Percutaneous retrograde recanalization of an occluded celiac artery complicating acute aortic dissection

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Gastroenterology

Background:

• Acute type B aortic dissection can lead to visceral artery complications, including celiac artery occlusion.
• Celiac artery occlusion can cause severe abdominal pain, elevated liver enzymes, and metabolic acidosis.
• Endovascular revascularization is a potential treatment for acute visceral artery ischemia.

Observation:

• A 79-year-old woman presented with persistent upper abdominal pain due to thrombosed acute type B aortic dissection with complete celiac artery occlusion.
• Progressive symptoms, elevated liver enzymes, and metabolic acidosis developed 11 hours after admission.
• Initial antegrade catheterization of the celiac artery ostium failed due to hard occlusion.

Findings:

• Emergent endovascular revascularization was performed.
• A retrograde recanalization approach through the pancreaticoduodenal arcade via the superior mesenteric artery was successfully employed.
• Stent placement was achieved using a pull-through technique.

Implications:

• This retrograde recanalization technique is a viable and safe option for treating celiac artery occlusion when antegrade approaches are challenging.
• Successful revascularization can alleviate symptoms and prevent further organ damage in patients with aortic dissection complications.
• This case highlights the importance of considering alternative endovascular strategies for complex visceral artery interventions.