title: True lumen stenting for a spontaneously dissected superior mesenteric artery may compromise major intestinal branches and aggravate bowel ischemia.
abstract: Optimal endovascular therapy for isolated superior mesenteric artery (SMA) dissection remains undetermined. Here, we report a 56-year-old male with ischemic bowel syndrome caused by such a serious vascular disease. He was treated with endovascular true lumen stenting yet got aggravated in bowel ischemia from unexpected jail of major intestinal branches perfused by the false lumen, requiring subsequent complex rewiring and dilatation procedures to resolve at the cost of excessive fluoroscopic and contrast medium exposure. Thus, when treating patients with isolated SMA dissection with a functioning false lumen, true lumen stenting may inadvertently compromise crucial intestinal branches and should not be indiscriminately considered as the prime therapeutic option.
authors.affiliation: 1Cardiovascular Center and Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Chih-Feng
authors.initials: CF
authors.lastname: Chang
authors.forename: Hui-Chin
authors.initials: HC
authors.lastname: Lai
authors.forename: Hang-Yun
authors.initials: HY
authors.lastname: Yao
authors.forename: Yu-Tsung
authors.initials: YT
authors.lastname: Cheng
authors.forename: Wen-Lieng
authors.initials: WL
authors.lastname: Lee
authors.forename: Kuo-Yang
authors.initials: KY
authors.lastname: Wang
authors.forename: Tsun-Jui
authors.initials: TJ
authors.lastname: Liu
mesh_terms: D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000601:surgery*; D065666:Mesenteric Ischemia; D008875:Middle Aged; D012307:Risk Factors; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy
keywords: artery; dissection; endovascular; ischemia; mesenteric; stenting