A 55-year-old female patient with a history of chronic smoking, moderate arterial hypertension and dyslipidemia under treatment, whose condition began in 2002, characterized by early postprandial abdominal pain, accompanied by frequent diarrhea and vomiting caused by a low weight of about 15 kg.
Studyed in the context of chronic diarrhea and search for inflammatory bowel disease, she underwent upper and lower endoscopy, as well as enteroscopy, intestinal transit and malabsorption study, which only concluded by responding to non-specific drugs, ulcerative colitis.
In January 2004, Doppler ultrasound of visceral arteries was performed, showing a speed of 400 cm/sec in the celiac trunk, compatible with stenosis 90%, occlusion of the collateral artery and upper occlusion month also by its upper occlusion.
An abdominal angiotac confirmed these findings.
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Given the important malnutrition conditions of the patient, he was considered to have high surgical risk, so in March of that year, angiographic study was performed and he was installed with an expanded balloon stent weight 17 mm.
However, after two months, abdominal pain and diarrhea reappeared, so it was controlled with abdominal echodoppler that revealed speeds of 400 cm/sec at the level of celiac trunk, compatible with significant stenosis.
A new angiography was performed, where a celiac trunk occlusion was investigated, and a second stent was placed expandable balloon in the proximal portion of the celiac trunk.
She remained asymptomatic until November, and again began with pain, diarrhea and vomiting.
A third Doppler ultrasound of the visceral arteries showed a velocity of 417 cm/sec in the celiac trunk, so he underwent a third angiographic study that showed a significant celiac trunk stent with permeable stenosis.
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After the last angiographic study, performed via the right femoral artery, always using the same access route for the other angiographic studies, the patient experienced severe claudication-like pain, which made her new limb ischemia re-admitted in December.
Nine angiographic studies revealed segmental stenosis of the femoral artery and thrombosis of the anterior tibial artery, which resolved with balloon angioplasty, improving limb ischemia.
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Due to the persistence of his discomfort and weight loss of about 5 kilos, he consulted in January 2005 in our hospital, this time with the vascular surgery team where a new celiac artery was punctured at a critical velocity of 4 cm.
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A surgical revascularization was proposed.
It was evaluated from the cardiological point of view with electrocardiogram and echocardiogram that were normal.
Among the blood tests only stood out anemia with hematocrit of 20% secondary to their nutritional status, weighing 45 kg.
Finally, on February 22, he underwent upper mesenteric bridge reconstruction with PTFE ring prosthesis of 6 mm and a prosthesis reimplantation of the inferior mesenteric artery at origin.
The postoperative evolution was uneventful, with realisation without problems, disappearance of postprandial pain and diarrhea, and recovery of weight.
At the date of this communication, one year after surgery, an angiotac revealed patency of the revascularization.
