Superior Mesenteric and Hepatic Artery Percutaneous Intervention by Left Radial Artery Approach in a Cachectic Patient with Severe Mesenteric Ischemia

Abstract

Chronic mesenteric ischemia is an under-recognized condition with every time more frequent diagnostic consideration due to improved imaging tools; its current treatment strategy includes surgical and percutaneous revascularization. The radial approach has not yet been published for the percutaneous modality. A clinical case is presented with a 53 years old male with recent history of intense pain at swallowing with weight loss up to evident caquexia and prostration in bed; the patient had history of smoking, dyslipidemia, systemic arterial hypertension and, chronic systolic aortic murmur and family history of premature cardiac death. He was hospitalized due to intense abdominal pain and the physical examination rendered an abdominal bruit; the abdominal arterial CT scan revealed complete ostial occlusion of the superior mesenteric artery (SMA); the hepatic branch of the coeliac trunk had severe stenosis and gave collateral circulation through the superior pancreaticoduodenal branch. The treatment was performed through left radial artery approach with a 5 x 30 mm bare metal stent implantation in the origin of the SMA and angioplasty of the hepatic artery with the 5 x 30 mm balloon of the stent; the angiographic result obtained was good and was followed by immediate pain relief, complete tolerance to swallowing and feeding plus fast clinical recovery and weight gain. The present case illustrates the feasibility of the percutaneous mesenteric revascularization through the access of the left radial artery.