Technique of Hybrid Retrograde Superior Mesenteric Artery Stent Placement for Acute-on-Chronic Mesenteric Ischemia

Abstract

Revascularization for acute mesenteric ischemia can be challenging in patients with bowel gangrene, peritoneal contamination, and no good source of inflow for a bypass graft. A 70-year-old female patient presented with acute-on-chronic mesenteric ischemia, flush superior mesenteric artery (SMA) occlusion, and diffuse aorto-iliac occlusive disease. This study describes the technique of hybrid retrograde SMA recanalization and stent placement using a midline laparotomy is described. The mid-portion of the SMA was exposed and jejunal branches were controlled with silastic vessel loop. Retrograde access was established under direct vision and the occluded SMA segment was crossed, pre-dilated, and stented using a balloon-expandable stent. The SMA was flushed through a longitudinal arteriotomy, which was closed using a saphenous vein patch. Retrograde hybrid SMA stenting is an expeditious option to revascularize patients with acute on chronic mesenteric ischemia who have peritoneal contamination and no other good source of inflow to the mesenteric arteries.