Successful endovascular treatment of acute mesenteric and hepatic ischemia in patient with celiomesenteric trunk occlusion

Abstract

Acute occlusion of celiomesenteric trunk variants such as a replaced common hepatic artery origin from a superior mesenteric artery can be catastrophic and requires immediate attention to reverse simultaneous mesenteric and hepatic ischemia and prevent death. We report the case of a 73-year-old woman with acute occlusion of her celiomesenteric trunk and proximal superior mesenteric artery who underwent successful endovascular repair with stent graft via brachial access. In the present case report, we describe a surgically relevant classification system of celiomesenteric trunk variants, highlight the feasibility of endovascular intervention in this uncommon scenario, and describe our technique.

Keywords: Celiacomesenteric trunk; Celiomesenteric trunk; Mesenteric ischemia; Replaced common hepatic artery.

Fig 1

Abdominal aortogram demonstrating occlusion of celiomesenteric trunk and proximal superior mesenteric artery (SMA) with reconstitution of the mid- and distal SMA via the arc of Riolan from the stenotic inferior mesenteric artery. An incidental finding of bilateral renal artery stenosis can be seen. Note that the splenic artery is not seen owing to the aberrant origin directly from aorta, which was above the level of the flush catheter.

Fig 2

Sagittal computed tomography (CT) angiogram demonstrating occlusion of celiomesenteric trunk with filling of the distal superior mesenteric artery (SMA).

Fig 3

Occlusion of celiomesenteric trunk.

Fig 4

Predilation of celiomesenteric trunk.

Fig 5

Completion arteriogram demonstrating widely patent celiomesenteric trunk stent graft, common hepatic artery, and superior mesenteric artery (SMA).