SUPERIOR MESENTERIC-ARTERY EMBOLY DURING RENAL PTA - SUCCESSFUL SURGICAL-TREATMENT AFTER FIBRINOLYSIS FAILURE

The paper presents a rare case of iatrogenic embolization of the super ior mesenteric artery which required an emergency operation after an u nsuccessful fibrinolytic treatment. An old woman, who had undergone re nal percutaneous angioplasty (r-PTA), presented sudden but transient a bdominal pain. Angiographic control of the angioplasty showed the goal of r-PTA but also an embolic occlusion of the main trunk of the super ior mesenteric artery that did not respond to a selective fibrinolytic treatment. Within a few hours, the abdominal pain appeared again and induced an exploratory laparotomy which showed an extensive ischaemia of the whole jejunum. A successful embolectomy was performed associate d with the resection of about 20 cm of necrotic jejunum. The postopera tive period was uncomplicated. The case underlines several topics: clo se collaboration is necessary between interventional radiologists and surgeons in order to get a surgical ''stand-by'' during PTA procedures ; the embolic occlusion of the superior mesenteric artery can produce irreversible, even if segmentary intestinal damage, also within a very short time after onset and, therefore, it seems to be at high risk fo r a fibrinolytic approach.