Endovascular revascularization of heavily calcified occlusion in superior mesenteric artery using Transcollateral approach

Background Mesenteric ischaemia is often a manifestation of severe vascular disease involving the superior mesenteric artery (SMA). Endovascular revascularization is challenging in a chronic total occlusion (CTO) of SMA. Case presentation A-73-year-old male patient was referred to our hospital because of a 2-year history of post prandial abdominal angina. Computed tomography (CT) images revealed a heavily calcified CTO in the ostium of SMA and three-dimensional CT (3D-CT) detected pancreaticoduodenal arcade with filling from the celiac artery. Then, endovascular procedure was attempted; however, angiography did not show the collateral route suitable for transcollateral approach. As demonstrated on the CT, we were successful in passing a guidewire through the SMA-CTO via the celiac trunk transcollateral route. After pull-through of the guidewire, two balloon-expandable stents were deployed in the ostium of SMA. During 3 months after stent implantation, the patient had no further episodes of abdominal angina on dual-anti-platelet therapy. Conclusion We demonstrate a case of a heavily calcified SMA occlusion successfully treated with endovascular stenting employing a transcollateral approach, guided by 3D-CT.

Endovascular Revascularization of Heavily Calcified Occlusion in Superior Mesenteric Artery using Transcollateral Approach

BACKGROUND: Mesenteric ischemia is often a manifestation of severe vascular disease involving the superior mesenteric artery (SMA). Endovascular revascularization is still challenging in a chronic total occlusion (CTO) of SMA.CASE PRESENTATION: An-73-year-old male was referred to our hospital because of a 2-year history of abdominal angina after each meal. Computed tomography (CT) images revealed a heavily calcified CTO in the ostium of SMA. Angiography did not show the collateral route suitable for transcollateral approach (TCA); however, the three-dimension CT detected pancreaticoduodenal arcade from the celiac artery to the occluded SMA. According to CT imaging, transcollateral wire crossing from the celiac artery was successful in the SMA-CTO. After pull-through of the guide wire, two balloon-expandable stents were deployed in the ostium of SMA. During 3 months after the stent implantation, the patient had no further episodes of abdominal angina on dual-anti-platelet therapyCONCLUSIONS: We demonstrated a case of SMA occlusion with heavy calcification treated with stent implantation using TCA guided by CT imaging.

Superior mesenteric artery dissection with prolonged abdominal angina treated by laparotomy, endarterectomy, patch angioplasty, and retrograde open mesenteric stenting: a case report

Background Most patients with isolated superior mesenteric artery (SMA) dissection are successfully managed conservatively. However, some patients require more invasive treatment. Case presentation We herein describe a 45-year-old man with isolated SMA dissection. He initially underwent conservative treatment. However, because of persistent abdominal angina, we considered the need for surgical revascularization. He was successfully treated by endarterectomy, patch angioplasty, and retrograde open mesenteric stenting. The abdominal angina was stabilized thereafter. Conclusions The combination of endarterectomy, patch angioplasty, and retrograde open mesenteric stenting is useful for isolated SMA dissection, and long patency can be expected for some patients.