A Rare Case of Ischemia–Reperfusion Injury After Mesenteric Revascularization

Abstract

Endovascular treatment of chronic mesenteric ischemia is currently the treatment of choice, regardless of the number of involved vessels. Unlike other anatomic areas, the hyperperfusion produced by revascularization and the consecutive reperfusion syndrome is only described in cases of acute bowel ischemia, which is usually resolved with traditional surgery. We present a case of severe hyperperfusion syndrome secondary to endovascular correction with stents of a critical ischemia affecting the celiac trunk and superior mesenteric artery.

Chronic mesenteric ischemia: Clinical practice guidelines from the Society for Vascular Surgery

“…Endovascular revascularization for CMI can be associated with both local and systemic complications from the intervention and underlying disease process. 132,133 The perioperative complications were lower after the endovascular approach and these lower rates partly justify the endovascular-first approach as detailed elsewhere in this article. Not surprisingly, access complications, contrast-induced renal insufficiency, target vessel dissection, device failure, and arterial embolization have all been reported after interventions for CMI.…”

Reperfusion Injury—Postendovascular Recanalization in Chronic Mesenteric Ischemia: A Rare Clinical Case Scenario

“…This complex and multifactorial pathophysiological process is not yet fully understood and has been studied in preclinical models in various organs, particularly the heart, brain, liver, and intestine. 3 The intestine is one of the most sensitive organs for RI. In RI injury, the barrier function of the mucosa is destroyed, and vascular permeability is increased.…”

“…2 However, given the spectrum of gastrointestinal disturbances associated with abdominal pain and weight loss, the diagnosis is often made late. 3 Most patients present with occlusion or stenosis of superior mesenteric artery (SMA) and at least one other mesenteric vessel, most commonly the celiac trunk. Endovascular therapy is the first line of treatment.…”

Reperfusion injury on computed tomography following endovascular revascularization of acute mesenteric ischemia: prevalence, risk factors, and patient outcome

“…Preclinical imaging studies using computed tomography (CT) or magnetic resonance imaging (MRI) to assess RI are scarce [ 25 – 28 ]. In clinical research, RI has been described as a component of ischemic colitis [ 29 , 30 ], in non-occlusive mesenteric ischemia [ 31 ], or in a case report following endovascular revascularization of severe chronic mesenteric ischemia [ 32 ]. All consistently report a thickening of the bowel wall due to submucosal edema and/or hemorrhage with adjacent fat stranding and ascites either after revascularization [ 32 ] or spontaneously in non-occlusive mesenteric ischemia [ 31 ] or colon infarction [ 29 ].…”

“…In clinical research, RI has been described as a component of ischemic colitis [ 29 , 30 ], in non-occlusive mesenteric ischemia [ 31 ], or in a case report following endovascular revascularization of severe chronic mesenteric ischemia [ 32 ]. All consistently report a thickening of the bowel wall due to submucosal edema and/or hemorrhage with adjacent fat stranding and ascites either after revascularization [ 32 ] or spontaneously in non-occlusive mesenteric ischemia [ 31 ] or colon infarction [ 29 ]. In contrast to the extensive literature of preclinical studies of bowel RI [ 33 ], no clinical research has been published on RI in AAMI.…”