Successful use of blunt microdissection catheter in a chronic total occlusion of a celiomesenteric artery

Successful endovascular treatment of acute mesenteric and hepatic ischemia in patient with celiomesenteric trunk occlusion

Acute occlusion of celiomesenteric trunk variants such as a replaced common hepatic artery origin from a superior mesenteric artery can be catastrophic and requires immediate attention to reverse simultaneous mesenteric and hepatic ischemia and prevent death. We report the case of a 73-year-old woman with acute occlusion of her celiomesenteric trunk and proximal superior mesenteric artery who underwent successful endovascular repair with stent graft via brachial access. In the present case report, we describe a surgically relevant classification system of celiomesenteric trunk variants, highlight the feasibility of endovascular intervention in this uncommon scenario, and describe our technique.

Recurrent Mesenteric Ischemia from Celiomesenteric Trunk Stenosis

A common origin of the celiac trunk and superior mesenteric artery (SMA), also termed as celiomesenteric trunk (CMT), is a rare occurrence. We report a rare case of symptomatic CMT stenosis requiring multiple interventions. The patient underwent an initial superior mesenteric artery bypass graft but required a subsequent endoluminal intervention. We present this case for the rarity of CMT stenosis and its potential to cause recurrent mesenteric ischemia. The treatment outcome in this patient suggests that revascularization of the SMA alone can result in adequate perfusion of the entire mesenteric bed and resolve symptoms of mesenteric ischemia including weight loss and food avoidance.

Endovascular treatment of mesenteric ischemia

OBJECTIVES

Our goal was to describe a single-center's experience in managing acute and chronic mesenteric ischemia with endovascular therapies.

BACKGROUND

Open surgical revascularization has been considered the historical gold standard treatment for mesenteric ischemia though it poses considerable morbidity and mortality risk. An aging population with increased comorbidities makes endovascular treatment a more attractive treatment option.

METHODS

Consecutive subjects receiving percutaneous mesenteric interventions for acute and chronic mesenteric ischemia from 2004 to 2010 were identified retrospectively. Information on comorbidities, symptoms, screening tests, procedural outcomes, and follow up was obtained.

RESULTS

Thirty-one patients received percutaneous mesenteric interventions during this period. The mean age of the population was 65.0 years with roughly equal proportions of males (48.4%) and females (51.6%). Traditional cardiovascular risk factors were highly prevalent (hypertension 45.2%, diabetes 25.8%, dyslipidemia 38.7%, nicotine use 45.2%). Procedural success was 93.5%; no periprocedural complications were reported. During a mean follow up of 13 months, 16.1% required repeat revascularization and 22.6% died. Endovascular treatment of acute mesenteric ischemia was successful (n = 8) and no patient required open surgical revascularization acutely or during follow-up.

CONCLUSIONS

Endovascular treatment of mesenteric ischemia is a safe and effective therapy with acceptable long-term results. Our experience with acute mesenteric ischemia suggests that percutaneous treatment may be an effective alternative to surgical revascularization in appropriately selected patients.

Percutaneous panvascular intervention in an unusual case of extensive atherosclerotic disease

It is common to see patients with atherosclerotic coronary disease and peripheral arterial disease in routine clinical practice. One needs to have a comprehensive and integrated multi-speciality approach and panvascular revascularization in such patients. We report a 54-year-old diabetic hypertensive male with extensive atherosclerotic coronary and peripheral arterial disease, who presented with congestive heart failure, claudication of both lower limbs and mesenteric ischemia. He underwent successful percutaneous panvascular revascularization of coronary, renal, mesenteric, aorto-iliac and superficial femoral arteries. Long-term patency of all the stents was also documented.

Multiple bailout interventions in a case of Takayasu's arteritis

PURPOSE

Takayasu's arteritis (TA) is a non-specific, chronic, inflammatory panarteritis, affecting the aorta, its major branches and pulmonary arteries. The percutaneous or surgical revascularization in these patients is often difficult and challenging because of diffuse and multi-vessel involvement, difficulty in management of disease activity, and high rate of restenosis and re-intervention.

CASE REPORT

We report a 33-year-old man, a case of TA with fulminant active disease and multi-vessel involvement. His disease activity could not be suppressed with steroid treatment. He had multiple sequential bailout interventions of carotid, left main coronary and mesenteric arteries secondary to cerebro-vascular event, angina and mesenteric ischemia, respectively.

CONCLUSION

Despite comprehensive multi-specialty approach in management and also the global revascularization, he ultimately died of acute mesenteric ischemia. To our knowledge, there is no similar type of case being published in world literature till date.