Endovascular Stenting and Stent-graft Repair of a Hemorrhagic Superior Mesenteric Artery Pseudoaneurysm and Dissection Associated with Pancreaticoduodenectomy

This report presents a 73-year-old woman with intraperitoneal bleeding from a superior mesenteric artery (SMA) pseudoaneurysm and dissection after pancreaticoduodenectomy (PD). A self-expanding bare metal stent was placed in the distal SMA across the area of dissection, and a stent-graft was subsequently placed across the pseudoaneurysm emerging from the proximal site by overlapping the bare stent, resulting in complete exclusion of the pseudoaneurysm and control of the dissection. Bleeding was controlled after the endovascular procedure. The combination of endovascular stenting and stent-graft repair is feasible and useful in comorbid cases of SMA pseudoaneurysm and dissection.     

孤立性肠系膜上动脉夹层介入治疗五例的护理体会

目的探讨裸支架腔内血管重建术治疗孤立性肠系膜上动脉夹层(SMAD)的围手术期护理。方法对采用裸支架载瘤动脉腔内血管重建术治疗孤立性的5例患者,予完善的术前准备,针对性的术后观察、护理。结果在围手术期精心护理下,4例腹痛症状患者术后3周腹痛消失;5例患者介入治疗均获得成功,术后无并发症发生,随访3至12个月效果满意。结论术前充分准备,术后细致观察、护理,为孤立性SMAD介入治疗提供有价值的护理经验。     

Spontaneous Dissection of Superior Mesenteric Artery: Long-Term Outcome of Stent Placement

Stent placement was performed in 10 patients with symptomatic spontaneous dissection of the superior mesenteric artery (SMA). A stent was placed as first-line treatment in 7 patients and as second-line treatment in 3 patients in whom conservative treatment had failed. Abdominal pain completely resolved within 2 days after stent placement, and follow-up (median 53 months; range, 11–99 months) CT angiography revealed complete obliteration of the false lumen and good stent patency in 9 patients. One patient showed asymptomatic stent occlusion at 99-month follow-up. Long-term patency of stent placement in patients with symptomatic SMA dissection seems to be acceptable.     

Successful Percutaneous Transluminal Angioplasty and Stenting in Acute Mesenteric Ischemia

Acute mesenteric ischemia (AMI) is a life-threatening emergency. The complications are high by the time of diagnosis in most cases and therefore only few data on primary percutaneous intervention with percutaneous transluminal angioplasty (PTA) and stenting in AMI are available. We present the case of an 84-year-old woman who presented to our emergency department complaining of an acute worsening of pre-existing abdominal periumbilical pain, nausea, vomiting, and diarrhea. She had previously undergone percutaneous transluminal embolectomy for an acute occlusion of the left common femoral artery. Due to suspicion of intestinal infarction, conventional angiography of the aorta and the superior mesenteric artery (SMA) was performed and confirmed a proximal occlusion of the SMA. Percutaneous SMA recanalization with balloon dilation and subsequent stent implantation was carried out successfully. The abdominal symptoms subsided after this procedure. In AMI that is diagnosed early, endovascular stenting should be considered as an alternative treatment to the surgical approach that avoids the need for surgical bowel resection.     

Value of endovascular stent placement for symptomatic spontaneous isolated superior mesenteric artery dissection

Objective

To evaluate the feasibility and efficacy of endovascular stent placement for the treatment of symptomatic spontaneous isolated superior mesenteric artery dissection.

Materials and methods

This retrospective study was undertaken in 12 consecutive patients who suffered from symptomatic spontaneous isolated superior mesenteric artery dissection. Seven patients with severe clinical symptoms underwent endovascular stent placement as a primary treatment and the other 5 patients received conservative treatment. The technical results, complications and clinical outcomes were analyzed. Follow-up was performed with computed tomographic angiography.

Results

Primary endovascular stent placement was successfully performed in 7 patients with severe clinical symptoms. Successful conservative treatment was achieved in 3 patients. Endovascular stent placement was additionally performed in 2 patients with unsuccessful conservative treatment. A stent was misplaced in the false lumen in one of those two patients due to a severely stenotic true lumen. The fasting time and length of stay were significantly shorter in patients with successful endovascular therapy (median: 3 days and 5.5 days) than in those conducted conservatively (median: 9 days and 14 days) (p < 0.05). During the follow-up period (median, 21 months; range, 10–36 months), 1 patient with endovascular stent placement had recurrent abdominal pain because of the wall adherent thrombus in the proximal segment of the superior mesenteric artery during the first follow-up month. No thrombosis or stenosis was found in the lumina of the stents.

Conclusion

Endovascular stent placement is a safe and feasible therapeutic approach for symptomatic spontaneous isolated superior mesenteric artery dissection with immediate success and satisfactory outcomes.     

Endovascular Treatment of a Giant Superior Mesenteric Artery Pseudoaneurysm Using a Nitinol Stent-Graft

A 68-year-old woman presenting with gastrointestinal bleeding (hematocrit 19.3%) and in a critical clinical condition (American Society of Anesthesiologists grade 4) from a giant superior mesenteric artery pseudoaneurysm (196.0 × 131.4 mm) underwent emergency endovascular treatment. The arterial tear supplying the pseudoaneurysm was excluded using a 5.0 mm diameter and 31 mm long monorail expanded polytetrafluoroethylene (ePTFE)-covered self-expanding nitinol stent. Within 6 days of the procedure, a gradual increase in hemoglobin levels and a prompt improvement in the clinical condition were observed. Multislice CT angiograms performed immediately, 5 days, 30 days and 3 months after the procedure confirmed the complete exclusion of the pseudoaneurysm.     

SolitaireAB型支架治疗肠系膜上动脉栓塞

目的 探讨SolitaireAB支架治疗肠系膜上动脉栓塞(SMAE)的疗效及安全性.方法 回顾性分析5例在DSA 透视下行SolitaireAB支架取栓术患者的临床资料.结果 SolitaireAB支架成功将5例患者肠系膜上动脉血栓取出,患者术后恢复可,无血管夹层、血管穿孔、出血等并发症及缺血性肠坏死事件发生.结论 SolitaireAB支架机械取栓术在急性肠系膜缺血的治疗中能显著提高血管再通率,具有微创、安全及并发症少等优点.     

Isolated Spontaneous Dissection of the Superior Mesenteric Artery: Percutaneous Stent Placement in Two Patients

Isolated spontaneous dissection of the superior mesenteric artery (SMA) is a rare cause of acute mesenteric ischemia. Two patients were successfully treated by percutaneous stent placement within the main trunk of the SMA. Emphasis is placed on the feasibility of nonsurgical management with percutaneous stent placement of isolated spontaneous dissection of the SMA.     

Percutaneous Thrombin Injection to Complete SMA Pseudoaneurysm Exclusion After Failing of Endograft Placement

Visceral aneurysms are potentially life-threatening vascular lesions. Superior mesenteric artery (SMA) pseudoaneurysms are a rare but well-recognized complication of chronic pancreatitis. Open surgical repair of such an aneurysm, especially in patients after previous surgical treatment, might be dangerous and risky. Stent graft implantation makes SMA pseudoaneurysm exclusion possible and therefore avoids a major abdominal operation. Percutaneous direct thrombin injection is also one of the methods of treating aneurysms in this area. We report a first case of percutaneous ultrasound-guided thrombin injection to complete SMA pseudoaneurysm exclusion after an unsuccessful endograft placement. Six-month follow-up did not demonstrate any signs of aneurysm recurrence.     

Endovascular management for isolated spontaneous dissection of the superior mesenteric artery: report of two cases and literature review

The clinical course and treatment strategies of isolated superior mesenteric artery (SMA) dissection have not been fully investigated. Two cases of uncontrolled abdominal pain caused by isolated SMA dissection were successfully treated with percutaneous endovascular stent placement. At follow-up 6 months later, computed tomography confirmed that the lesions had stabilized. The patients remained symptom free at 14- and 13-month follow-up, respectively. The present report describes these two cases of isolated SMA dissection treated successfully with percutaneous endovascular stent placement, along with a review of the related literature.     

肠系膜上动脉病变 MSCTA 诊断价值

目的：探讨多层螺旋 CT 血管成像(MSCTA)诊断肠系膜上动脉(SMA)病变临床价值。方法回顾性分析40例 SMA病变患者 MSCTA 图像特点,运用容积再现(VR)、多平面重组(MPR)、曲面重组(CPR)及最大密度投影(MIP)等多种后处理重建技术。结果SMA 缺血16例,包括 SMA 急性闭塞8例,其中并发小肠缺血性坏死1例并行坏死小肠切除术。SMA 慢性闭塞8例;孤立性 SMA 夹层10例;SMA 真性动脉瘤7例,感染性心内膜炎相关假性动脉瘤1例;SMA 溃疡3例,其中1例合并肠系膜下动脉(IMA)重度狭窄;腹腔干重度狭窄2例;IMA 闭塞1例。本组40例患者可见 SMA 疾病相关侧支循环13例,4例见于 SMA 慢性闭塞,3例见于 SMA 急性闭塞,1例见于孤立性 SMA 夹层,1例见于 SMA 假性动脉瘤,2例分别见于 IMA 狭窄和闭塞。2例见于腹腔干重度狭窄。其中包括胰十二指肠前、后动脉弓3例,胰背动脉侧支2例、Riolan 弓10例。结论MSCTA 可以清晰观察SMA 各类病变、侧支循环开通情况以及评估肠腔缺血状态。     

孤立性肠系膜上动脉夹层血管腔内治疗

目的 探讨孤立性肠系膜上动脉夹层（ISMAD）的DSA表现以及腔内治疗的疗效.方法 4例ISMAD患者,入院后48～96h经过保守治疗后腹痛症状缓解不明显,行肠系膜上动脉造影,后行血管腔内裸支架植入.结果 肠系膜上动脉造影显示肠系膜上动脉真腔变细小,部分对比剂通过破口进入假腔.4例患者共植入6枚裸支架,支架植入后造影显示破口封堵成功,支架腔内血流通畅,假腔消失.术后腹痛症状不同程度缓解,3天后腹痛均消失.结论 DSA是诊断ISMAD可靠的方法;腔内裸支架植入术治疗ISMAD安全、有效.     

Treatment of Internal Carotid Artery Dissections with Endovascular Stent Placement: Report of Two Cases

Extracranial carotid artery dissection may manifest as arterial stenosis or occlusion, or as dissecting aneurysm formation. Anticoagulation and/or antiplatelet therapy is the first-line treatment, but because it is effective and less invasive than other procedures, endovascular treatment of carotid artery dissection has recently attracted interest. We encountered two consecutive cases of trauma-related extracranial internal carotid artery dissection, one in the suprabulbar portion and one in the subpetrosal portion. We managed the patient with suprabulbar dissection using a self-expandable metallic stent and managed the patient with subpetrosal dissection using a balloon-expandable metallic stent. In both patients the dissecting aneurysm disappeared, and at follow-up improved luminal patency was observed.     

Superior Mesenteric Artery Stent-graft Placement in a Patient with Pseudoaneurysm Developing from a Pancreatic Pseudocyst

Pseudoaneurysm is a relatively rare but serious complication of pancreatitis which is often fatal. We report successful stent-graft placement in the superior mesenteric artery in a 45-year-old man with a pancreatic pseudocyst that grew during therapy for chronic pancreatitis and developed into a pseudoaneurysm. After a stent graft was inserted in the superior mesenteric artery, the pseudoaneurysm disappeared and no further complications developed. Stent-graft placement was considered to be a useful therapy for pseudoaneurysms in the superior mesenteric arterial region.     

Covered Stent and Coils Embolization of a Pulmonary Artery Pseudoaneurysm After Gunshot Wound

We report the first case of endovascular covered stent implantation for the treatment of a large pulmonary artery pseudoaneurysm (PAPA) following a right thoracic gunshot wound. After resuscitation and hemodynamic stabilization, a CT angiography was performed to analyze the neck size of the PAPA and its position relative to the branches of the parent artery. Covered stent implantation with additional coil embolization was successfully performed. At the 4-year follow-up, the stents remained patent and there was neither pseudoaneurysm recurrence nor treatment-related complication.     

Three-dimensional CT in isolated dissecting aneurysm of the superior mesenteric artery: a case report.

Isolated dissecting aneurysm of the superior mesenteric artery (SMA) without aortic dissection is a rare condition. We report a case of isolated dissecting aneurysm of the SMA incidentally detected by postcontrast abdominal computed tomography (CT). Three-dimensional CT using helical scanning was helpful for the evaluation of dissecting aneurysmal structures such as the intimal flap, true lumen, and false lumen with thrombosis. CT angiography (CTA) was useful for the assessment of characteristic morphology and three-dimensional relationship between the dissecting portion and SMA branches.     

Superior Mesenteric Artery Pseudoaneurysm Following Pancreaticoduodenectomy: Management by Endovascular Stent-Graft Placement and Transluminal Thrombin Injection

Superior mesenteric artery (SMA) pseudoaneurysm formation is a rare and potentially fatal postoperative complication. Herein we present a case of a large post-pancreaticoduodenectomy SMA pseudoaneurysm that required thrombin injection after initial stent-graft deployment to accomplish complete pseudoaneurysm occlusion.     

Stent-coil treatment of a distal internal carotid artery dissecting pseudoaneurysm on a redundant loop by use of a flexible, dedicated nitinol intracranial stent

Treatment of dissecting pseudoaneurysms of the distal cervical internal carotid artery with preservation of the parent artery by using stents or coils has become routine. Tortuosity remains a significant obstacle to successful endovascular treatment in some cases. We report the use of a stent-coil technique to treat a nonhealing dissecting pseudoaneurysm and associated stenosis with anatomic preservation of a redundant loop involving the stented arterial segment. This was accomplished by using a Neuroform dedicated intracranial stent.     

Endovascular stent placement for isolated spontaneous dissection of the superior mesenteric artery: report of a case

Spontaneous dissection of the superior mesenteric artery (SMA) is rare and has been reported only sporadically. The therapeutic options are either a surgical approach, which is the most frequently adopted, or simple observation. We present a patient with acute abdominal pain due to superior mesenteric artery dissection who was successfully treated by percutaneous endovascular stent placement.     

Spiral-shaped iatrogenic arterial dissection during superior mesenteric arteriography: a latent risk of diagnostic angiography using the power injector.

We report a rare case of iatrogenic arterial dissection of the superior mesenteric artery (SMA) during diagnostic angiography. A conventional superior mesenteric arteriogram obtained using an automated power injector revealed an arterial dissection 2s after the initiation of contrast-medium injection. This case indicates that although careful catheter manipulations during angiography are essential, certain unavoidable complications may occur.