Successful Percutaneous Thrombectomy of Aortic Tumor Emboli Extending into the Origin of the Superior Mesenteric Artery with Half-Deployment of a Nitinol Stent

Abstract

A 73-year-old woman with leiomyosarcoma presented with a 3-day history of abdominal pain. An abdominal computed tomography (CT) scan revealed a 1.5-cm abdominal aortic mass extending into the origin of the superior mesenteric artery (SMA) (arrow in Fig 1). Chest CT scan showed tumor thrombi in the left superior pulmonary vein and left atrium (straight and right-angle arrows in Fig 2) and multiple metastatic lesions in both lungs (arrowheads in Fig 2) and the left fourth rib (curved arrow in Fig 2). Together, these findings indicated that a pulmonary metastatic lesion had invaded the pulmonary vein and caused systemic tumor embolization. Aortography performed through a transfemoral 45-cm 8-F sheath (Super Arrow-Flex sheath; Arrow International, Inc, Reading, Pennsylvania) showed a filling defect at the SMA origin (arrow in Fig 3). A 16-F sheath (St. Jude Medical, Minnetonka, Minnesota) was inserted through the contralateral femoral artery using a “preclosure” technique. A 16-mm diameter self-expanding closed cell nitinol stent (Niti-S; Taewoong Medical Co, Ltd, Gimpo, Korea) was advanced through the sheath and halfdeployed, caudally, to capture emboli. A 6-F 20-mm thrombectomy-type