Preliminary experience of endovascular treatment of acute mesenteric occlusion in stable patients with acute type A aortic dissection

Abstract

Background: Patients presenting with Stanford type A aortic dissection complicated by acute occlusion of the superior mesenteric artery (SMA) exhibit an exceedingly high mortality rate, even if emergency surgery for ascending aorta repair is performed. consequently, appropriate management of acute SMA occlusion arising from acute Stanford type A aortic dissection is crucial. This study aimed to evaluate the safety and efficacy of endovascular treatment of acute mesenteric occlusion first in stable patients with acute type A aortic dissection.

Methods: The study was a single-center case series. Data collected from 11 consecutive patients over 12 years, from March 2010 to November 2022, were retrospectively analyzed. All were expeditiously escorted to the interventional suite via the prioritized green channel of the chest pain center and received the endovascular treatment of acute mesenteric occlusion first. Post-procedure, patients were promptly transferred to the Intensive Care Unit for close monitoring and got standardized medication. After hospital discharge, patients underwent follow-up aortic computed tomography angiography (CTA) at 1 month, 6 months, and annually thereafter to ensure continuous monitoring of the patient's condition and timely identification of any potential complications.

Results: All patients were male, with a mean age of 49.5 years. Time from abdominal distension and pain onset to admission to the catheterization laboratory was 4-13 (mean 6.9) hours. Endovascular repair of the SMA was successfully completed with uneventful hospital courses in all patients. Bowel sounds weakened in 6 cases and disappeared in 5, while bloody stools occurred in 3 without intestinal necrosis. At 2-32 months follow-up, the patients had no abdominal pain, distension nor other signs of mesenteric artery ischemia.

Conclusions: For patients with acute SMA occlusion caused by acute Stanford type A aortic dissection, endovascular treatment first to restore blood supply to the SMA appears feasible, safe and efficacious.

Keywords: Type A aortic dissection; endovascular treatment; superior mesenteric artery occlusion (SMA occlusion).

Figure 1

The static type and mixed type of SMA occlusion caused by type A aortic dissection and presentation of one representative case interventional treatment and follow-up results. (A) Aortic CTA shows type A aortic dissection, SMA occlusion (static type) (indicated by the arrow). (B) Aortic CTA shows type A aortic dissection, SMA occlusion (static + dynamic type) (indicated by the arrow). (C) Selective angiography of SMA confirming occlusion (indicated by the arrows). (D) Place the coronary thrombus aspiration catheter in the distal lumen of the superior mesenteric artery and perform angiography to clarify the morphology of the distal vessel (indicated by the arrow). (E) The coronary thrombus aspiration is gradually withdrawn from the distal of the superior mesenteric artery, and angiography is performed to identify the affected area of the dissection (indicated by the arrows). (F) After placing stents from the distal segment to the ostial of SMA, angiography showed that the SMA is unobstructed (indicated by the arrows). (G) One month later, aortic CTA showed that the stent of the superior mesenteric artery is unobstructed (indicated by the arrow). (H) Six months later, aortic CTA showed that the stent of the superior mesenteric artery is unobstructed (indicated by the arrow). (I) Twenty months later, aortic CTA showed that the stent of the superior mesenteric artery is unobstructed (indicated by the arrow). SMA, superior mesenteric artery; CTA, computed tomography angiography.