Percutaneous stenting of an latrogenic superior mesenteric artery dissection complicating suprarenal aortic aneurysm repair.
OBJECTIVE
To report endovascular repair of an iatrogenic superior mesenteric artery (SMA) dissection caused by a balloon occlusion catheter.


METHODS
A 68-year-old man with a suprarenal aortic aneurysm underwent conventional prosthetic replacement, during which visceral artery back bleeding was controlled with balloon occlusion catheters. Six hours postoperatively, the patient experienced an episode of bloody diarrhea with abdominal pain and tenderness and mild metabolic acidosis. Colonoscopy revealed colitis (grade I) without necrosis of the right and left colon. An emergent abdominal computed tomographic scan showed signs of mesenteric ischemia with bowel dilatation and SMA wall hematoma; angiography identified a dissection 1 cm distal to the SMA origin. An Easy Wallstent was deployed percutaneously, successfully reestablishing SMA patency. The postoperative course was uneventful, and the patient remains asymptomatic with a patent SMA stent and aortic graft at 1 year.


CONCLUSIONS
latrogenic SMA dissection should be suspected after suprarenal aortic aneurysm repair if signs of mesenteric ischemia arise. Prompt and thorough imaging studies are necessary to confirm the diagnosis and assess the potential for an endoluminal treatment.
Desgranges
P
P
Department of Vascular Surgery, Henri Mondor Hospital, Créteil, France. pascal.desgranges@wanadoo.fr
Bourriez
P A
PA
d'Audiffret
A
A
Zubilewicz
T
T
Mathieu
D
D
Becquemin
J P
JP
Kobeiter
H
H
D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000628:therapy*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D021721:Balloon Occlusion / Q000295:instrumentation*; D019917:Blood Vessel Prosthesis Implantation; D006801:Humans; D007049:Iatrogenic Disease; D007422:Intestines / Q000098:blood supply; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D007511:Ischemia / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000628:therapy; D011859:Radiography; D015607:Stents