Background: Isolated dissection of visceral artery organs is very infrequently reported and when occurred mostly affected is the superior mesenteric artery (SMA) with abdominal pain as the commonest presenting features in symptomatic patients. Dissection can be detected by ultrasound and CT, but computed tomography angiography (CTA) is the best for demonstration of the true and false lumens of the lesion. Nonetheless, the perfect treatment has not been accepted yet. However, if left untreated, it is a lifethreatening condition. Objectives: Our aim is to evaluate diagnostic imaging and endovascular treatment outcome of spontaneous isolated superior mesenteric artery dissection (SISMAD). Based on the angiographic configuration of SMA and location of dissection we will share our experience based on deployment of a bare straight stent, bare tapered stent, overlapping bare stent or coil assisting bare stent. Patients and Methods: Medical data from patients presented with symptomatic superior mesenteric artery dissection (SMAD) and had received endovascular treatment between January 2007 and December 2017 were extracted. Patient demographics, symptoms, diagnostic imaging, endovascular treatment, and follow-up findings were analyzed.Results: Total of 31 patients were included in this study [87.1% (n = 27) male, 12.9% (n = 4) female, and mean age 52.9 ± 8.2 years]. All patients had abdominal pain as the main presenting symptom. The mean length of dissection was (4.79 ± 3.03) cm, mean distance from the aorta to dissection entry was 2.5 ± 1.0cm, mean percentage stenosis was 63.3 ± 12.7%, Sakamoto type IIA was seen in 35.5%(n = 11), and type IIB in 64.5% (n = 20). All of the patients received bare self-expandable stent whereby 90.3% (n = 28) received stent(s) without coil, of which 64.3% (n = 18) received single straight stent, 21.4% (n = 6) received overlapping stent and 14.3% (n = 4) received tapered stent. On the other hand, 9.7% (n = 3) received coil assisting stent. Post-procedure normal blood supply to the distal SMA and relief of symptoms was noted. One hundred percent (n = 31) primary success rate was recorded during mean fasting and follow-up time of 4.9 ± 1.9 days and 15.5 ± 4.8 months, respectively. Conclusion:Endovascular treatment with a bare stent is a safe, effective, and successful treatment for symptomatic SISMAD with satisfactory outcomes. We highly recommend it to be considered as a first-line treatment in severe co-morbidity patients who are unfit for open surgery.

Background Secondary hypertension accounts for 5% of all cases of hypertension. Renal artery stenosis is one of the common causes of secondary hypertension. Atherosclerosis and fibromuscular dysplasia are the commonest types of stenosis associated with renal vascular hypertension, with the former accounting for 70–80% of all cases and the latter accounting for 10% of the incidence. The greatest incidence atherosclerosis is in men over the age of 40 years, mostly affecting the proximal part of the renal arteries, whereas fibromuscular dysplasia affects women ranging in age from 30 to 50 years. Currently, possible treatments are medical treatment using blood pressure-lowering drugs, balloon angioplasty with or without stent insertion, and surgery to reconstruct the artery. Case presentation We report a case of a 46-year-old Asian woman with stenosis of two branches of renal artery bifurcation treated by percutaneous balloon dilatation and stenting of both branches after referral to our department for a renal angiogram following 8 months of uncontrolled hypertension despite receiving medications. Initially, the patient presented with severe headache and fatigue. She was a known nonsmoker, was not diabetic, and had no history of diabetes in her family. She had no history of atherosclerosis. Apart from high blood pressure, the result of her physical examination was unremarkable. Laboratory investigations revealed normal serum cholesterol, lipid profile, and serum creatinine. She had been attending a hypertension clinic and receiving antihypertensive drugs for the past 8 months on a regular basis under close observation. Despite this treatment and care, her blood pressure remained high at 175/110 mmHg, which the attending doctor concluded to be uncontrolled blood pressure. Initial imaging indicated left renal artery stenosis, and the patient was referred to our department. Conclusions For patients with uncontrolled hypertension despite receiving medications, renal Doppler ultrasound should be included in the diagnostic workup for secondary hypertension. Once renal artery stenosis is suspected, renal angiography is highly recommended because the technique is able to accurately diagnose stenosis in the branch arteries, unlike computed tomographic angiography and magnetic resonance angiography. Percutaneous transluminal renal angioplasty is the treatment of choice for renal artery stenosis in patients with renovascular hypertension or renal dysfunction.