Use of ICG imaging to confirm bowel viability after upper mesenteric stenting in patient with acute mesenteric ischemia: Case report

INTRODUCTION: Acute mesenteric ischemia (AMI) is a rare and life-threatening disease. Despite modern advances in open and endovascular treatments it has unacceptably high mortality rate. PRESENTATION OF CASE: A 70-year-old man with NSTEMI was diagnosed with acute mesenteric ischemia on the 3rd day after primary coronary intervention. CT with intravenous contrast revealed a generalized abdominal aorta atherosclerosis and a circular thrombus in SMA. Then a superior mesenteric angiography with aspiration thrombectomy, percutaneous transluminal angioplasty and stenting was performed. The next day abdominal pain still persisted. A diagnostic laparoscopy with ICG fluorescence was implemented. There were no ischemia and necrotic changes. The patient was alive at 4 months after the operative treatment of AMI. DISCUSSION: In patients with myocardial infarction, atrial fibrillation, accompanied by any invasive procedure, especially endovascular, the incidence of thrombosis and thromboembolic complications is high. This is the key to the suspicion of such a serious complication as AMI. It can be assumed that in some cases, with adequate revascularization of the small intestine, reperfusion syndrome may occur and cause ischemic necrosis of the intestinal wall. In this case it is necessary to perform control laparoscopy in 24–48 h. CONCLUSION: In patients with suspected AMI timely applying of MDCT, angiography, endovascular revascularization and ICG quality control of perfusion after revascularization are expedient to improve the results of treatment. These patients should be treated by a multidisciplinary team consisting of a cardiologist, a cardiovascular and endovascular surgeon, a general surgeon with experience in working with such patients.