Superior mesenteric artery dissection with prolonged abdominal angina treated by laparotomy, endarterectomy, patch angioplasty, and retrograde open mesenteric stenting: a case report

Shinichi Tanaka,Eisuke Kawakubo,Atsushi Fukuda,Takuya Matsumoto

doi:10.1186/s40792-019-0736-0

Abstract

BackgroundMost patients with isolated superior mesenteric artery (SMA) dissection are successfully managed conservatively. However, some patients require more invasive treatment.Case presentationWe herein describe a 45-year-old man with isolated SMA dissection. He initially underwent conservative treatment. However, because of persistent abdominal angina, we considered the need for surgical revascularization. He was successfully treated by endarterectomy, patch angioplasty, and retrograde open mesenteric stenting. The abdominal angina was stabilized thereafter.ConclusionsThe combination of endarterectomy, patch angioplasty, and retrograde open mesenteric stenting is useful for isolated SMA dissection, and long patency can be expected for some patients.

Highlights

BackgroundSuperior mesenteric artery (SMA) dissection was historically thought to be rare but has been identified more frequently with the development of imaging techniques
Most patients with isolated superior mesenteric artery (SMA) dissection are successfully managed conservatively
We report a case of acute SMA dissection without intestinal ischemic necrosis but with persistent abdominal angina

Summary

Background

Superior mesenteric artery (SMA) dissection was historically thought to be rare but has been identified more frequently with the development of imaging techniques. Because of the patient’s continuous abdominal pain, we considered the need for emergency surgical therapy and transferred him to our university hospital. He was treated by conservative therapy including antiplatelet agents and prostaglandin, and his continuous abdominal pain disappeared He was discharged on day 20 and returned to our hospital for follow-up. We longitudinally incised the SMA from the thrombotic occluded part to the false lumen, performed thromboendarterectomy with a flap under a direct view, inserted a sheath into the central side (probably the false lumen), clamped the site with vascular tape, and placed an endovascular stent on the. Follow-up CT showed good flow and a thin flap between the stent and patch (Fig. 4) He was symptom-free 3 years after the surgery with a good nutritional status

Discussion

Conclusions