ABSTRACT
Acute mesenteric venous thrombosis is an uncommon condition that is usually treated with systemic anticoagulation. Catheter-directed thrombolysis through the superior mesenteric artery may be a viable adjunct to treat this morbid condition. In the present article, we have described a case of superior mesenteric venous thrombosis treated with catheter-directed infusion of tissue plasminogen activator through the superior mesenteric artery.
Subject(s)
Fibrinolytic Agents/administration & dosage , Ischemia/drug therapy , Mesenteric Vascular Occlusion/drug therapy , Mesenteric Veins , Thrombolytic Therapy , Tissue Plasminogen Activator/administration & dosage , Vascular Diseases/drug therapy , Venous Thrombosis/drug therapy , Acute Disease , Catheterization, Peripheral , Humans , Infusions, Intra-Arterial , Ischemia/diagnostic imaging , Male , Mesenteric Arteries , Mesenteric Ischemia , Mesenteric Vascular Occlusion/diagnostic imaging , Middle Aged , Tomography, X-Ray Computed , Treatment Outcome , Vascular Diseases/diagnostic imaging , Venous Thrombosis/diagnostic imagingABSTRACT
PURPOSE: The purpose of this study was to describe the preliminary results of prophylactic temporary balloon occlusion of the internal iliac arteries for bleeding control in patients with placenta accreta during cesarean hysterectomy. METHODS: From May 2006 to March 2010, 21 patients diagnosed with placenta accreta using ultrasound and/or magnetic resonance imaging were submitted to prophylactic balloon occlusion before hysterectomy. Fluoroscopy, balloon occlusion time, surgical duration, intraoperative blood loss, transfusion volume, and procedure complications were analyzed. RESULTS: The mean age was 30.5 years with a mean of 3.6 previous gestations. Imaging studies revealed that all patients had placenta accreta and all were submitted to cesarean hysterectomy. One hysterectomy was due to previous diagnosis of fetal death and another due to cesarean with uterine curettage. Mean fluoroscopy time was 7.5 min, balloon occlusion time was 164 min, and surgery duration was 260 min. Estimated blood loss was 1,671.5 ml with mean reposition fluids of 3,538 ml of crystalloids, 309.5 ml of colloids, and 1.24 ml of packed red blood cells. Two patients were submitted to thromboembolectomy due to prolonged surgical time. There was no maternal or fetal mortality related to the procedure. CONCLUSIONS: The results demonstrated that prophylactic balloon occlusion of internal iliac artery is a safe method and appears to reduce blood loss and transfusion requirements in patients diagnosed with placenta accreta who undergo cesarean hysterectomy. Antenatal imaging diagnosis of placenta accreta enables preoperative planning.
