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Case Reports
. 2021 Jun 3:9:2050313X211021184.
doi: 10.1177/2050313X211021184. eCollection 2021.

Successfully superior mesenteric artery stenting in operated type A aortic dissection complicated with delayed mesenteric malperfusion

Roxana Carmen Geana  1 , Platon Pavel  1 , Reza Nayyerani  1 , Iulia Kulcsar  1 , Adrian Tulin  1 , Oana Honciuc  1 , Irina Balescu  1 , Nicolae Bacalbasa  1 , Ovidiu Stiru  1 , Vlad Anton Iliescu  1 , Catalina Andreea Parasca  1
Affiliations
Case Reports

Successfully superior mesenteric artery stenting in operated type A aortic dissection complicated with delayed mesenteric malperfusion

Roxana Carmen Geana et al. SAGE Open Med Case Rep. .

Abstract

Here, we describe a case of a 61-year-old male patient with acute type A aortic dissection involving the ascending aorta, aortic arch, descending aorta, and the abdominal aorta down to the iliac bifurcation with evidence of left common iliac artery occlusion. Computed tomography angiography revealed progressive dissection into the superior mesenteric artery and left renal artery with no clinical signs of mesenteric ischemia. Emergent ascending aortic reconstruction of the dissected aorta relieves the leg ischemia. On a postoperative day 9, the evolution was complicated by massive right hemothorax. Although the patient was hemodynamically stable after obtaining hemostasis, the patient developed paralytic ileus with a high elevated lactate level. Visceral malperfusion was not detected by exploratory laparotomy. Emergency abdominal aortic angiography revealed superior mesenteric artery intermittent occlusion, successfully treated by stenting implantation.

Keywords: Mesenteric malperfusion; acute type A aortic dissection; superior mesenteric artery stenting.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Preoperative reconstruction of contrast-enhanced angio-CT 3D showing the ascending aorta, aortic arch, and descending aorta dissection.
Figure 2.
Figure 2.
Preoperative reconstruction of contrast-enhanced angio-CT 3D showing LCIA occlusion, SMA dissection, and LRA occlusion. SMA: superior mesenteric artery; LCIA: left common iliac artery; LRA: left renal artery.
Figure 3.
Figure 3.
Intraoperative view of complete replacement of the ascending aorta and aortic hemiarch with No. 30 INTERGARD Woven Vascular Graft.
Figure 4.
Figure 4.
Angiography with evidence of the SMA obstruction by dissection fold. SMA: superior mesenteric artery.
Figure 5.
Figure 5.
Postprocedural angiography of the SMA after stent placement stabilizes the dissection fold and improved peripheral blood flow.
Figure 6.
Figure 6.
Postoperative reconstruction of contrast-enhanced angio-CT 3D at 2 months follow-up showing the INTERGARD Woven Vascular Graft in the ascending aorta, the correct position of the stent and patency of the SMA as well as the restoration of normal blood flow in the LCIA. SMA: superior mesenteric artery; LCIA: left common iliac artery.
See this image and copyright information in PMC

References

    1. Hagan PG, Nienaber CA, Isselbacher EM, et al.. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 2000; 283(7): 897–903. - PubMed
    1. Rodiere M, Thony F, Michoud M, et al.. Les malperfusions viscérales aiguës, complications précoces du syndrome aortique: comment les détecter et les prendre en charge? [Acute visceral ischaemia, early complication of the aortic syndrome: how to detect and manage it?]. Presse Med 2011; 40(1, Pt 1): 54–61. - PubMed
    1. Di Eusanio M, Trimarchi S, Patel HJ, et al.. Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection. J Thorac Cardiovasc Surg 2013; 145(2): 385–390. - PubMed
    1. Khayat M, Cooper KJ, Khaja MS, et al.. Endovascular management of acute aortic dissection. Cardiovasc Diagn Ther 2018; 8(Suppl. 1): S97–S107. - PMC - PubMed
    1. Zientara A, Domenghino AR, Schwegler I, et al.. Interdisciplinary approach in emergency revascularization and treatment for acute mesenteric ischemia. BMC Surg 2021; 21(1): 89. - PMC - PubMed

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