Using US guidance, the left brachial artery was accessed at the antecubital fossa. A 5-french introducer was advanced into the left brachial artery. Then, a 5-french angled catheter was used to redirect the catheter and wire toward the descending thoracic aorta. The catheter was advanced to the abdominal aorta under fluoroscopic guidance. Contrast was injected and abdominal aortogram was obtained and revealed occlusion of the superior mesenteric artery stent.
A 5-french angled catheter was used to engage the origin of the superior mesenteric artery stent. This was done with great difficulty due to occlusion of the superior mesenteric stent. A Glidewire was then slowly manipulated inside the occluded stent in the superior mesenteric artery. Contrast was injected and revealed flow distal to the stent with multiple filling defects proximally. This is compatible with occluded proximal superior mesenteric artery and may be related to thrombosis or underlying dissection.
During the wire catheter exchange, a small dissection was noted at proximal superior mesenteric artery without frank extravasation of contrast.
A 5-mm x 4cm stent was then deployed in the region of the proximal superior mesenteric artery for treatment of localized dissection. Contrast was injected following placement of the stent and revealed patency of the superior mesenteric artery with residual filling defect distally consistent with extension of the dissection distally into the branches of the superior mesenteric artery. At this point, the catheter was removed and heparin was started using heparin protocol. The plan is to have the patient fully heparinized and starting Coumadin to allow improved vascularization into the small bowel.
Incidental note was made of the high-grade stenosis at the origin of the inferior mesenteric artery. This was caused by extensive atherosclerotic plaque at the origin.
Any help would be appreciated!!
A 5-french angled catheter was used to engage the origin of the superior mesenteric artery stent. This was done with great difficulty due to occlusion of the superior mesenteric stent. A Glidewire was then slowly manipulated inside the occluded stent in the superior mesenteric artery. Contrast was injected and revealed flow distal to the stent with multiple filling defects proximally. This is compatible with occluded proximal superior mesenteric artery and may be related to thrombosis or underlying dissection.
During the wire catheter exchange, a small dissection was noted at proximal superior mesenteric artery without frank extravasation of contrast.
A 5-mm x 4cm stent was then deployed in the region of the proximal superior mesenteric artery for treatment of localized dissection. Contrast was injected following placement of the stent and revealed patency of the superior mesenteric artery with residual filling defect distally consistent with extension of the dissection distally into the branches of the superior mesenteric artery. At this point, the catheter was removed and heparin was started using heparin protocol. The plan is to have the patient fully heparinized and starting Coumadin to allow improved vascularization into the small bowel.
Incidental note was made of the high-grade stenosis at the origin of the inferior mesenteric artery. This was caused by extensive atherosclerotic plaque at the origin.
Any help would be appreciated!!