PMC6715789_01
Contrast enhanced computed tomography scan shows the isolated superior mesenteric artery dissecting aneurysm arising from the false lumen. The arrow shows the compressed true lumen.
gr1.jpg
PMC6715789_01_gr1.jpg
fig1
The aneurysm arose from the false lumen measuring 3.0 cm x 2.2 cm (anteroposterior x transverse) in cross sectional diameter (Fig. 1).
On table angiogram shows cannulation of the true (marked with thick arrow) and false (marked with thin arrow) lumens of the superior mesenteric artery dissecting aneurysm.
gr2.jpg
PMC6715789_01_gr2.jpg
fig2
The 5 F arterial sheath was changed to a 7 F, 70 cm Ansel guiding sheath (Cook Medical) over the Rosen guidewire and engaged in the SMA (Fig. 2). The false lumen of the SMA was cannulated with another 0.035 inch guidewire (Terumo Co, Ltd, Tokyo, Japan) and a 5 F C1 catheter (Cordis Corp, Warren, NJ, USA) (Fig. 2).
On table angiogram after deployment of a bare stent within the true lumen of the proximal SMA and a covered stent at the SMA orifice demonstrates the expansion of true lumen and preservation of the jejunal and ileal branches of SMA. The red arrows point to the ends of the bare stent, and the blue arrows mark the ends of the covered stent. SMA = superior mesenteric artery.
gr3.jpg
PMC6715789_01_gr3.jpg
fig3
A 10 mm x 38 mm iCAST covered stent (Atrium, Hudson, NH, USA) was implanted via the guiding sheath and deployed at the SMA orifice to cover the entry tear (Fig. 3).
Completion angiogram shows successful obliteration of the aneurysm with no endoleak observed.
gr4.jpg
PMC6715789_01_gr4.jpg
fig4
No side branches of the SMA were covered (Fig. 4).
Magnetic resonance imaging scans performed post-operatively show patent stents with an occluded aneurysm sac.
gr5.jpg
PMC6715789_01_gr5.jpg
fig5
The perfusion in major branches of the SMA was good (Fig. 5).