Korean J Gastroenterol.  2010 Jan;55(1):58-61. 10.4166/kjg.2010.55.1.58.

Isolated Spontaneous Dissection of Superior Mesenteric Artery: Treated by Percutaneous Endovascular Stent Placement

• Kwak JW
• Paik CN
• Lee KM
• Chung WC
• Jung SH
• Kim JE
• Baik JH
• Yang JM

• KMID: 1775927
• DOI: http://doi.org/10.4166/kjg.2010.55.1.58

Abstract

Isolated spontaneous dissection of the superior mesenteric artery (SMA) without aortic dissection is a rare cause of acute mesenteric ischemia. A sudden decrease of intestinal blood flow can lead to fatal complications such as ischemic necrosis, shock, and death. Therefore, early diagnosis and therapeutic approach before the occurrence of intestinal infarction are the most important factor to determine the patient's prognosis. A 52-year-old male presented with postprandial periumbilical pain, and isolated spontaneous dissection of the superior mesenteric artery with mural thrombus was detected by abdominal computed tomography with contrast enhancement. By the percutaneous implantation of vascular metallic stent via femoral artery, he was treated successfully. We report a case of isolated spontaneous dissection of the SMA treated by a percutaneous endovascular stent replacement with a review of literature.

Keyword

Superior mesenteric artery dissection; Percutaneous stent

MeSH Terms

Aneurysm, Dissecting/complications/*diagnosis/surgery
Humans
Male
*Mesenteric Artery, Superior/radiography
Mesenteric Vascular Occlusion/etiology/surgery
Middle Aged
*Stents
Tomography, X-Ray Computed

Figure

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  Fig. 1. Contrast-enhanced abdominal CT scan findings. (A) A Intimal flap in the superior mesenteric artery (SMA) separating two lumen (white arrow). (B) A partial intraarterial low density thrombus in the proximal portion of the SMA without aortic dissection was demonstrated (white arrow).

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  Fig. 2. SMA angiography findings. (A) A dissection of proximal superior mesenteric artery was noted (white arrow). (B) A dissection of SMA was located about 2 cm distal to SMA orifice and the collapse of true lumen was showed (white arrow).

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  Fig. 3. SMA angiography finding after the stent insertion. A 6-40-mm self-expandible stent was placed covering the opening of the intimal flap (white arrows).

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