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Retrograde Stent Placement for Symptomatic Spontaneous Isolated Dissection of the Superior Mesenteric Artery.
Ann Vasc Surg. 2016 Aug; 35:203.e17-21.AV

Abstract

Various treatment options are currently available for spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) including conservative management, anticoagulation therapy, endovascular stenting, and surgical repair. We report an experience with retrograde open mesenteric stenting for SIDSMA. A 45-year-old man presented to the emergency department with acute onset of severe abdominal and back pain. Computed tomography angiography revealed a long occlusion of the SMA trunk. Initially, an endovascular solution was attempted, but this was unsuccessful as the guidewire failed to cross the lesion. Four hours after the onset of symptoms, because of aggravation of abdominal pain, the patient underwent an exploratory laparotomy under general anesthesia. The small intestine looked pale, and the arterial pulsation was not recognized in the mesentery. A 5-cm mesenteric portion of the SMA trunk was exposed. The SIDSMA diagnosis was confirmed after arteriotomy because a freshly formed thrombus and a severely stenosed true lumen (TL) were detected beneath the adventitia. From the proximal stump of the TL, a 6-French sheath introducer was inserted in a retrograde fashion. The occlusion was traversed with a 0.035-in guidewire. After predilatation, self-expandable stents were placed inside the occluded SMA. The patient was discharged from the hospital 3 weeks after the operation. Stent patency has been confirmed for 6 months. Retrograde stenting performed under laparotomy could be a rescue procedure after the failure of percutaneous stenting for SIDSMA.

Authors+Show Affiliations

Department of Cardiovascular Surgery, Shizuoka Municipal Hospital, Shizuoka-city, Japan. Electronic address: mitsuoka1178@shizuokahospital.jp.Department of Cardiovascular Surgery, Shizuoka Municipal Hospital, Shizuoka-city, Japan.Department of Cardiovascular Surgery, Shizuoka Municipal Hospital, Shizuoka-city, Japan.Department of Cardiovascular Surgery, Shizuoka Municipal Hospital, Shizuoka-city, Japan.Department of Cardiovascular Surgery, Shizuoka Municipal Hospital, Shizuoka-city, Japan.Department of Cardiovascular Surgery, Shizuoka Municipal Hospital, Shizuoka-city, Japan.Department of Cardiovascular Surgery, Shizuoka Municipal Hospital, Shizuoka-city, Japan.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

27236096

Citation

Mitsuoka, Hiroshi, et al. "Retrograde Stent Placement for Symptomatic Spontaneous Isolated Dissection of the Superior Mesenteric Artery." Annals of Vascular Surgery, vol. 35, 2016, pp. 203.e17-21.
Mitsuoka H, Nakai M, Terai Y, et al. Retrograde Stent Placement for Symptomatic Spontaneous Isolated Dissection of the Superior Mesenteric Artery. Ann Vasc Surg. 2016;35:203.e17-21.
Mitsuoka, H., Nakai, M., Terai, Y., Gotou, S., Miyano, Y., Tsuchiya, K., & Yamazaki, F. (2016). Retrograde Stent Placement for Symptomatic Spontaneous Isolated Dissection of the Superior Mesenteric Artery. Annals of Vascular Surgery, 35, e17-21. https://doi.org/10.1016/j.avsg.2016.01.029
Mitsuoka H, et al. Retrograde Stent Placement for Symptomatic Spontaneous Isolated Dissection of the Superior Mesenteric Artery. Ann Vasc Surg. 2016;35:203.e17-21. PubMed PMID: 27236096.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Retrograde Stent Placement for Symptomatic Spontaneous Isolated Dissection of the Superior Mesenteric Artery. AU - Mitsuoka,Hiroshi, AU - Nakai,Masanao, AU - Terai,Yasuhiko, AU - Gotou,Shinnosuke, AU - Miyano,Yuuta, AU - Tsuchiya,Kouich, AU - Yamazaki,Fumio, Y1 - 2016/05/26/ PY - 2015/03/10/received PY - 2015/11/10/revised PY - 2016/01/16/accepted PY - 2016/5/29/entrez PY - 2016/5/29/pubmed PY - 2017/1/24/medline SP - 203.e17 EP - 21 JF - Annals of vascular surgery JO - Ann Vasc Surg VL - 35 N2 - Various treatment options are currently available for spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) including conservative management, anticoagulation therapy, endovascular stenting, and surgical repair. We report an experience with retrograde open mesenteric stenting for SIDSMA. A 45-year-old man presented to the emergency department with acute onset of severe abdominal and back pain. Computed tomography angiography revealed a long occlusion of the SMA trunk. Initially, an endovascular solution was attempted, but this was unsuccessful as the guidewire failed to cross the lesion. Four hours after the onset of symptoms, because of aggravation of abdominal pain, the patient underwent an exploratory laparotomy under general anesthesia. The small intestine looked pale, and the arterial pulsation was not recognized in the mesentery. A 5-cm mesenteric portion of the SMA trunk was exposed. The SIDSMA diagnosis was confirmed after arteriotomy because a freshly formed thrombus and a severely stenosed true lumen (TL) were detected beneath the adventitia. From the proximal stump of the TL, a 6-French sheath introducer was inserted in a retrograde fashion. The occlusion was traversed with a 0.035-in guidewire. After predilatation, self-expandable stents were placed inside the occluded SMA. The patient was discharged from the hospital 3 weeks after the operation. Stent patency has been confirmed for 6 months. Retrograde stenting performed under laparotomy could be a rescue procedure after the failure of percutaneous stenting for SIDSMA. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/27236096/Retrograde_Stent_Placement_for_Symptomatic_Spontaneous_Isolated_Dissection_of_the_Superior_Mesenteric_Artery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(16)30343-0 DB - PRIME DP - Unbound Medicine ER -