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Case Reports
. 2017 Mar 22;3(1):30-34.
doi: 10.1016/j.jvscit.2016.10.004. eCollection 2017 Mar.

Endovascular treatment with flow-diverting stents of symptomatic superior mesenteric artery after dissection aneurysm

Giuseppe Baldino  1 , Paolo Mortola  1 , Marta Cambiaso  1 , Alessandro Valdata  2 , Amerigo Gori  1
Affiliations
Case Reports

Endovascular treatment with flow-diverting stents of symptomatic superior mesenteric artery after dissection aneurysm

Giuseppe Baldino et al. J Vasc Surg Cases Innov Tech. .

Abstract

Isolated and spontaneous superior mesenteric artery dissection is a rare cause of acute abdominal pain. Whereas there is widespread consensus on conservative treatment of asymptomatic forms, revascularization would seem indicated in symptomatic complicated cases. A 73-year-old man presented with worsening epigastric pain. A computed tomography scan revealed an isolated and spontaneous superior mesenteric artery dissection with aneurysmal evolution of the false lumen, involving multiple side branches. The postdissection aneurysm was treated by endovascular exclusion with flow-diverting stents. The abdominal pain was completely relieved, and the patient remained asymptomatic at follow-up.

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Figures

Fig 1
Fig 1
Preoperative contrast-enhanced computed tomography (CT) scan (A-C) with three-dimensional reconstructions (D and E) showing the isolated and spontaneous superior mesenteric artery dissection (ISMAD) with aneurysmal evolution of the false lumen (maximum transverse diameter, 32 mm). The false lumen has connections with the true lumen at both ends. The lesion length is approximately 10 cm, involving multiple superior mesenteric artery (SMA) side branches.
Fig 2
Fig 2
Intraoperative angiography showing the isolated and spontaneous superior mesenteric artery dissection (ISMAD; A and B), the deployment of the two flow-diverting stents (FDSs; C and D), and the final result of the procedure with good expansion of the true lumen and patency of the superior mesenteric artery (SMA) and its side branches (E).
Fig 3
Fig 3
The 6-month follow-up contrast-enhanced computed tomography (CT) scan showing patency of the superior mesenteric artery (SMA) and its side branches (A and B) and complete thrombosis of the false lumen of the dissection (C-E).
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