At the King Danylo LNMU University Hospital, doctors performed a series of four complex operations on a 78-year-old resident of Lviv region to halt dangerous thromboembolic complications that threatened the loss of her leg and her life.
At first, Mrs Maria was being treated for a heart condition at her local hospital, but her condition deteriorated: her legs began to go numb and “give way”. The woman turned to the University Hospital where, after examinations and a CT scan, doctors diagnosed thromboembolism of the vessels of the lower limb. She underwent emergency surgery to prevent gangrene, amputation and severe complications, including kidney failure.
The intervention was carried out by vascular surgeons Professor Yuri Orel and Zoryana Ludyn. During the operation, they saw that the clot resembled a bacterial substrate in its structure, so it was sent for histological examination. After the clot was removed, blood flow to the leg was restored and the patient’s condition improved, but she later developed severe abdominal pain.
“There can be a situation where a clot from somewhere, most often from the heart, moves and first ends up in the legs, and then another fragment in a different area. Our patient developed thromboembolism of the mesenteric vessels, acute mesenteric ischaemia… In our patient, one potentially fatal situation turned into another,” said Professor Yuri Orel, vascular surgeon
The doctors performed a second vascular intervention – this time on the mesenteric vessels, restoring the blood supply to the bowel. To determine the source of the clots, cardiac surgeons and cardiologists were brought in for further assessment. Echocardiography revealed damage to the aortic valve against the background of infective endocarditis.
Cardiac surgeon Professor Lyubomyr Kulyk noted that the patient had an advanced rheumatic heart disease with pronounced valve stenosis, on which clots were forming. They were not firmly attached and, with the blood flow, travelled to various organs and vessels. Surgeons performed an operation to replace the diseased heart valve using cardiopulmonary bypass; the postoperative period passed without complications.
However, just before her planned discharge, the patient again experienced an episode of thromboembolism in the vessels of the intestine. At first, the doctors tried to resolve the problem using a minimally invasive endovascular technique via the vessels, but this attempt proved unsuccessful. Professor Yuri Orel then, together with the on-call team of vascular surgeons, urgently carried out what was now the fourth operation, once again removing clots from the artery supplying the bowel.
Thanks to the coordinated work of the University Hospital’s multidisciplinary team – vascular surgeons, cardiac surgeons, cardiologists and interventional specialists – all the procedures were successful, and the rehabilitation period passed without significant complications. Mrs Maria gradually recovered and returned to her normal life with her family.
The hospital highlights the contribution of the entire operating team: vascular surgeons Professor Yuri Orel, Zoryana Ludyn, Bohdan Havryliv and Vasyl Pelekh; cardiac surgeons Professor Lyubomyr Kulyk and Volodymyr Pryshlyak; cardiologist Iryna Bodak and interventional cardiologist Liliya Sorokhtey.