Mesenteric ischemia and distal atheroembolism due to penetrating aortic ulcer: case report

Introdução: A Úlcera Penetrante (UP) de Aorta é caracterizada pela formação de uma placa aterosclerótica ulcerada que pode embolizar e gerar eventos agudos vasculares importantes, devido a obstrução e isquemia de órgãos internos e à oclusão de vasos das extremidades. A Isquemia mesentérica, por sua vez, é uma das causas de abdome agudo vascular, gerada pela interrupção abrupta do aporte sanguíneo para os órgãos abdominais. Já o ateroembolismo distal refere-se à obstrução mecânica arterial devido a um êmbolo de colesterol com isquemia aguda, gerando um quadro clínico de dor e cianose, que pode levar à necrose do membro acometido. Objetivo: Relacionar a UP de aorta com eventos ateroembólicos, tais como a isquemia mesentérica e ateroembolismo distal. Relato de caso: Paciente feminina de 64 anos, com diagnósticos consecutivos de abdome agudo vascular por isquemia mesentérica e ateroembolismo distal do hálux esquerdo, ambos secundários à UP de aorta. Conclusão: Apesar de rara, a hipótese de UP de aorta como causa de eventos ateroembólicos não pode ser subestimada e, apesar de um manejo desafiador, sua suspeição precoce ajuda a minimizar complicações. Palavras chave: Doenças da aorta, Isquemia mesentérica, Ateroembolia, Abdome agudo Abstract Introduction: Penetrating Aortic Ulcer (PAU) is characterized by the formation of an ulcerated atherosclerotic plaque that can embolize and generate important acute vascular events, due to obstruction and ischemia of internal organs and occlusion of vessels in the extremities. Therefore, the mesenteric ischemia is one of the causes of vascular acute abdomen, generated by the abrupt interruption of the blood supply to the abdominal organs. Distal atheroembolism, on the other hand, refers to mechanical arterial obstruction due to a cholesterol embolus leading to acute ischemia, generating a clinical picture of pain and cyanosis, which can lead to necrosis of the affected limb Objective: To relate PAU with atheroembolic events, such as mesenteric ischemia and distal atheroembolism. Case report: A 64-year-old female patient with consecutive diagnoses of acute vascular abdomen due to mesenteric ischemia and distal atheroembolism of the left hallux, both secondary to PAU. Conclusion: Although rare, the hypothesis of aortic PU as a cause of atheroembolic events cannot be underestimated and, despite its challenging management, its early suspicion helps to minimize complications. Keywords: Aortic diseases, Mesenteric ischemia, Atheroembolism, Acute abdomen Introduction: Penetrating Aortic Ulcer (PAU) is characterized by the formation of an ulcerated atherosclerotic plaque that can embolize and generate important acute vascular events, due to obstruction and ischemia of internal organs and occlusion of vessels in the extremities. Therefore, the mesenteric ischemia is one of the causes of vascular acute abdomen, generated by the abrupt interruption of the blood supply to the abdominal organs. Distal atheroembolism, on the other hand, refers to mechanical arterial obstruction due to a cholesterol embolus leading to acute ischemia, generating a clinical picture of pain and cyanosis, which can lead to necrosis of the affected limb Objective: To relate PAU with atheroembolic events, such as mesenteric ischemia and distal atheroembolism. Case report: A 64-year-old female patient with consecutive diagnoses of acute vascular abdomen due to mesenteric ischemia and distal atheroembolism of the left hallux, both secondary to PAU. Conclusion: Although rare, the hypothesis of aortic PU as a cause of atheroembolic events cannot be underestimated and, despite its challenging management, its early suspicion helps to minimize complications.