intestinal Ischemia-Reperfusion (I/R) injury. Melatonin has been considered as an antioxidant that prevents injuries resulting from Ischemia/Reperfusion in various tissues. This study was designed to determine the effects of melatonin at a dose dependent manner in intestinal I/R damages by contractile responses of Malondialdehyde (MDA), a product of lipid peroxidation in rats.Material and methods: A total of 36 young male Wistar - Albino rats (80 - 120 g) were divided equally in to 6 groups and subjected to different concentration of melatonin (10, 20, 30 mg/Kg) .Group 1 was control, group 2 was sham that were subjected to surgical process for Superior Mesenteric Artery (SMA) dissection. Groups 3, 4, 5 and 6 were I/R that were given melatonin at 0, 10, 20 and 30 mg/kg respectively. After laparatomy, a microvascular traumatic clip was placed across the SMA under general anesthesia, and following ischemia for 30 minutes it was removed. The first dose of melatonin was administrated before, and the second dose was administrated just after reperfusion, and the third dose was administrated on the second day, all by intramuscular route. On the third day of the experiment all rats were killed, and their bowels were removed. Results: The levels of tissue malondialdehyde were found to be significantly lower in group 4 compared to group 3 (P < 0.05).There was significant differences in histopathological patterns of group 4 compared with group 3 (P < 0.01). MDA levels, in groups 5 and 6, showed no significant changes in comparison to I/R group.Conclusion: These results showed that Melatonin at dose of 10 mg/Kg has antioxidant effects and prevents rat intestinal ischemia - reperfusion damages.
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