Background: Acute mesenteric ischemia (AMI) represents a severe complication of chronic mesenteric ischemia (CMI) which is a disorder caused by severe stenosis or occlusion of mesenteric arterial supply. If untreated, patients could face mesenteric infarction and death.
Case report: A 41-year-old female smoker and drug abuser, previously treated with angioplasty and stenting of the superior mesenteric artery (SMA) for CMI four years before, was admitted to our institution suffering from acute abdominal pain due to complete occlusion of the stent. After a few hours of thrombolytic therapy, she experienced sudden worsening of clinical conditions, including AMI, due to complete rethrombosis of the SMA. Thereafter, she underwent urgent thrombectomy and a subsequent retrograde 6 mm prosthetic aorto-mesenteric bypass graft. The patient reported complete relief of symptoms afterwards. A CT scan at 1-month follow-up showed primary patency of the bypass in the absence of clinical recurrence.
Discussion: In cases of CMI, treatment options include surgical, endovascular or hybrid approaches. Endovascular therapy, based on percutaneous angioplasty with or without stenting, seems to be effective, although it can have worse midterm and long-term results.
Conclusion: In patients already treated with an endovascular revascularization of the SMA or celiac trunk (CT), open surgical repair through a single retrograde aorto-mesenteric prosthetic bypass in cases of acute mesenteric ischemia, seems to offer a valid and safe approach in order to prevent bowel infarction.
Key words: Acute mesenteric ischemia Angioplasty, Bypass, stent,Thrombolysis.
Riportiamo il caso di una ischemia mesenterica acuta gravemente sintomatica, complicanza tardiva di pregressa rivascolarizzazione endovascolare, insorta in modo inusuale in donna giovane. Il caso giunto alla nostra osservazione riguarda una giovane donna (41 a.), tabagica e con precedente abuso di droga, giunta alla nostra osservazione per reocclusione mesenterica di precedente PTA/stenting. Dopo un primo approccio endovascolare con infusione locoregionale di trombolitico, in seguito al drammatico peggioramento clinico, abbiamo provveduto di necessit al confezionamento in urgenza di by-pass aorto-mesenterico. Viene descritto il caso e viene fornita una revisione della Letteratura sullo specifico argomento.