ACUTE EMBOLISM OF THE SUPERIOR MESENTERIC ARTERY AND SIGNIFICANT STENOSIS OF THE CELIAC TRUNK SUCCESSFULLY TREATED WITH PERCUTANEOUS ANGIOPLASTY AND STENT IMPLANTATION

Among patients presenting with acute abdominal symptoms, patients with acute mesenteric ischemia (AMI) constitute 0.09% - 0.2% of cases. Unfortunately, due to the short period between the first symptoms and irreversible ischemic changes in the intestine, the mortality rate in this group is high - up to 60% - 100%. We present a case of a 75-yearold female with severe comorbidities (ischemic heart disease, atrial fibrillation, poorly controlled arterial hypertension, and a history of colorectal carcinoma previously treated with radio- and chemotherapy). The patient was admitted due to severe abdominal pain. Computed tomography (CT) confirmed superior mesenteric artery (SMA) and celiac trunk embolism. Due to the relatively short time of symptoms onset as well as the soft abdomen, the patient was qualified for percutaneous treatment. Successful percutaneous transluminal angioplasty was performed with stent implantation to SMA and celiac trunk (Neptun C, Balton, Poland). As a result, the patency of both arteries was fully restored. The patient's condition improved within 24 hours, and she was discharged home.

Ankle-Brachial Pressure Index Estimated by Laser Doppler in Patients Suffering from Peripheral Arterial Obstructive Disease

Ankle-brachial index (ABI) measurements are widely used for evaluating the functional state of circulation in the lower limbs. However, there is some evidence that the value of ABI does not accurately reflect the degree of walking impairment in symptomatic patients with peripheral arterial obstructive disease (PAOD). We investigated the diagnostic value of ABI estimated by means of laser Doppler flowmetry (IT) for evaluating limb ischemia. We wanted to know whether laser Doppler could be more sensitive than the Doppler method in predicting walking capacity in patients with stable intermittent claudication. We analyzed a group of 30 patients with intermittent claudication (Fontain II, II/III) who were admitted for reconstructive treatment. There were 21 men and 9 women, aged 46-74 (mean 61) years. All patients underwent the treadmill test, and pain-free walking distances were measured. In each patient, we measured ABI using the two different methods: Doppler ultrasound device (ABI-Doppler) and laser Doppler (ABI-laser Doppler). The claudication distances were 25-200 m (mean 73 +/- 50.2 m). ABI-Doppler was 0.2-0.7 (0.582 +/- 0.195). ABI-laser Doppler measurements were 0.581 (+/-0.218). A correlation was found between ABI-Doppler and claudication distance (r = 0.46, P = 0.009). Also, ABI-laser Doppler values significantly correlated with claudication distances (r = 0.536, P = 0.002). The ABI evaluated by laser Doppler correlated well with claudication distances in patients with PAOD. Comparison of Doppler and laser Doppler measurements used for determining ABI showed that both methods have similar predictive power for walking capacity; however, higher correlation was observed between claudication distances and ABI measured by laser Doppler flowmetry. ABI-laser Doppler measurements are easier, are quicker, and seem to be better suited for noncompliant patients. Further investigation should be undertaken to determine whether laser Doppler is superior to the Doppler method in advanced occlusive arterial disease.