Bir Kedide Aortik Tromboembolizm Vakası: Kateter Yönlendirmeli Balon Trombektomi Uygulaması

Öz

Kedilerde aortik tromboembolizm; ani başlayan, arka ekstremite felci, şiddetli ağrı ve femoral nabız kaybı ile karakterize, hızlı müdahale gerektiren vasküler, kritik bir acil durumdur. Bu makalede; bilateral arka ekstremite paralizisi ile kliniğe başvuran dört yaşlı, kastre erkek kedide tanımlanan aortik tromboembolizm olgusu tanı ve tedavi protokolü yönüyle tartışıldı.  Kontrast bilgisayarlı tomografi bulguları, bilateral kan akım kaybını destekleyen fizik muayene bulguları ile uyumlu olarak, her iki arka ekstremite perfüzyonunu etkileyen trifurkasyon düzeyi bir trombüs varlığını ortaya koydu. Hasta sahip olduğu metabolik bozukluklar ve hemodinamik instabilite nedeniyle açık cerrahi arteriyel trombektomi için riskli olarak değerlendirildi. Bu nedenle tedavi protokolünde minimal invaziv bir yaklaşım olan floroskopik kateter destekli balon trombektomi tercih edildi. Bu amaçla yararlanılan Fogarty kateteri başlıca beşeri tıpta kendine uygulama alanı bulmakla birlikte, sunulan olguda floroskopi altında, kedi femoral arter çapına uygun kontrollü şişirme yapılan balon trombektomi tekniği kullanıldı. Acil kategorisinde değerlendirdiğimiz bu hastada öncelikle sağ femoral artere uygulama yapıldı. İşlem sonrası kan akımı yeniden sağlandı. Bununla birlikte, bu ilk girişim sonrası hastanın durumu akut olarak kötüleşti ve sol femoral arter balon trombektomi uygulanmadı. Hasta yoğun bakıma alındı. Operasyon öncesi metabolik yük ve muhtemel iskemi-reperfüzyon hasarına bağlı kedi erken postoperatif dönemde kaybedildi. Bu olgu; risk taşıyan akut feline aortik tromboembolizm durumlarında, acil tedavide minimal invaziv kateter destekli balon trombektominin potansiyel bir alternatif oluşturabileceğine ve reperfüzyon sonrası dönemde dikkatli klinik yönetime vurgu yapmaktadır.

Anahtar Kelimeler

• Trombüs
• Femoral arter
• İskemi
• Reperfüzyon
• Fogarty kateteri

A Case of Aortic Thromboembolism in a Cat: Application of Catheter-Directed Balloon Thrombectomy

Öz

Feline aortic thromboembolism is a critical vascular emergency characterized by the acute onset of hindlimb paralysis, severe pain, and loss of femoral pulses, requiring rapid intervention. In this article, a case of aortic thromboembolism identified in a 4-year-old neutered male cat presenting with bilateral hindlimb paralysis was discussed in terms of diagnostic and treatment protocols. Contrast-enhanced computed tomography findings revealed the presence of a trifurcation thrombus affecting perfusion to both hindlimbs, in accordance with physical examination findings suggestive of bilateral loss of blood flow. The patient was considered high risk for open surgical arterial thrombectomy due to existing metabolic disturbances and hemodynamic instability. For this reason, fluoroscopically guided catheter-directed balloon thrombectomy, a minimally invasive approach, was preferred in the treatment protocol. Although the Fogarty catheter used for this purpose is primarily applied in human medicine, in the present case a balloon thrombectomy technique was used under fluoroscopic guidance, with controlled inflation adjusted to the diameter of the feline femoral artery. In this patient, which was evaluated as an emergency case, the procedure was initially performed on the right femoral artery. Following the procedure, blood flow toward the right side was successfully restored. However, after this initial intervention, the patient’s condition acutely deteriorated, and balloon thrombectomy of the left femoral artery was not performed. The patient was transferred to the intensive care unit. But, the cat died during the early postoperative period due to the preoperative potential metabolic burden and likely ischemia–reperfusion injury. This case emphasizes that minimally invasive catheter-directed balloon thrombectomy may represent a potential alternative in the emergency treatment of high-risk acute feline aortic thromboembolism and highlights the importance of careful clinical management during the post-reperfusion period.

Anahtar Kelimeler

• Thrombus
• Femoral artery
• Ischemia
• Reperfusion
• Fogarty catheter

Kaynakça

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