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Presentation and Management of Arterial Thromboembolisms during Active Inflammatory Bowel Disease: Case Series and Literature Review.
- Source :
-
Annals of vascular surgery [Ann Vasc Surg] 2020 Aug; Vol. 67, pp. 532-541.e3. Date of Electronic Publication: 2020 Mar 24. - Publication Year :
- 2020
-
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.<br />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.<br />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.<br />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.<br /> (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Amputation, Surgical
Colitis, Ulcerative complications
Colitis, Ulcerative diagnosis
Colitis, Ulcerative mortality
Crohn Disease complications
Crohn Disease diagnosis
Crohn Disease mortality
Female
Humans
Limb Salvage
Mesenteric Ischemia diagnostic imaging
Mesenteric Ischemia etiology
Mesenteric Ischemia mortality
Mesenteric Vascular Occlusion diagnostic imaging
Mesenteric Vascular Occlusion etiology
Mesenteric Vascular Occlusion mortality
Middle Aged
Risk Factors
Thromboembolism diagnostic imaging
Thromboembolism etiology
Thromboembolism mortality
Time Factors
Treatment Outcome
Colectomy adverse effects
Colectomy mortality
Colitis, Ulcerative surgery
Crohn Disease surgery
Embolectomy adverse effects
Embolectomy mortality
Mesenteric Ischemia therapy
Mesenteric Vascular Occlusion therapy
Thrombectomy adverse effects
Thrombectomy mortality
Thromboembolism therapy
Thrombolytic Therapy adverse effects
Thrombolytic Therapy mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1615-5947
- Volume :
- 67
- Database :
- MEDLINE
- Journal :
- Annals of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 32220617
- Full Text :
- https://doi.org/10.1016/j.avsg.2020.02.025