23 Mesenteric Stenting

CASE 23


Clinical Presentation


A 58-year-old female who had lost 20 pounds over the past year presented with complaints of abdominal pain after eating and “food fear.”



image

Figure 23-1 Noninvasive evaluation of superior mesenteric stenosis. (A) Doppler ultrasound of SMA reveals an elevated velocity of 233 cm/s. (B) CTA shows high-grade stenoses of both the celiac and SMA.


Radiologic Studies


Doppler Ultrasound


An abdominal ultrasound was performed. Doppler interrogation of the superior mesenteric artery (SMA) revealed a velocity of 233 cm/s (Fig. 23-1A).


CT Angiography (CTA)


CTA showed high-grade stenoses of both the celiac artery and the SMA (Fig. 23-1B).


Angiogram


The right common femoral artery was catheterized using the Seldinger technique, and a 6-French (F) Balkan sheath was placed. A pigtail catheter was advanced into the abdominal aorta and lateral aortography was performed showing moderate-to-high grade stenoses of both the superior mesenteric and celiac arteries (Fig. 23-2A).



image

Figure 23-2 (A) Lateral aortogram confirms CTA findings of high-grade mesenteric stenoses. (B) Lateral fluoroscopic image shows positioning of stent at stenosis. (C) Lateral fluoroscopic image shows balloon deployment of stent. (D) Digital subtraction angiogram shows alleviation of the SMA stenosis.


Diagnosis


Celiac and SMA stenoses with symptoms of chronic mesenteric ischemia.


Treatment


Equipment


Puncture needle or micropuncture kit


5F and 6F guiding sheath


5F pigtail and endhole catheters


0.035” and 0.014” angioplasty balloons, wires, and balloon-expandable stents (4 to 6 mm)


Contrast material


Heparin


Inflation syringe


Mesenteric Angioplasty and Stent Insertion

Jan 8, 2016 | Posted by in INTERVENTIONAL RADIOLOGY | Comments Off on 23 Mesenteric Stenting
Premium Wordpress Themes by UFO Themes