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Updated: Oct 8, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Retrograde Superior Mesenteric Artery Stenting in Case of SMA Shuttering
Jason Zhang1, Rohan Basu1, Ann Gaffey1
1Department of Surgery, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Insights
This case highlights retrograde open superior mesenteric artery stenting (ROMS) as a successful salvage technique for bowel ischemia caused by endovascular repair complications. ROMS effectively treated shuttering of the superior mesenteric artery, resolving patient symptoms.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Gastrointestinal Surgery
Background:
- Endovascular repair of thoracoabdominal aneurysms can lead to complications such as celiac artery coverage.
- Stent graft deployment may inadvertently occlude the superior mesenteric artery, causing bowel ischemia.
Purpose of the Study:
- To describe a case of successful management of endovascular repair-induced superior mesenteric artery occlusion.
- To demonstrate the utility of retrograde open superior mesenteric artery stenting (ROMS) as a salvage procedure.
Main Methods:
- A patient with an extent V thoracoabdominal aneurysm underwent endovascular repair.
- Superior mesenteric artery occlusion occurred post-deployment, leading to bowel ischemia.
- Retrograde open superior mesenteric artery stenting was performed successfully.
Main Results:
- The patient developed symptoms of bowel ischemia following endovascular repair.
- Retrograde open superior mesenteric artery stenting successfully restored flow and resolved ischemic symptoms.
- This intervention served as a crucial salvage option for a rare complication.
Conclusions:
- Retrograde open superior mesenteric artery stenting is a viable salvage option for iatrogenic superior mesenteric artery occlusion during endovascular procedures.
- This technique can effectively manage bowel ischemia resulting from endovascular repair complications.
- ROMS expands its application beyond acute mesenteric ischemia to include intraprocedural complications.
Abstract:
This case describes a patient who underwent endovascular repair for an extent V thoracoabdominal aneurysm with planned coverage of the celiac artery. Following deployment of the stent graft, the superior mesenteric artery was shuttered, and the patient subsequently developed signs and symptoms of bowel ischemia. The patient underwent successful retrograde open superior mesenteric artery stenting with resolution of her symptoms. Although retrograde open mesenteric artery stenting (ROMS) has been primarily shown to be effective in acute mesenteric ischemia, this case demonstrates that ROMS can be used as a salvage option for shuttering during endovascular procedures.
