Effective kissing stent to severe stenosis of the superior mesenteric artery replacing the common hepatic artery

Abstract

BackgroundEndovascular therapy (ET) for chronic mesenteric ischemia (CMI) is a effective treatment to relieve the symptoms, such as postprandial abdominal pain, food fear, and progressive weight loss. CMI is not known to be caused by rare anatomical variation of severe stenosis of the superior mesenteric artery (SMA), with replaced the common hepatic artery to the SMA. The treatment of such a rare anatomical variation using ET technique has not been discribed. ET with kissing stent technique can be applied to the CMI accompanied with a rare anatomical variation.Case presentationAn 80-year-old woman presented with a history of intermittent, severe epigastric pain. Over the preceding 5 months, she had less severe and self-resolving epigastric pain 15–30 min after every meal. Abdominal computed tomography (CT) showed severe calcification of the SMA origin and bubble-like intramural gas of the small bowel with the contrasted wall pneumoperitoneum. As the patient did not have peritonitis, a conservative approach was used. Angiography performed after symptom resolution showed severe stenosis of the SMA origin with calcification, and the SMA had replaced the common hepatic artery. ET with the kissing stent technique, namely stenting to the SMA and common hepatic artery, was successfully performed and relieved the patient’s symptoms.ConclusionsCMI cause the symptoms of Pneumatosis intestinalis (PI) and pneumoperitoneum. Severe stenosis of the SMA origin replacing the common hepatic artery is a rare anatomic variation, which can cause CMI symptoms. ET with a kissing stent is the effective treatment option for the mesenteric artery stenosis accompanied with such rare anatomical variation.

Successful endovascular treatment of acute mesenteric and hepatic ischemia in patient with celiomesenteric trunk occlusion

“… 8 Reports of patients with mesenteric ischemia in the setting of a celiomesenteric trunk variant have described excellent clinical results with thoughtful and timely open and endovascular intervention. 4 , 5 , 9 , 11 Other reports have acknowledged that mesenteric ischemia in a patient with a celiomesenteric trunk presents diagnostic and therapeutic challenges but that delay in definitive treatment has lethal consequences. 3 , 6 , 12 We report the case of a 73-year-old woman with acute occlusion of her celiomesenteric trunk who underwent successful endovascular repair.…”

“…The terms currently used in the literature include replaced common hepatic artery (or RCHA), celiomesenteric trunk, celiacomesenteric trunk, and quadrification, among others. 3 , 6 , 7 , 9 , 11 , 13 The aberrant origin of some of these arteries is likely related to the persistence of vitelline arteries during embryologic development. 14 Previous classification systems of these anomalies failed to provide the level of anatomic detail required by surgeons and interventionists planning revascularization.…”

“…Prior studies reported treatment of a short celiomesenteric trunk type using kissing stents. 11 The report of future interventions in terms of these celiomesenteric trunk types could be helpful.…”