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Treatment of symptomatic isolated dissection of superior mesenteric artery  Zhihui Dong, MD, Weiguo Fu, MD, Bin Chen, MD, Daqiao Guo, MD, Xin Xu, MD, Yuqi.

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Presentation on theme: "Treatment of symptomatic isolated dissection of superior mesenteric artery  Zhihui Dong, MD, Weiguo Fu, MD, Bin Chen, MD, Daqiao Guo, MD, Xin Xu, MD, Yuqi."— Presentation transcript:

1 Treatment of symptomatic isolated dissection of superior mesenteric artery 
Zhihui Dong, MD, Weiguo Fu, MD, Bin Chen, MD, Daqiao Guo, MD, Xin Xu, MD, Yuqi Wang, MD  Journal of Vascular Surgery  Volume 57, Issue 2, Pages 69S-76S (February 2013) DOI: /j.jvs Copyright © 2013 Society for Vascular Surgery Terms and Conditions

2 Fig 1 In patient 4, (A) Riolan's arch (three long arrows) was perfused from the inferior mesenteric artery (IMA, short arrow). B, The primary entry site (arrow) was located 30 mm distal to the origin of superior mesenteric artery (SMA) with the true lumen highly compressed by the false one and impaired perfusion of distal SMA and its main branches. C, A stent (Maris 6 × 80 mm; Invatec, Brescia, Italy) was placed via the brachial artery after failure in the attempted femoral approach. However, the stent had foreshortened during deployment, causing inadequate proximal landing and endoleak (short arrow). Meanwhile, it was noted that the Riolan's arch disappeared with only IMA (long arrow) opacified. D, An additional stent (Maris 6 × 40 mm) was then deployed more proximally with its proximal end (short arrow) a little bit protruding into the abdominal aorta, and endoleak vanished. The IMA (long arrow) could still be visualized, whereas Riolan's arch could not. E and F, The follow-up computed tomographic angiography (CTA) at 16 months revealed patent stent and satisfactory perfusion of SMA and its main branches. Journal of Vascular Surgery  , 69S-76SDOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

3 Fig. 2 In patient 10, the preoperative computed tomographic angiography (CTA) showed (A) the true lumen (short arrow) slightly compressed by the thrombosed false lumen (long arrow) at the proximal portion of superior mesenteric artery (SMA) and (B) the true lumen (short arrow) highly compressed by the patent false lumen (long arrow) at the middle segment of SMA. C, The middle portion (arrow) of SMA appeared big in diameter, however, the majority of the opacified area was the false lumen rather than the true one, underlying a few branches opacified and the distal perfusion significantly impaired. Intraoperatively, (D) the exploration found the pallor of the distal ileum (left side of the arrow) and (H) after the middle segment of SMA was transected, two lumens were disclosed, the small true lumen (short arrow) and the big false lumen (long arrow). The follow-up CTA at 1 month demonstrated (E) at the proximal portion of SMA, the true (short arrow) and false lumens (long arrow) remained unchanged. F, At the middle segment immediately distal to the surgical fenestration, the false lumen was eliminated, and the true lumen (arrow) was dramatically expanded. G, The proximal segment of SMA was expanded compared with the preoperative CTA (C), the middle portion (arrow) appeared unchanged in diameter; nevertheless, it was the true lumen that was opacified, rather than the false lumen, underlying much more branches visualized and the distal perfusion markedly improved. Journal of Vascular Surgery  , 69S-76SDOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

4 Fig. 3 Treatment algorithm for symptomatic isolated dissection of superior mesenteric artery (SIDSMA). Journal of Vascular Surgery  , 69S-76SDOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

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