Retrograde Superior Mesenteric Artery Stenting in Case of SMA Shuttering

2021 ◽  
pp. 153857442110729
Author(s):  
Jason Zhang ◽  
Rohan Basu ◽  
Ann Gaffey ◽  
Julia Glaser ◽  
Venkat Kalapatapu
Keyword(s):  
Superior Mesenteric Artery ◽  
Endovascular Repair ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Endovascular Procedures ◽  
Acute Mesenteric Ischemia ◽  
Signs And Symptoms ◽  
Celiac Artery ◽  
Bowel Ischemia ◽  
Thoracoabdominal Aneurysm

This case describes a patient who underwent endovascular repair for an extent V thoracoabdominal aneurysm with planned coverage of the celiac artery. Following deployment of the stent graft, the superior mesenteric artery was shuttered, and the patient subsequently developed signs and symptoms of bowel ischemia. The patient underwent successful retrograde open superior mesenteric artery stenting with resolution of her symptoms. Although retrograde open mesenteric artery stenting (ROMS) has been primarily shown to be effective in acute mesenteric ischemia, this case demonstrates that ROMS can be used as a salvage option for shuttering during endovascular procedures.

Combined Endovascular and Surgical Retrograde Superior Mesenteric Artery Recanalization

2018 ◽  
Author(s):  
Syed M. Peeran
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Atherosclerotic Lesion ◽  
Acute Mesenteric Ischemia ◽  
Exploratory Laparotomy ◽  
Chronic Mesenteric Ischemia ◽  
Hybrid Technique ◽  
Current Standard ◽  
Stent Deployment

Acute mesenteric ischemia is a life-threatening vascular emergency associated with a very high mortality rate. In the setting of necrotic bowel, the current standard of care requires a laparotomy with bowel resection and surgical or endovascular revascularization of the superior mesenteric artery. Unfortunately, mesenteric bypass confers high perioperative mortality, in some reports up to 45%. A hybrid technique that employs an exploratory laparotomy, catheterization of the distal superior mesenteric artery, and stent deployment across the atherosclerotic lesion was first described in 2004 for the treatment of acute-on-chronic mesenteric ischemia. This chapter describes the appropriate clinical indications, the technical aspects of performing this hybrid procedure, as well as the challenges and common pitfalls encountered.

scholarly journals Necessity of revascularization for acute mesenteric ischemia in symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery

Vascular ◽  
2019 ◽  
Vol 28 (1) ◽  
pp. 109-114
Author(s):  
Hiroyuki Otsuka ◽  
Atsushi Uehata ◽  
Keiji Sakurai ◽  
Toshiki Sato ◽  
Hiromichi Aoki ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Laboratory Data ◽  
Acute Mesenteric Ischemia ◽  
True Lumen ◽  
Bowel Necrosis ◽  
Abnormal Laboratory ◽  
Number Of Patients ◽  
Residual Ratio

Objectives We evaluated the necessity of revascularization for acute mesenteric ischemia in symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery. Methods This retrospective study included 28 consecutive, symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery treated at our hospital between December 2005 and December 2017. Patients with concomitant aortic dissection were excluded. We reviewed the patients’ clinical presentation; laboratory evaluations; computed tomography findings, including the true lumen residual ratio (i.e., the minimum true lumen size compared to the diameter of the transverse section of the dissected artery) at the time of admission; the number of patients who were suspected of having bowel ischemia; and the number of patients who required surgical or endovascular treatment and their outcomes. Additionally, to evaluate the true lumen residual ratio in symptomatic patients with bowel ischemia, the true lumen residual ratio in those with abnormal laboratory data were compared with that in those without abnormal laboratory data. Initial true lumen residual ratio values were also compared with final values. Furthermore, we assessed the clinical details of patients who had bowel necrosis. Categorical variables were compared using the χ2 test or Fisher’s exact test, and continuous values were presented as either the mean ± standard deviation or median (interquartile range 25–75%). Variables were analyzed using Student’s t-test or the Mann–Whitney U test. Results The patients’ age ranged between 41 and 85 years, and 25 were men. Although nine patients were suspected of having acute mesenteric ischemia, only one underwent bowel resection. None of the patients had an indication for revascularization. The true lumen residual ratio of the nine patients with abnormal laboratory data were significantly lower than those of the 19 without abnormal laboratory data (10 [0–25]% vs. 40 [20–50]%, p = 0.005). The patient who underwent bowel resection had a true lumen residual ratio of 10%; however, there was no obvious abnormal laboratory data suggestive of bowel necrosis. Dissections were managed conservatively in all patients. True lumen residual ratio increased from initial value of 30 (10–48)% to 98 (60-100)%at the final imaging study ( p < 0.0001). There were no adverse events related to the mesenteric circulation during the follow-up period of 2–11 years. Conclusions Reintervention is rarely required for spontaneous isolated dissection of the superior mesenteric artery, even in symptomatic patients, and spontaneous resolution of the luminal compromise is the rule.

Results of retrograde revascularizations of the superior mesenteric artery for acute mesenteric ischemia

2017 ◽  
Vol 44 ◽  
pp. 27-28
Author(s):  
Arnaud Roussel ◽  
Nellie Della Schiava ◽  
Raphael Coscas ◽  
Quentin Pellenc ◽  
Tarek Boudjelit ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia

Endovascular Techniques in Mesenteric Ischemia

2018 ◽  
Author(s):  
Sarah E Strot ◽  
M Ashraf Mansour
Keyword(s):  
Mesenteric Ischemia ◽  
Hybrid Approach ◽  
Acute Mesenteric Ischemia ◽  
Vascular Occlusion ◽  
Standard Of Care ◽  
Celiac Artery ◽  
Bowel Ischemia ◽  
Chronic Mesenteric Ischemia ◽  
Hybrid Technique ◽  
Invasive Treatment

Mesenteric ischemia is a rare cause of abdominal pain but is a highly morbid and life-threatening condition. Despite significant improvements in diagnostic and therapeutic options, diagnosis continues to be a challenge and contributes to the high-mortality rate. Open exploration and revascularization should not be delayed if peritonitis or bowel ischemia is present, but with advances in technology and available endovascular devices, endovascular therapy has become a feasible option. It is being used to treat acute mesenteric ischemia in select patients and is now often the standard of care in many institutions for the treatment of chronic mesenteric ischemia. The use of aspiration embolectomy, thrombolytics, and angioplasty with stenting offers very sick patients a less invasive treatment option and may reduce the time to revascularization, reducing bowel ischemia. Additionally, a hybrid approach can offer the best of both open and endovascular treatments, allowing evaluation of the intra-abdominal contents for ischemia while avoiding a traditional arterial bypass.   This review contains 16 figures and 65 references Key Words: acute mesenteric ischemia, celiac artery, chronic mesenteric ischemia, embolism, endovascular, hybrid technique, mesenteric arteriography, mesenteric vascular occlusion, superior mesenteric artery, thrombosis

AN EMERGENT MANAGEMENT OF ACUTE SUPERIOR MESENTERIC ARTERY EMBOLISM WITH ILEAL GANGRENE

2021 ◽  
pp. 3-4
Author(s):  
Nishant Agarwal ◽  
Abhishek Kaushal ◽  
Shrey Aren ◽  
Srikanth Muraleedhar ◽  
Sudhir Kumar Panigrahi
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Intestinal Ischemia ◽  
Hospital Admissions ◽  
Bowel Resection ◽  
Acute Mesenteric Ischemia ◽  
Artery Embolism ◽  
Visceral Arteries ◽  
Bowel Gangrene

Acute mesenteric ischemia (AMI) occuring due to sudden, partial or complete interruption of blood ow in main visceral arteries of the abdomen eventually resulting in intestinal ischemia and/or bowel gangrene is a surgical emergency. It represents 0.1% of hospital admissions and 2% of the revascularization operations for atheromatous lesions. 50% of AMI is caused by embolic phenomenon, 25% by thrombotic episode and rest 25% by both. The most common vessel involved in AMI is superior mesenteric artery. Acute mesenteric embolic ischemia (AMEI) arises typically from a cardiac emboli in patients with atrial brillation or following MI. Patients usually presents with central abdominal pain, out of proportion to the physical ndings initially, later becoming diffuse associated with bloody diarrhoea during the episode. An early diagnosis, an aggressive resuscitation, intravascular or surgical restoration of blood ow and subsequent bowel resection based on bowel viability helps reduce morbidity and mortality.

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