J Korean Surg Soc.  2010 Feb;78(2):127-131. 10.4174/jkss.2010.78.2.127.

A Stent Graft Placement in a Focally Progressed Dissection in the Superior Mesenteric Artery

• Byun SJ

• KMID: 2096568
• DOI: http://doi.org/10.4174/jkss.2010.78.2.127

Abstract

Focal aneurysmal change after spontaneous superior mesenteric artery (SMA) dissection has been reported rarely. A stent graft implantation can exclude false lumen and possibly make major abdominal operation avoidable. A 52-year-old male patient was admitted due to abdominal pain for 10 days. A CT scan showed severe narrowing of the true lumen of SMA, approximately a 7 cm segment from the origin, due to compression by the thrombosed false lumen. Five days after admission, abdominal pain aggravated progressively. The follow-up CT revealed focal aneurysmal dilatation of the dissected SMA segment. I report here an endovascular treatment with stent graft implantation for a focal aneurysmal change after SMA dissection.

Keyword

Superior mesenteric artery dissection; Stent graft

MeSH Terms

Abdominal Pain
Aneurysm
Dilatation
Follow-Up Studies
Humans
Male
Mesenteric Artery, Superior
Middle Aged
Polyenes
Stents
Transplants
Polyenes

Figure

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  Fig. 1 Diffuse narrowing of the true lumen by thrombosed false lumen (white arrow) is noted. Intimal flap and stenosis on right common iliac artery is visible (dot arrow). Distension of stomach (arrow head) is noted.

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  Fig. 2 Computed tomography angiography demonstrates a focal SMA aneurysmal change (white arrow), diffuse narrowing of the true lumen (dot arrow) by thrombosed false lumen (arrow head).

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  Fig. 3 (A) Selective angiogram of the SMA shows dissection of the main trunk of the SMA with true (black arrows) and false (white arrows) lumens. (B) Post-stent graft (white arrow) implantation angiogram of SMA with complete exclusion of the false lumen.

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  Fig. 4 (A, B) The follow-up CT angiogram shows complete recanalization and estabilishment of proximal jejunal branches of the SMA. (C, D) CT angiogram shows mesenteric hematoma (white arrow) and focal bowel ischemia with suggestive pneumatosis intestinalis (dot arrows).

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  Fig. 5 (A) Intraoperative finding. A 150 cm distal area of Treitz ligament showed mesenteric tear with hematoma and focal bowel ischemia. (B) The follow-up CT angiogram shows complete recanalization of SMA and stapler ring on site of end-to-end anastomosis (white arrow).

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