HYBRID TREATMENT OF ACUTE ON CHRONIC MESENTERIC ISCHAEMIA ASSOCIATED WITH TAKAYASU’S DISEASE. CLINICAL CASE

Abstract

Introduction. Mesenteric ischemia remains a currently underdiagnosed pathology with high mortality rates in hospitals. In recent years, endovascular and hybrid approaches have widely begun to be used in the treatment of these patients.

Clinical case. We present the case of a 56-year-old woman diagnosed with acute on chronic mesenteric ischemia associated with Takayasu's arteritis. Considering the worsened medical history and imaging data, the decision was made to resort to hybrid intervention for the revascularization of the superior mesenteric artery. The following procedures were performed: direct and indirect thrombectomy from the superior mesenteric artery, open retrograde mesenteric stenting, and autologous venous patch plasty of the arterial defect. Intraoperatively, due to difficulties in passing the endograft from the retrograde approach, a brachial artery puncture and negotiation of the lesion from antegrade and retrograde approaches were employed. Immediate postoperative angiographic findings: restoration of anterograde flow in the superior mesenteric artery with good perfusion of the arterial territory; upon abdominal cavity revision, the liver (right lobe) and intestine were viable throughout. The patient's preoperative symptoms disappeared upon the commencement of feeding. Intestinal transit remained intact. Follow-up at 1 and 5 months confirmed stent patency. Discharged home in a satisfactory condition with tab. Clopidogrel 75 mg and tab. Rivaroxaban 5 mg treatment.

Conclusions. Mesenteric ischemia represents a devastating event that requires a prompt strategy for diagnosis and treatment. Hybrid intervention for the revascularization of the superior mesenteric artery stands as a safe and effective method in treating this pathology.