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Isolated spontaneous dissection of the superior mesenteric artery: percutaneous stent placement in two patients.

Kim JH, Roh BS, Lee YH, Choi SS, So BJ - Korean J Radiol (2004 Apr-Jun)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Wonkwang University School of Medicine, Iksan, Korea.

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.

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Related in: MedlinePlus

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).
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Figure 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).

Mentions: A 48-year-old woman suddenly experienced a diffuse rending abdominal pain, and so she visited the hospital. Her blood pressure was 190/130 mmHg and an antihypertensive drug was prescribed. Emergency contrast-enhanced abdominal CT revealed the presence of mural thrombus within the main trunk of the SMA without any evidence of abdominal aortic aneurysm or dissection (Fig. 1A). There was no finding of bowel ischemia such as bowel wall thickening or abnormal contrast enhancement. She was referred to our hospital 6 hours after her symptom's onset. Her medical history included hypertension, which had been controlled with a single drug for 4 years. The physical examination revealed a temperature of 36.8℃, blood pressure 110/70 mmHg, and the pulse was 68 beats per minute and regular. The abdomen showed diffuse mild tenderness. Routine lab findings were normal. An electrocardiogram, chest radiograph, and abdominal plain films were also normal. Under the impression of thromboembolic occlusion of the SMA, we tried catheter-directed thrombolytic therapy. The superior mesenteric arteriogram demonstrated the complete occlusion of the ileocolic and right colic branches of the SMA (Fig. 1B). An inferior mesenteric arteriogram showed collateral flow through a marginal artery to the occluded branches. A 5-F 11-cm multisidehole infusion catheter (COOK, Bloomington, IN, U.S.A.) was placed within the main trunk of the SMA and then urokinase was infused at a rate of 100,000 IU per hour. After 14-hours of infusion of urokinase, she still suffered from the symptoms, and the follow-up arteriogram revealed an isolated dissection of the SMA (Fig. 1C). We considered percutaneous stent placement instead of surgical bypass graft. Over the guidewire (Terumo, Tokyo, Japan) via a right femoral artery approach, an 8×70-mm self-expandable Wallstent (Boston Scientific, Watertown, MA, U.S.A.) was placed in the true lumen so that the proximal end was dipped into the aortic lumen (Fig. 1D). We used a relatively long stent because of the stability of this stent within the SMA. The control angiogram showed a patent, true lumen with good blood flow in all the branches of the SMA. The patient complained of postprandial abdominal pain for a week, however, the symptom was gradually subsided and the patient was discharged two weeks after the stent placement. Two months later, CT angiograms showed good blood flow through the fully expanded stent and all the branches of the SMA. However, the stent was shortened and the proximal segment of the SMA was narrowed by 50-75% (Fig. 1E), but the patient didn't complain of any symptoms for 6 months after the stent placement.


Isolated spontaneous dissection of the superior mesenteric artery: percutaneous stent placement in two patients.

Kim JH, Roh BS, Lee YH, Choi SS, So BJ - Korean J Radiol (2004 Apr-Jun)

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).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698142&req=5

Figure 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).
Mentions: A 48-year-old woman suddenly experienced a diffuse rending abdominal pain, and so she visited the hospital. Her blood pressure was 190/130 mmHg and an antihypertensive drug was prescribed. Emergency contrast-enhanced abdominal CT revealed the presence of mural thrombus within the main trunk of the SMA without any evidence of abdominal aortic aneurysm or dissection (Fig. 1A). There was no finding of bowel ischemia such as bowel wall thickening or abnormal contrast enhancement. She was referred to our hospital 6 hours after her symptom's onset. Her medical history included hypertension, which had been controlled with a single drug for 4 years. The physical examination revealed a temperature of 36.8℃, blood pressure 110/70 mmHg, and the pulse was 68 beats per minute and regular. The abdomen showed diffuse mild tenderness. Routine lab findings were normal. An electrocardiogram, chest radiograph, and abdominal plain films were also normal. Under the impression of thromboembolic occlusion of the SMA, we tried catheter-directed thrombolytic therapy. The superior mesenteric arteriogram demonstrated the complete occlusion of the ileocolic and right colic branches of the SMA (Fig. 1B). An inferior mesenteric arteriogram showed collateral flow through a marginal artery to the occluded branches. A 5-F 11-cm multisidehole infusion catheter (COOK, Bloomington, IN, U.S.A.) was placed within the main trunk of the SMA and then urokinase was infused at a rate of 100,000 IU per hour. After 14-hours of infusion of urokinase, she still suffered from the symptoms, and the follow-up arteriogram revealed an isolated dissection of the SMA (Fig. 1C). We considered percutaneous stent placement instead of surgical bypass graft. Over the guidewire (Terumo, Tokyo, Japan) via a right femoral artery approach, an 8×70-mm self-expandable Wallstent (Boston Scientific, Watertown, MA, U.S.A.) was placed in the true lumen so that the proximal end was dipped into the aortic lumen (Fig. 1D). We used a relatively long stent because of the stability of this stent within the SMA. The control angiogram showed a patent, true lumen with good blood flow in all the branches of the SMA. The patient complained of postprandial abdominal pain for a week, however, the symptom was gradually subsided and the patient was discharged two weeks after the stent placement. Two months later, CT angiograms showed good blood flow through the fully expanded stent and all the branches of the SMA. However, the stent was shortened and the proximal segment of the SMA was narrowed by 50-75% (Fig. 1E), but the patient didn't complain of any symptoms for 6 months after the stent placement.

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Wonkwang University School of Medicine, Iksan, Korea.

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.

Show MeSH
Related in: MedlinePlus