Yonsei Med J.  2011 Sep;52(5):859-862. 10.3349/ymj.2011.52.5.859.

Rapidly Aggravated Dissecting Flap by Angiography during Percutaneous Stent Placement for Acute Isolated Superior Mesenteric Artery Dissection

• Yang HJ
• Cho YK
• Son TJ
• Jung YY
• Choi SA
• Lee SH

• KMID: 1108082
• DOI: http://doi.org/10.3349/ymj.2011.52.5.859

Abstract

Acutely aggravated dissecting flap and consequent occlusion of the superior mesenteric artery (SMA) by simple contrast passage during initial angiography for percutaneous stent placement is a uncommon event, which usually is not reported. After analysis of many factors that underlie development of such complications, we present herein one case of successful treatment of isolated SMA dissection and its complications with favorable outcomes during 25 months follow-up after percutaneous stent placement.

Keyword

Superior mesenteric artery dissection; percutaneous stent

MeSH Terms

Adult
Aneurysm, Dissecting/*surgery
Angiography/adverse effects
Contrast Media/adverse effects
Embolectomy
Humans
Male
Mesenteric Artery, Superior/radiography/*surgery
Mesenteric Vascular Occlusion/etiology
Stents/*adverse effects
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Abdominal CT shows a focal dissecting flap in the proximal SMA (white arrow) with severely narrowed true lumen. CT, computed tomography; SMA, superior mesenteric artery.

• 

  Fig. 2 (A) The first frame of the initial SMA angiography shows a focal dissecting flap 2 cm distally from the origin (arrow), aneurismal change of the proximal SMA (arrow heads), and narrowing of the distal trunk of the SMA. (B) The second frame of the same angiography shows sudden extension of the dissecting flap to the distal trunk of the SMA (arrows) and propagated intraluminal thrombus (arrow-heads) immediately after simple passage of contrast material via a 6F guiding catheter. SMA, superior mesenteric artery.

• 

  Fig. 3 (A) Follow-up angiography after deployment of a 7 mm×6 cm self expandable stent shows a completely excluded dissection flap with recanalized SMA trunk (white arrows), but multiple jejunal branches are occluded due to distally migrated thrombus (white arrow-heads). (B) Completion angiography shows complete recanalization and removal of intraluminal thrombus after additional pharmacomechanical thrombolysis. SMA, superior mesenteric artery.

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