An Uncommon Complication of a Common Endovascular Procedure

Background: At a time when endovascular treatment is increasingly being regarded as the first-choice treatment for chronic mesenteric ischemia (CMI), we describe a case of reperfusion injury, an uncommon complication following endovascular superior mesenteric artery (SMA) stenting for CMI.

Materials and Methods: We present a patient with postprandial abdominal pain and weight loss for 10 months, with CT abdominal angiography showing complete occlusion of celiac axis and 70 to 80% stenosis of proximal superior mesenteric artery and 80 to 90% stenosis of ostioproximal inferior mesenteric artery. He was taken up for endovascular stenting of SMA, the procedure went well with no intra and periprocedural complication. He developed abdominal distension, limb edema, and bleeding per rectum within the next few days. Blood investigations revealed fall in hemoglobin and serum albumin. Repeat CT angiography revealed that the stent was patent and there was presence of ascites with bowel wall edema and hyperemia. Patient was managed conservatively with complete resolution of symptoms in next 10 days.

Results: The above symptoms and imaging findings may be attributed to reperfusion injury of the bowel due to restoration of blood flow after prolonged ischemia. Reperfusion syndrome is an entity more commonly described following treatment of carotid stenosis and peripheral arterial occlusion. Limited literature is available of reperfusion syndrome following endovascular revascularization of CMI. Reperfusion injury can present with symptoms ranging from mild abdominal pain to multiorgan failure or severe inflammatory response syndrome. The risk of reperfusion is more if stenosis is severe, prolonged ischemia and all the vessels are diseased.

Conclusion: Reperfusion injury is a rare but significant complication of revascularization following CMI recorded. Knowledge of reperfusion injury is important to differentiate between other relatively common complications, like stent thrombosis/occlusion and mesenteric arterial injury, leading to hemoperitoneum.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
14 December 2021