Akute Verschlüsse der Viszeralgefäße

Abstract

Acute occlusions of the visceral vessels are rare findings but most often occur in visceral arteries due to thromboembolism in patients with atrial fibrillation. Symptoms can range from abdominal discomfort, increased transaminases, gastrointestinal bleeding to segmental splenic infarctions. Massive thrombosis of the hepatic arteries has often a grim prognosis. Occlusion of the mesenteric artery leads to an ischemic syndrome with abdominal pain and leukocytosis often associated with a history of heart disease. After a silent period (7-12 h), aggravating shock symptoms, peritonitis and paralytic ileus develop. Often segmental embolisation can result in later intestinal stenosis. Emboli can develop in aneurysms, in patients with arteritis and after an accident. A non-occlusion disease can occur due to functional or angiospastic ischemias which can be induced by several drugs (ergotism, digitalis, catecholamines), heart insufficiency or during shock. Only angiographic imaging, e.g. angio-CT or DSA can prove visceral vessel occlusions in the early phase. Treatment can be done by catheter lysis or surgical in more severe cases. Embolectomy with a Fogarty catheter is sometimes possible in case of embolic occlusion, infarcted areas need to be resected.