Incident Thromboembolism in the Aorta and the Renal, Mesenteric, Pelvic, and Extremity Arteries After Discharge From the Hospital With a Diagnosis of Atrial Fibrillation

Frost, Lars; Engholm, Gerda; Johnsen, Søren Paaske; Møller, Henrik; Henneberg, E W; Husted, Steen

doi:10.1001/archinte.161.2.272

Cited by 130 publications

(91 citation statements)

References 30 publications

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“…Activated coagulation systems also cause mesenteric ischemia. In the Denmark study patients with peripheral arterial thromboembolism caused by atrial fibrillation occurred 29% in the mesenteric arteries, 2% in the renal artery and 61% in the extremities, and sometimes more than one site at the same time [6]. Generalized atherosclerosis is also major risk for acute mesenteric ischemia; Mishima Y reported 27% of 162 cases has general atheroma [7].…”

Section: Discussionmentioning

confidence: 99%

Acute Mesenteric Ischemia after Recurrent Embolic Stroke

Oguro¹,

Yamaguchi²

2015

Int J Gastroenterol Disord Ther

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We report the case of a 76-year-old woman with acute mesenteric artery ischemia and atrial fibrillation after recurrent embolic strokes. She had sudden severe abdominal pain and vomiting, and was admitted to the hospital in coma and shock state. Accompanied with metabolic acidosis and multiple organic failures, she died at 13 hours after the onset. Pathological examination revealed that acute thrombotic occlusion of superior mesenteric artery, splenic artery and right celiac artery. The occluded arteries pathologically showed progressive arteriosclerotic change and secondary multiple thrombi. This case demonstrated that atrial fibrillation with recurrent embolic stroke could cause mesenteric artery ischemia, progressive thrombi of abdominal viscera and sudden death. Acute Mesenteric Ischemia after Recurrent Embolic Stroke Keywords:Acute mesenteric ischemia, Recurrent embolic stroke, Case ReportOpen Access IntroductionAcute mesenteric artery ischemia is relatively rare acute abdominal vascular event caused by aging, atrial fibrillation, aortic atheroma and infectious endocarditis [1, 2]. The incidence is 5.3 per 100,000 inhabitants yearly, and its mortality is 60% to 80% [3]. It counts 0.4 % in patients with acute abdominal pain. Acute mesenteric ischemia is a life-threatening emergency that requires early diagnosis, intervention to restore mesenteric blood flow and resection of the necrotic bowel tissues by surgical treatments [4]. This report describes a patient with atrial fibrillation and recurrent stroke which rarely cause acute mesenteric ischemia and sudden death with multiple organic failures and lower limb ischemia. After stroke onset sudden abdominal pain and followed by shock state is suggestive of diagnosis of acute mesenteric ischemia. Case ReportA 77-year-old Japanese woman with atrial fibrillation and hypercardiomyopathy was treated by a cardiologist. Two months earlier she had embolic strokes of the right middle cerebral artery, then oral anticoagulation by warfarin had been administered to prevent recurrent stroke. In spite of controlling anticoagulant therapy by warfarin within two months, the prothrombin time-international normalized ratio(PT-INR) with 10 times analysis, three of ten times apparently showed inadequate values below the therapeutic range (0.93, 1.00 and 1.33). The CT scan of the head showed hemorrhagic infarction caused by recanalization after occlusion of the right middle cerebral artery (Figure 1). The echocardiography showed left atrial spontaneous echo contrast on previous stroke onset. On the 66 th day after the stroke onset, she experienced severe nausea, vomiting and abdominal pain in the morning, and delivered to our hospital. On arrival at our emergency department, she was coma. Her blood pressure could not be measured, and heart rater pulse was 124 bpm with irregular rhythm. Respiratory rate was 42/min and her temperature was 34.2 degrees. Right lower limb showed pale color and hemorrhagic purpura with pulseless iliac artery. Her abdomen showed rebound tenderne...

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Section: Discussionmentioning

confidence: 99%

Acute Mesenteric Ischemia after Recurrent Embolic Stroke

Oguro¹,

Yamaguchi²

2015

Int J Gastroenterol Disord Ther

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“…Bu trombüslerin kaynağı çoğunlukla kardiyak kökenlidir ve 600 hastayı kapsayan bir çalışmada, kardiyak kökenli bu trombüslerin periferde en sık ekstremite arterleri (%61), mezenterik arterler (%29), pelvik arterler (%9), aorta (%7) ve renal arterlerde (%2) tromboemboliye neden oldukları görülmüştür. 7 Dolaşımdaki kolesterol embolileri ise genellikle çapı 150-200 mm olan küçük arterleri tıkamakta olup, bunun böbrekteki karşılığı arkuat, interlobüler ve terminal arterlerdir. 8 Teşhiste görüntüleme yöntemi olarak renal ultrasonografi, izotoplu renal sintigrafi, ekskretuvar ürografi, BT ve selektif renal anjiyografi kullanılabilir.…”

Section: Discussionunclassified

Renal Infarction in a Patient with Psoriasis: Case Report

Yamaner¹,

Özbilen²,

Dervişoğlu³

et al. 2013

Turkiye Klinikleri J Med Sci

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“…Frost L et al [9] followed 30,000 patients with atrial fibrillation over a 13-year period and noted 2% incidence of renal artery embolism. Hazanov N et al [6] reported 44 cases of ARI in patients with atrial fibrillation over 18-year period.…”

Section: Discussionmentioning

confidence: 99%

Acute Renal Infarction: An Underdiagnosed Disorder

Baig

2012

J Med Cases

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Acute renal infarction is usually diagnosed when the triad of flank pain, hematuria and elevated lactate dehydrogenase is observed. Since the symptoms are non specific, diagnosis requires high degree of suspicion or may be missed or confused with renal colic. The incidence of ARI in emergency department visits is 0.007 % whereas in autopsy series is reported 1.4 % indicating the condition goes undiagnosed frequently. With the increase use of contrast enhanced computed tomography and magnetic resonance angiography the accuracy might be improving at the present time.

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Incident Thromboembolism in the Aorta and the Renal, Mesenteric, Pelvic, and Extremity Arteries After Discharge From the Hospital With a Diagnosis of Atrial Fibrillation

Abstract: A hospital diagnosis of AF is an important risk factor for peripheral arterial thromboembolic complications.

Cited by 130 publications

References 30 publications

Acute Mesenteric Ischemia after Recurrent Embolic Stroke

Acute Mesenteric Ischemia after Recurrent Embolic Stroke

Renal Infarction in a Patient with Psoriasis: Case Report

Acute Renal Infarction: An Underdiagnosed Disorder

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