Korean J Radiol.  2004 Jun;5(2):134-138. 10.3348/kjr.2004.5.2.134.

Isolated Spontaneous Dissection of the Superior Mesenteric Artery: Percutaneous Stent Placement in Two Patients

• Kim JH
• Roh BS
• Lee YH
• Choi SS
• So BJ

• KMID: 753994
• DOI: http://doi.org/10.3348/kjr.2004.5.2.134

Abstract

Isolated spontaneous dissection of the superior mesenteric artery (SMA) is a rare cause of acute mesenteric ischemia. Two patients were successfully treated by percutaneous stent placement within the main trunk of the SMA. Emphasis is placed on the feasibility of nonsurgical management with percutaneous stent placement of isolated spontaneous dissection of the SMA.

Keyword

Mesentery, ischemia; Arteries, mesenteric; Stents and prostheses

MeSH Terms

Aneurysm, Dissecting/radiography/*therapy
*Angioplasty, Balloon
Female
Human
Male
*Mesenteric Artery, Superior/radiography
Middle Aged
*Stents
Support, Non-U.S. Gov't

Figure

• 

  Fig. 1 A 48-year-old woman with sudden abdominal pain. A. The contrast-enhanced CT scan showed mural thrombus (arrow) within the main trunk of the superior mesenteric artery. B. Superior mesenteric arteriogram demonstrated the complete occlusion of ileocolic and right colic branches of the SMA. C. After continuous infusion of urokinase into the superior mesenteric artery, arteriograms revealed the intimal flap (arrow). D. An 8×70-mm self-expandable Wallstent was placed in the true lumen so that the proximal stent was dipped into the aortic lumen (arrow). E. Two months after stent placement, the maximum intensity projection image demonstrated the proximal shortening of the stent and the stenosis of the SMA orifice (arrow).

• 

  Fig. 2 54-year-old man with severe epigastric pain after drinking cold water. A, B. The contrast-enhanced CT scan showed the intimal flap (long arrow) and the mural thrombus (short arrow). C. The celiacomesenteric arteriogram demonstrated a severely narrowed true lumen (long arrow) and aneurysmally dilated false lumen (short arrow). D. After the stent placement, the proximal end was located at the orifice of the SMA (arrow). The control angiogram showed a patent true lumen with good blood flow in all the branches of the SMA, and an almost vanished false lumen. E. At 4 months after the stent placement, the arteriogram showed the recurrence of aneurysmally dilated false lumen (arrow). F. Another 10-50-mm self-expandable stent (arrow) was placed within the Wallstent covering the opening of intimal flap. The aneurysmally dilated false lumen was significantly decreased.

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