血管医学および外科ジャーナル

概要

A Rare Case of Simultaneous Acute Embolic Occlusions of the Right Upper and Lower Extremity, Recanalized with Endovascular Thrombectomy

Stanislav Kernov*, Ivan Martinov

Acute thromboembolic events are limb-threatening complications, necessitating immediate treatment. Endovascular Thrombectomy (EVT) can be a simple, safe and well-tolerated treatment modality for patients with acute limb ischemia. We report a clinical case of EVT of acute simultaneous embolism of the right upper and lower extremity, which occurred in the settings of atrial fibrillation and long-term oral anticoagulation with Edoxaban. A 74-year-old female patient was admitted to our department, because of sudden onset of numbness, coldness and weakness of right upper and lower extremities. The main factor that can improve survival of patients with acute limb ischemia is early aggressive treatment aimed at restoring the patency of occluded arteries. Faced with the threat of the both limbs loss, the patient underwent simultaneous endovascular thrombectomy with AngioJet Â^® thrombectomy system (Boston Scientific) and could remove the clots, despite of distal embolization. The patient was discharged after a 3-day hospital stay. The most common cause of acute extremity ischemia is emboli from a cardiac source. When acute embolism occurs, it first manifests are sensory deficit, followed by a motor deficit and muscle weakness. Endovascular thrombectomy can be a simple, safe and well-tolerated treatment modality for patients with Acute Limb Ischemia (ALI). The AngioJet Â^® system creates a local low-pressure zone to entrain, fragment, and aspirate thrombi with the Venturi-Bernoulli's principle of fluid dynamics. However, this treatment should be performed in very experienced centers with this endovascular technique in different vascular territories and with full access to vascular surgical intervention in case of a failed endovascular approach. Knowledge of such cases is essential in order to create specific protocols for prophylaxis of thrombotic events and giving the priority to endovascular treatment over direct surgery due to its milder invasiveness and shortened hospital stay.