Predstavujeme prípad pacientky s akútnou ischémiou na hornej aj dolnej končatine v dôsledku paradoxnej embolizácie. 67-ročná žena bez anamnézy venózneho tromboembolizmu utrpela v novembri 2017 dislokovanú fraktúru pately s potrebou operačného riešenia. Dva mesiace po operácii bola rehospitalizovaná pre obojstrannú embóliu do arteria pulmonalis, oklúziu ľavej arteria subclavia, ľavej arteria femoralis communis a arteria mesenterica superior. Transezofageálna echokardiografia zistila prítomnosť foramen ovale patens. Cievny chirurg neindikoval embolektómiu a intervenčný rádiológ neindikoval farmakomechanickú trombolýzu z dôvodu veľkého rozsahu oklúzie. Následne bola úspešne podaná systémová trombolýza (altepláza) s rozpustením embolov v ľavej arteria subclavia, v ľavej arteria femoralis communis a v arteria mesenterica supeior.

We present a case report of a patient with acute upper and lower limb ischemia due to paradoxical embolism. A 67-year old woman without history of venous thromboembolism suffered dislocated patellar fracture requiring surgery in November 2017. Two months after surgery she presented to the emergency room with bilateral pulmonary embolism, occlusion of the left subclavian artery, left common femoral artery and superior mesenteric artery. Transesophageal echocardiography detected patent foramen ovale. Vascular surgeon decided against embolectomy, interventional radiologist against pharmacomechanical thrombolysis due to the extent of the occlusions. Systemic thrombolysis (alteplase) was administered successfully with resolution of the emboli in the left subclavian artery, left common femoral artery and superior mesenteric artery.

4 th Department of Internal Medicine Faculty of Medicine Comenius University in Bratislava and University Hospital Bratislava St Cyril and Method Hospital Slovak republic

Rádiológia s r o University Hospital Bratislava St Cyril and Method Hospital Slovak Republic

Akútna končatinová ischémia v dôsledku paradoxnej embolizácie liečená systémovou trombolýzou