Middle Aortic Syndrome with Mesenteric artery stenosis- successful percutaneous endovascular reconstruction

Abstract

Chronic mesenteric ischemia (CMI) is a challenging problem especially when both the superior mesenteric artery (SMA) and celiac artery (CA) are involved. We report a case 65year-old female with hypertension, type II diabetes, and dyslipidemia who presented with exertional angina for 11-months duration and abdominal angina with weight loss for 5months. Coronary computed tomographic (CT) angiogram revealed critical discrete lesion of mid right coronary artery (RCA). A contrast CT angiogram revealed a high grade, long segment stenosis of supra-renal abdominal aorta which was mildly calcified, mild ostial stenosis of celiac artery, and critical ostial stenosis of superior mesenteric artery (SMA) suggesting middle aortic syndrome with mesenteric artery stenosis. RCA was revascularised by deployment of 3.5 x 18 mm Xience prime Everolimus eluting stent (Abott Vascular; USA) at 13 atm pressure achieving TIMI III flow through left transbrachial approach. Aorta was stented transfemorally using two overlapping Epic self-expanding stents (Boston scientific, USA)-12x60 mm proximally and 10 x 40 mm distally. SMA was stented with 6 x 18 mm stent (Herculink, Boston, USA) after predilatation achieving complete revascularization.