Abstract 361: Multifocal Vascular Disorders Due to the Uncommon Anti-phosholipid Antibody Syndrome

Abstract

Purpose: We report three cases with uncommon anti-phosholipid antibody syndrome. The difficulty in diagnosing as well as treatment procedures for multifocal vascular disorders is discussed. Patients and Methods: All patients were examined and were initially treated for digestive disorders. Patient 1, 84-year-old woman, with gastrointestinal bleeding Patient 2, 76-year-old man, with sudden onset of upper abdominal pain Patient 3, 54-year-old man, with nausea and vomiting, liver dysfunctionClinical manifestation was superior mesenteric artery (SMA) thrombosis in the patient 1 and 2, and portal vein thrombosis in the patient 3. Serial CT scans were examined on 64 multidetector-row CT; Hitachi and GE, with bolus injection of contrast media for CT angiography. Abdominal angiography and coronary angiography with endovascular intervention performed on were performed on Allura; Philips. Results: CTA of for patient 1 and 2 showed decreased contrast enhancement of SMA and SMV enhancement. The intestinal enhancement was poor in patient 1 and well preserved in patient 2. A week later, patient 1 died suddenly due to multiple organ failure. Although the symptom improved in patient 2, the follow-up CT revealed the enlargement ofSMA thrombosis. The aspiration and the dissolution of SMA thrombosis were performed and resulted in complete recanalization. Then he felt chest oppression and 75% stenosis of RCA #4, followed by complete spastic occlusion on Acetylcholine loading on the coronary angiography, which recovered perfectly with intracoronary nitroglycerin administration.He discharged our hospital with health, while he developed cerebellar infarction. On patient 3, to resolve portal hypertension, balloon-occluded retrograde transvenous obliteration and splenic arterial embolization were successfully performed. Discussion and Conclusions: Acute deterioration encountered in patient 1, the progressive SMA thrombosis with coronary disease and subsequent cerebellar occlusion seen in patient 2, and portal vein thrombosis and portal hypertension without chronic hepatitis, cirrhosis or alcoholic liver damage in the patient 3 were seemed to be unusual. To discover underlining disorders such as uncommon anti-phosholipid antibody syndrome is important to prevent serious vascular diseases in sequence.