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Case Reports
Published online: 2019-06-17
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Middle Aortic Syndrome with Mesenteric artery stenosis- successful percutaneous endovascular reconstruction

Santosh Kumar Sinha, Vinay Krishna, Mahmodula Razi, Ramesh Thakur, Puneet Aggarwal, Pradyot Tewari, Lokendra Rekwal
DOI: 10.5603/FC.a2019.0047

open access

Ahead of print
Case Reports
Published online: 2019-06-17

Abstract

Chronic mesenteric ischemia (CMI) is a challenging problem especially when both the superior mesenteric artery (SMA) and celiac artery (CA) are involved. We report a case 65-year-old female with hypertension, type II diabetes, and dyslipidemia who presented with exertional angina for 11-months duration and abdominal angina with weight loss for 5-months. Coronary computed tomographic (CT) angiogram revealed critical discrete lesion of mid right coronary artery (RCA). A contrast CT angiogram revealed a high grade, long segment stenosis of supra-renal abdominal aorta which was mildly calcified, mild ostial stenosis of celiac artery, and critical ostial stenosis of superior mesenteric artery (SMA) suggesting middle aortic syndrome with mesenteric artery stenosis. RCA was revascularised by deployment of 3.5x18 mm Xience prime Everolimus eluting stent (Abott Vascular; USA) at 13 atm pressure achieving TIMI III flow through left transbrachial approach. Aorta was stented transfemorally using two overlapping Epic self-expanding stents (Boston scientific, USA) - 12x60 mm proximally and 10x40 mm distally. SMA was stented with 6x18 mm stent (Herculink, Boston, USA) after predilatation achieving complete revascularization.

Abstract

Chronic mesenteric ischemia (CMI) is a challenging problem especially when both the superior mesenteric artery (SMA) and celiac artery (CA) are involved. We report a case 65-year-old female with hypertension, type II diabetes, and dyslipidemia who presented with exertional angina for 11-months duration and abdominal angina with weight loss for 5-months. Coronary computed tomographic (CT) angiogram revealed critical discrete lesion of mid right coronary artery (RCA). A contrast CT angiogram revealed a high grade, long segment stenosis of supra-renal abdominal aorta which was mildly calcified, mild ostial stenosis of celiac artery, and critical ostial stenosis of superior mesenteric artery (SMA) suggesting middle aortic syndrome with mesenteric artery stenosis. RCA was revascularised by deployment of 3.5x18 mm Xience prime Everolimus eluting stent (Abott Vascular; USA) at 13 atm pressure achieving TIMI III flow through left transbrachial approach. Aorta was stented transfemorally using two overlapping Epic self-expanding stents (Boston scientific, USA) - 12x60 mm proximally and 10x40 mm distally. SMA was stented with 6x18 mm stent (Herculink, Boston, USA) after predilatation achieving complete revascularization.

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Keywords

Atherosclerosis; Chronic mesenteric ischemia; Abdominal angina; Superior Mesenteric Artery angioplasty; Percutaneous Endovascular Treatment

About this article
Title

Middle Aortic Syndrome with Mesenteric artery stenosis- successful percutaneous endovascular reconstruction

Journal

Folia Cardiologica

Issue

Ahead of print

Published online

2019-06-17

DOI

10.5603/FC.a2019.0047

Keywords

Atherosclerosis
Chronic mesenteric ischemia
Abdominal angina
Superior Mesenteric Artery angioplasty
Percutaneous Endovascular Treatment

Authors

Santosh Kumar Sinha
Vinay Krishna
Mahmodula Razi
Ramesh Thakur
Puneet Aggarwal
Pradyot Tewari
Lokendra Rekwal

References (12)
  1. Moawad J, Gewertz BL. Chronic mesenteric ischemia. Clinical presentation and diagnosis. Surg Clin North Am. 1997; 77(2): 357–369.
  2. Foley MI, Moneta GL, Abou-Zamzam AM, et al. Revascularization of the superior mesenteric artery alone for treatment of intestinal ischemia. J Vasc Surg. 2000; 32(1): 37–47.
  3. Cho JS, Carr JA, Jacobsen G, et al. Long-term outcome after mesenteric artery reconstruction: a 37-year experience. J Vasc Surg. 2002; 35(3): 453–460.
  4. Herbert GS, Steele SR. Acute and chronic mesenteric ischemia. Surg Clin North Am. 2007; 87(5): 1115–34, ix.
  5. Casserly IP, Sachar R, Yadav JS. Practical Peripheral Vascular Intervention. 2nd ed. Lippincott Williams & Wilkins, Philadelphia 2012.
  6. Turba UC, Saad WE, Arslan B, et al. Chronic mesenteric ischaemia: 28-year experience of endovascular treatment. Eur Radiol. 2012; 22(6): 1372–1384.
  7. Sarac TP, Altinel O, Kashyap V, et al. Endovascular treatment of stenotic and occluded visceral arteries for chronic mesenteric ischemia. J Vasc Surg. 2008; 47(3): 485–491.
  8. Grilli CJ, Fedele CR, Tahir OM, et al. Recanalization of chronic total occlusions of the superior mesenteric artery in patients with chronic mesenteric ischemia: technical and clinical outcomes. J Vasc Interv Radiol. 2014; 25(10): 1515–1522.
  9. Dahl T, Stout C, Veale W, et al. Our Experience with 140 Visceral Artery Stents: Should Celiac Artery Stenting be Abandoned? Journal of Vascular Surgery. 2010; 51(4): 1071.
  10. Gotsman I, Verstandig A. Intravascular stent implantation of the celiac artery in the treatment of chronic mesenteric ischemia. J Clin Gastroenterol. 2001; 32(2): 164–166.
  11. Matsumoto AH, Angle JF, Spinosa DJ, et al. Percutaneous transluminal angioplasty and stenting in the treatment of chronic mesenteric ischemia: results and longterm followup. J Am Coll Surg. 2002; 194(1 Suppl): S22–S31.
  12. Schaefer PJ, Schaefer FKW, Mueller-Huelsbeck S, et al. Chronic mesenteric ischemia: stenting of mesenteric arteries. Abdom Imaging. 2007; 32(3): 304–309.

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