Fortis Doctors successfully treat a rare case of arterial blockage with a multidisciplinary approach

Jaipur, January XX 2022: In one of the rare kind of cases reported at Fortis Jaipur, Dr. Ashwani Kumar Sharma, Consultant, Cardiology at Fortis Escorts Hospital, Jaipur treated an unusual case of abdominal pain triggered by an arterial blockage in a 44-year-old man through multi-disciplinary approach.

Dr. Sharma came across the rare case where a 44-year-old man had been complaining about abdominal pain for past five days. Later, CT abdomen reports revealed that the patient was suffering from   blockage in the artery supplying blood to the intestine (Superior Mesenteric Artery). Further evaluation, was performed through Endovascular Imaging with IVUS technique, which revealed an elongated clot over the ruptured plaque (blockage).

The patient had suffered similar but less intense pain 9 months ago which was treated with over the counter medication and provided relief to him thus no further evaluation was performed. Then, recently the patient had began suffering from abdominal pain and underwent thorough evaluation. The patient's initial upper GI endoscopy was performed at Kota which suggested normal results. CT abdomen was done which revealed thrombus (clot) in his SMA (Superior Mesenteric Artery) which supplies the blood to the intestine. Post evaluation at Kota, the patient came to Fortis Jaipur and was initially admitted under Dr. Lokesh Goyal, GI Surgeon. After thorough evaluation Dr. Goyal suggested that the patient didn’t need surgery since the intestine was not damaged. 

The case was further referred to Dr. Ashwani Kumar, Consultant Cardiology who performed his angiography, which revealed 90 percentage blockage in the superior mesenteric artery measuring 30 mm in length without obvious thrombus (clot).

“We had earlier decided of performing an angioplasty with stent implantation, but the symptoms weren't matching. The stable-looking lesion (blockage) was causing recurrent acute pain. Usually pain occurs in these kind of lesions once they get ruptured with superimposed thrombus formation causing complete or near complete occlusion. To further evaluate, we used the IVUS technique which identified that there was a plaque, 39 mm in length. It was ruptured at the distal end with superimposed thrombus (clot) formation (now called unstable blockade) and this clot was freely-hanging for another 40 mm beyond this lesion,” explained Dr Ashwani. 

He further shared, “Due to heavy thrombus CDT (Catheter Directed Thrombolysis) was planned. However, the patient developed severe pain after 2 hours and wasn't even responding to painkillers. The patient was taken for angioplasty and stenting. Now, when the IVUS was repeated, the clot burden had reduced to 30 mm in length. We then deployed an 80 mm stent successfully and the patient was immediately pain-free. He recovered fully within two days with no pain and was discharged on medication."

Dr. Ashwani further stressed the need for the correct technique and procedure, "For this particular case, on basis the angiography reports, a 40- 50 mm stent was used, the clot would have definitely migrated into the distal smaller branches leading to further complications.  We don't come across such cases of acute blockage in abdominal arteries too often. Another challenge with such cases is that they are reported in later stages, when we are left with no other options other than removing the permanently damaged intestine called gangrenous intestine. The patient in this particular case was a smoker, which might have been a possible risk factor leading to such large clot formation."