Can Aortography Precipitate Mesenteric Infarction in Patients With Chronic Intestinal Ischemia? Case Studies

Three patients with symptoms suggesting chronic mesenteric ischemia underwent diagnostic aortography. All three patients were well-hydrated before, during and after the procedure, and no technical or physiologic mishaps occurred during the performance of the aortogram. The arteriograms demonstrated occlusion of two mesenteric vessels and severe stenosis of the remaining vessel in each patient. Bowel infarction occurred shortly after the radiographic procedure in all three patients.Angiographic contrast agents are hyperosmolar and can induce both localized and systemic hypovolemic states. These dyes also induce changes in the blood cells and vessel walls, especially in areas distal to critical stenoses, that tend to shift the ratio of prostacyclin to thromboxane in favor of thromboxane. It is recommended that operative intervention be planned soon after arteriographic confirmation of the diagnosis of chronic mesenteric ischemia because the radiographic contrast agent may induce changes that cause bowel inf...