Case report: Percutaneous transluminal angioplasty of the inferior mesenteric artery in the treatment of chronic mesenteric ischaemia

Crotch-Harvey, M.A.; Gould, Debby; Green, A.T.

doi:10.1016/s0009-9260(05)80689-0

Cited by 13 publications

(3 citation statements)

References 6 publications

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“…5). There are case reports of therapeutic benefit from isolated IMA angioplasty when both the SMA and celiac arteries are completely occluded, 10,11 but there is no such case report of IMA angioplasty and stenting in this scenario. So, our case demonstrates benefits of angioplasty and stenting of IMA to improve collateral circulation when rests of the two mesenteric arteries are not accessible.…”

Section: Discussionmentioning

confidence: 99%

“…So far, there have been only two previous case reports of an isolated IMA angioplasty for CMI but none was with stenting. 10,11 According to retrospective study of 292 patients treated by ER approach done by Kougias et al, found that selective stenting has better outcomes over simple angioplasty in terms of technical success, but early and late symptomatic relief, restenosis rates, and mortality were equivalent in either approach. 12 Nevertheless, angioplasty with stenting is a rescue procedure for dissection, acute occlusion, or failure to maintain adequate dilatation following angioplasty of a tight stenosis of the SMA or celiac axis.…”

Section: Discussionmentioning

confidence: 99%

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Rare Case of “Wandering Artery of Drummond” As a Result of Chronic Triple Mesenteric Vessel Occlusion Treated by Isolated Angioplasty and Stenting of the Inferior Mesenteric Artery

et al. 2013

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Chronic mesenteric ischemia (CMI) is often times underrecognized cause of postprandial abdominal pain. More than 90% of all cases of CMI are caused by atherosclerotic occlusion or stenosis of mesenteric arteries. 1 The other causes of CMI include Takayasu diseases, fibromuscular dysplasia, thromboangitis obliterans, polyartertritis nodosum, radiation therapy, and median arcuate syndrome. 1 The classic presentation of CMI has gradual onset with clinical features of significant abdominal angina, food phobia (or anorexia), weight loss, and malnourishment. It is more prevalent in women than men. The majorities of CMI patients have traditional atherosclerotic risk factors and associated peripheral vascular diseases (PVD) or coronary artery diseases (CAD). 2 Clinical presentations may suggest gastrointestinal, hepatic, gallbladder, or pancreatic pathologies. Therefore, a high index of suspicion should be kept for CMI in patients with similar presentation and the diagnosis can be confirmed by bolus-timed spiral computed tomography angiography (CTA) of abdomen or mesenteric vessels duplex ultrasonography. Traditionally, the treatment of choice has been either operative revascularization (OR) or endovascular revascularization (ER). 2 Hereby, we present a case of chronic triple mesenteric vessel occlusion treated by isolated angioplasty and stenting of the inferior mesenteric artery (IMA) ostial stenosis and illustrate the angiographic findings before and after the procedure and various treatment alternatives. Keywords► non-ST elevation myocardial infarction ► superior mesenteric artery ► inferior mesenteric artery AbstractWe report a rare clinical scenario of chronic mesenteric ischemia (CMI) patient with obstruction of all the three major gut vessels including celiac, superior mesenteric artery (SMA), and inferior mesenteric artery (IMA) with a sole artery supplying the collaterals through marginal artery of left colon (the "wandering artery of Drummond").A 70-year-old man was presented to hospital with acute onset of dyspnea, diaphoresis, severe epigastric pain, nausea, and vomiting that started after lunch. Initially, patient was diagnosed and treated for non-ST elevation myocardial infarction (NSTEMI). Furthermore, work-up, including computed tomographic scan of abdomen followed by angiogram, revealed 100% obstruction of celiac and SMA, whereas inferior IMA had 90% ostial lesion with poststenotic dilatation and collaterals supplying to entire colon. Subsequently, IMA ostial lesion was stented through percutaneous intervention and patient noted significantly improved symptoms and quality of life. To conclude, percutaneous endovascular treatments confer favorable strategy for CMI, and it may either be curative or allow nutritional optimization before definitive surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rare Case of “Wandering Artery of Drummond” As a Result of Chronic Triple Mesenteric Vessel Occlusion Treated by Isolated Angioplasty and Stenting of the Inferior Mesenteric Artery

et al. 2013

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“…If there is inadequate fi lling of distal collaterals, angioplasty can be dangerous as the infl ated balloon can thrombose or dissect the artery (120,121) . Angioplasty of the inferior mesenteric artery is rarely indicated unless abnormalities exist in the celiac artery and SMA that are not amenable to intervention (122) . Patients with radiographic evidence of celiac -artery compression are not candidates for percutaneous transluminal angioplasty, which is routinely unsuccessful because the lesion is secondary to external compression and not intraluminal obstruction.…”

Section: Treatmentmentioning

confidence: 99%