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Presentation and Management of Arterial Thromboembolisms during Active Inflammatory Bowel Disease: Case Series and Literature Review.
Pezold, Michael; Pergamo, Matthew; Rockman, Caron; Lugo, Joanelle.
Afiliación
  • Pezold M; Division of Vascular Surgery, New York University Langone Health, New York, NY.
  • Pergamo M; Department of Surgery, New York University Langone Health, New York, NY.
  • Rockman C; Division of Vascular Surgery, New York University Langone Health, New York, NY.
  • Lugo J; Division of Vascular Surgery, New York University Langone Health, New York, NY. Electronic address: Joanelle.Lugo@nyulangone.org.
Ann Vasc Surg ; 67: 532-541.e3, 2020 Aug.
Article en En | MEDLINE | ID: mdl-32220617
ABSTRACT

BACKGROUND:

Active inflammatory bowel disease (IBD) is associated with considerable risk for thromboembolism; however, arterial thromboembolism is rare and associated with considerable morbidity and mortality. Their management requires careful coordination between multiple providers, and as a consequence, much of the published literature is limited to case reports published across specialties.

METHODS:

We examined our recent institutional experience with aortoiliac, mesenteric, and peripheral arterial thromboembolisms in patients with either Crohn's disease or ulcerative colitis. To supplement our experience, a comprehensive literature review was performed using MEDLINE and EMBASE databases from 1966 to 2019. Patient demographics, flare/thromboembolism management, and outcomes were abstracted from the selected articles and our case series.

RESULTS:

Fifty-two patients with IBD, who developed an arterial thromboembolism, were identified (49 from published literature and 3 from our institution). More than 82% of patients presented during an active IBD flare. Surgical intervention was attempted in 77% of patients, which included open thromboembolectomy, catheter-directed thrombolysis, or bowel resection. Thromboembolism resolution was achieved in 76% of patients with comparable outcomes with either catheter-directed thrombolysis or open thrombectomy (83.3% vs. 68.2%). Nearly one-third of patients underwent small bowel resection or colectomy. In 2 patients, thromboembolism resolution was achieved only after total abdominal colectomy for severe pancolitis. Multiple thromboembolectomies were associated with higher risk for amputation. Overall mortality was 11.5% but was greatest for occlusive aortoiliac and mesenteric thromboembolism (14.3% and 57%, respectively). All survivors of occlusive superior mesenteric artery thromboembolism suffered short gut syndrome requiring small bowel transplant.

CONCLUSIONS:

Patients with IBD, who develop an arterial thromboembolism, can expect overall poor outcomes. Catheter-directed thrombolysis achieved comparable outcomes with open thromboembolectomy without undue bleeding risk. Total abdominal colectomy for moderate-to-severe pancolitis is an emerging strategy in the management of refractory arterial thromboembolism. Successful surgical management may include open thromboembolectomy, catheter-directed thrombolysis, and bowel resection when indicated.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Tromboembolia / Colitis Ulcerosa / Enfermedad de Crohn / Terapia Trombolítica / Trombectomía / Embolectomía / Colectomía / Isquemia Mesentérica / Oclusión Vascular Mesentérica Tipo de estudio: Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Idioma: En Revista: Ann Vasc Surg Asunto de la revista: ANGIOLOGIA Año: 2020 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Tromboembolia / Colitis Ulcerosa / Enfermedad de Crohn / Terapia Trombolítica / Trombectomía / Embolectomía / Colectomía / Isquemia Mesentérica / Oclusión Vascular Mesentérica Tipo de estudio: Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Idioma: En Revista: Ann Vasc Surg Asunto de la revista: ANGIOLOGIA Año: 2020 Tipo del documento: Article