When a 35-year-old man arrived at Burjeel Hospital’s emergency department complaining of severe back and left shoulder pain, medical staff initially suspected a common musculoskeletal issue. However, what they discovered would prove to be one of the most challenging and rare vascular emergencies ever treated at the facility.
The Mystery Behind Persistent Pain
The patient had been experiencing excruciating pain for five days, visiting two other hospitals without receiving a definitive diagnosis. His symptoms were persistent and debilitating, affecting his daily activities and causing significant distress.
Upon arrival at Burjeel Hospital, the medical team immediately recognized the severity of his condition and ordered comprehensive diagnostic tests, including a full blood workup and CT angiogram.
A Shocking Discovery: Multiple Vascular Abnormalities
The CT angiogram revealed a medical emergency that would challenge even the most experienced vascular specialists. The imaging showed serious bleeding from a ruptured left hepatic artery aneurysm, but this was just the beginning of a complex vascular puzzle.
Further examination revealed an extremely rare condition called Segmental Arterial Mediolysis, which had caused multiple life-threatening vascular abnormalities throughout the patient’s body:
- Ruptured left hepatic artery aneurysm causing active bleeding
- Dissection in the right internal carotid artery
- Aneurysm in the right common carotid artery
- Bilateral renal artery dissections with massive kidney damage
- Calcified false aneurysm in the right common iliac artery
- True aneurysm in the left iliac artery
Advanced Endovascular Treatment: A Life-Saving Intervention
Dr. Mohamed Almarzooqi, Medical Director and Consultant Interventional Radiologist, led the treatment approach. The primary concern was the actively bleeding hepatic artery aneurysm, which required immediate intervention to prevent life-threatening hemorrhage.
Using minimally invasive endovascular techniques, the surgical team successfully treated the leaking aneurysm by placing coils through the right common femoral artery. This advanced procedure stopped the bleeding and stabilized the patient’s condition.
Unexpected Complications and Heroic Medical Response
While the initial treatment was successful, the patient’s journey was far from over. He subsequently developed a right common femoral artery false aneurysm at the access site, which later ruptured into the right thigh.
This complication required an open surgical approach and became extremely complex when the patient developed Disseminated Intravascular Coagulation (DIC) and experienced massive bleeding. The medical team’s heroic response included:
- Administration of 124 units of blood and blood products
- Management of extensive open wounds in the lower abdomen and upper thigh
- Innovative wound healing using negative pressure dressing therapy
The Challenge of Conflicting Medical Needs
This case presented a unique medical dilemma that highlighted the complexity of treating Segmental Arterial Mediolysis. The patient had two conflicting medical needs:
- Arterial dissections typically require anticoagulation therapy
- Multiple aneurysms and active bleeding contraindicate blood thinners
Dr. Moatasiem Bukhari, Consultant Vascular Surgeon, worked closely with the interventional radiology team to navigate this challenging balance between preventing clot formation and controlling bleeding.
Remarkable Recovery and Long-term Outlook
After approximately two months of intensive care and treatment, the patient was successfully discharged from the hospital. His recovery has been remarkable, demonstrating the effectiveness of Burjeel’s multidisciplinary approach to complex vascular conditions.
The patient continues under regular follow-up care, with monitoring for any changes in his remaining vascular abnormalities. His case serves as a testament to the importance of:
- Early recognition of complex vascular emergencies
- Advanced diagnostic imaging capabilities
- Multidisciplinary expertise in interventional radiology and vascular surgery
- State-of-the-art endovascular treatment options
Why Choose Burjeel for Complex Vascular Emergencies?
This case demonstrates Burjeel’s commitment to treating even the most challenging medical conditions. Our facilities are equipped with:
- Advanced imaging technology including CT angiography
- Hybrid operating rooms for combined procedures
- Experienced vascular specialists trained in the latest techniques
- Comprehensive blood banking and transfusion services
- Intensive care units for complex post-operative management
