Endovascular revascularization of heavily calcified occlusion in superior mesenteric artery using Transcollateral
Kazunori Horie1, Akiko Tanaka2, Norio Tada2
1Department of Cardiovascular Medicine, Sendai Kousei Hospital, 4-15 Hirose-cho, Aoba-ku, Sendai, Miyagi, 980-0873, Japan. horihori1015@gmail.com.
Insights
This study presents a successful endovascular stenting of a chronic total occlusion in the superior mesenteric artery (SMA). A novel transcollateral approach, guided by 3D-CT, effectively treated severe vascular disease causing abdominal angina.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Disease
Background:
- Mesenteric ischemia often results from severe vascular disease affecting the superior mesenteric artery (SMA).
- Endovascular revascularization of chronic total occlusions (CTOs) in the SMA presents significant challenges.
Purpose of the Study:
- To describe a successful endovascular treatment for a heavily calcified SMA CTO.
- To highlight the utility of a transcollateral approach guided by 3D-CT in complex SMA occlusions.
Main Methods:
- A 73-year-old male with chronic abdominal angina underwent evaluation for SMA CTO.
- 3D-CT identified collateral filling from the celiac artery.
- A transcollateral guidewire passage through the SMA CTO was achieved, followed by stent deployment.
Main Results:
- Successful endovascular stenting of a heavily calcified SMA CTO was performed using a transcollateral approach.
- The patient experienced complete resolution of abdominal angina post-procedure.
- No adverse events were reported during 3 months of dual-anti-platelet therapy.
Conclusions:
- Endovascular stenting with a transcollateral approach is a viable treatment for complex, heavily calcified SMA CTOs.
- 3D-CT imaging is crucial for planning and executing transcollateral approaches in SMA revascularization.
Background:
Mesenteric ischaemia is often a manifestation of severe vascular disease involving the superior mesenteric artery (SMA). Endovascular revascularization is challenging in a chronic total occlusion (CTO) of SMA.
Case Presentation:
A-73-year-old male patient was referred to our hospital because of a 2-year history of post prandial abdominal angina. Computed tomography (CT) images revealed a heavily calcified CTO in the ostium of SMA and three-dimensional CT (3D-CT) detected pancreaticoduodenal arcade with filling from the celiac artery. Then, endovascular procedure was attempted; however, angiography did not show the collateral route suitable for transcollateral approach. As demonstrated on the CT, we were successful in passing a guidewire through the SMA-CTO via the celiac trunk transcollateral route. After pull-through of the guidewire, two balloon-expandable stents were deployed in the ostium of SMA. During 3 months after stent implantation, the patient had no further episodes of abdominal angina on dual-anti-platelet therapy.
Conclusion:
We demonstrate a case of a heavily calcified SMA occlusion successfully treated with endovascular stenting employing a transcollateral approach, guided by 3D-CT.
