title: Technique of recanalization of long-segment flush superior mesenteric artery occlusions.
abstract: OBJECTIVE
  To describe technical tips for recanalization of long-segment flush superior mesenteric artery (SMA) occlusions.
  
  
  METHODS
  Ultrasound-guided left brachial artery access was gained in 2 patients with a 7F 90-cm sheath being advanced to the supraceliac aorta. The SMA stump was visualized using a selective inferior mesenteric artery (IMA) catheterization via femoral approach. A combination of a 7F 100-cm Multipurpose (MPA) guide and a 5F 125-cm MPA catheter was utilized to provide support for selective catheterization. Subsequently, a 0.018-inch wire and catheter were advanced crossing the area of occlusion. Predilatation was performed, followed by placement of covered stent. Both patients had uncomplicated course and resolution of symptoms.
  
  
  CONCLUSIONS
  Flush SMA occlusions are challenging lesions but may be treated by antegrade percutaneous recanalization with good results. Technical aspects that facilitate recanalization include brachial approach, use of a stiff system (sheath, guide, and catheter) and concomitant injection to facilitate visualization of the SMA stump.
authors: Department of Surgery, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors: Rafael D
authors: RD
authors: Malgor
authors: Gustavo S
authors: GS
authors: Oderich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000295:instrumentation; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008638:Mesenteric Arteries; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014654:Vascular Patency