Multiple (multi-sited) thromboembolism: a clinical model

Degtyarev Oleg L., Lageza Arkadiy B., Demin Konstantin A., Sagatelyan Susan A.

INTRODUCTION. In clinical medicine, simulation of pathologies serves as the primary method of pathophysiology and pathogenesis research. Transferability of experimental data into routine clinical practices is a criterion indicating adequacy of the created model. Classification and analysis of individual medical cases lay the path to development of an optimal method to study the pathogenic process. Massive micro-thromboembolism of the arterial bloodstream in the pancreatobiliary area results in blood supply disconnection from the existing arterial vessels and collateral circulation formed earlier representing an essential factor in acute ischemic injury of pancreatic parenchyma. Blood supply of the organ appears to be insufficient in shock-induced hypotension state. TARGET. Prove and study the possibility of multiple thromboembolic lesions of the pancreatobiliary zone with passage through the "pulmonary" filter. MATERIAL AND METHODS. Based on the analysis of 93 fatal outcomes of general in-patient care cases in the context of acute pancreas ischemia research, necrosis of pancreatic parenchyma was revealed in 8 cases. Among these occasions, the key role in the development of pancreatic ischemia belonged to multiple thromboembolism manifestations in 5 cases. Clinical model of multiple thromboembolism was formed using 41 fatal case records as the basis. RESULTS. In accordance with the performed analysis of materials and defined purpose of the created clinical model, the probability of multiple thromboembolism including the arterial bed of the pancreatobiliary area (celiac trunk, hepatic artery, splenic artery, pancreaticoduodenal branches) was proven as well as the probability of pancreatic necrosis development resulting from PBA micro-thromboembolism. The source causing micro-thromboembolism may have different locations and pathogenesis. CONCLUSION. Probable permeability of "pulmonary filter" between the source of thromboembolism risk and the target organ was proven.

Keywords:clinical model, thromboembolism of the pancreas, necrosis of the pancreas, "pulmonary filter", acute ischemic pancreatopathy.