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Mel J. Sharafuddin, MD, Rachael M. Nicholson, MD, Timothy F

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1 Endovascular recanalization of total occlusions of the mesenteric and celiac arteries 
Mel J. Sharafuddin, MD, Rachael M. Nicholson, MD, Timothy F. Kresowik, MD, Parth B. Amin, MD, Jamal J. Hoballah, MD, William J. Sharp, MD  Journal of Vascular Surgery  Volume 55, Issue 6, Pages (June 2012) DOI: /j.jvs Copyright © 2012 Society for Vascular Surgery Terms and Conditions

2 Fig 1 Example of recanalization of occluded superior mesenteric artery (SMA) in the setting of an obliterated stump in a 47-year-old woman who presented with an acute abdomen. During exploratory laparotomy, she was found to have an intra-abdominal abscess with extensive inflammation, segmental of patchy ischemia of the small bowel, and a pulseless mesentery. Revascularization was deemed difficult given the hostile abdomen. A, Lateral reconstruction of a contrast-enhanced computerized tomography (CT) of the abdomen shows occlusion of the celiac artery (CA) and SMA with no visible stumps. B, Axial slice demonstrates an obliterated stump of the SMA, which is just above the takeoff of the renal arteries. C, Lateral flush aortogram from a brachial approach demonstrates a featureless suprarenal aorta with no stumps visualized. D, Probing anteriorly at the level of the renal artery engaged the obliterated stump of the SMA, with subsequent subintimal recanalization. E, Final angiography following deployment of a 5- × 28-mm balloon-expanded stent. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

3 Fig 2 Sixty-year-old woman with extensive peripheral vascular disease presenting with severe postprandial pain, fear of eating, and 20-pound weight loss. A, Lateral reconstruction of a contrast-enhanced computerized tomography (CT) of the abdomen shows a 3-cm-long occlusion of the superior mesenteric artery (SMA) with no visible stump. B, Progressive burrowing at the suspected level of the obliterated SMAP stump, using the celiac artery and visible calcifications on fluoroscopy as a reference. C, Ostial stenting of the SMA with balloon dilatation of the recanalized track shows recoil of the subintimal track. D, Final appearance following prolonged inflation of 5-mm balloon diameter shows an optimal anatomic result. E, Angiography showed in-stent restenosis and restenosis/recoil of the subintimal-true lumen fenestration. F, Following scoring balloon angioplasty, there is improved flow but hazy appearance of the mid-SMA. G, Final result following placement of a 6- × 100-mm self-expanding nitinol stent. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

4 Fig 3 Table analysis of primary and assisted freedom from symptoms. Comparison of the primary and assisted curves using log-rank Cox analysis showed significant difference (P = .05). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

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