case_images: PMC2698142_01
case_images: A 48-year-old woman with sudden abdominal pain.. A. The contrast-enhanced CT scan showed mural thrombus (arrow) within the main trunk of the superior mesenteric artery.. B. Superior mesenteric arteriogram demonstrated the complete occlusion of ileocolic and right colic branches of the SMA.. C. After continuous infusion of urokinase into the superior mesenteric artery, arteriograms revealed the intimal flap (arrow).. D. An 8x70-mm self-expandable Wallstent was placed in the true lumen so that the proximal stent was dipped into the aortic lumen (arrow).. E. Two months after stent placement, the maximum intensity projection image demonstrated the proximal shortening of the stent and the stenosis of the SMA orifice (arrow).
case_images: kjr-5-134-g001.jpg
case_images: PMC2698142_01_kjr-5-134-g001.jpg
case_images: F1
case_images: Emergency contrast-enhanced abdominal CT revealed the presence of mural thrombus within the main trunk of the SMA without any evidence of abdominal aortic aneurysm or dissection (Fig. 1A). The superior mesenteric arteriogram demonstrated the complete occlusion of the ileocolic and right colic branches of the SMA (Fig. 1B). After 14-hours of infusion of urokinase, she still suffered from the symptoms, and the follow-up arteriogram revealed an isolated dissection of the SMA (Fig. 1C). Wallstent (Boston Scientific, Watertown, MA, U.S.A.) was placed in the true lumen so that the proximal end was dipped into the aortic lumen (Fig. 1D). We used a relatively long stent because of the stability of this stent within the SMA. However, the stent was shortened and the proximal segment of the SMA was narrowed by 50-75% (Fig. 1E), but the patient didn't complain of any symptoms for 6 months after the stent placement.
case_images: PMC2698142_02
case_images: 54-year-old man with severe epigastric pain after drinking cold water.. A, B. The contrast-enhanced CT scan showed the intimal flap (long arrow) and the mural thrombus (short arrow).. C. The celiacomesenteric arteriogram demonstrated a severely narrowed true lumen (long arrow) and aneurysmally dilated false lumen (short arrow).. D. After the stent placement, the proximal end was located at the orifice of the SMA (arrow). The control angiogram showed a patent true lumen with good blood flow in all the branches of the SMA, and an almost vanished false lumen.. E. At 4 months after the stent placement, the arteriogram showed the recurrence of aneurysmally dilated false lumen (arrow).. F. Another 10-50-mm self-expandable stent (arrow) was placed within the Wallstent covering the opening of intimal flap. The aneurysmally dilated false lumen was significantly decreased.
case_images: kjr-5-134-g002.jpg
case_images: PMC2698142_02_kjr-5-134-g002.jpg
case_images: F2
case_images: An intimal flap was noted 1.5 cm distal to the orifice of the common trunk with a distally thrombosed and proximally patent false lumen (Figs. 2A, B). A celiacomesenteric arteriogram demonstrated a severely narrowed true lumen and an aneurysmally dilated false lumen (Fig. 2C). The control angiogram showed a patent true lumen with good blood flow in all the branches of the SMA (Fig. 2D). Four months later, his celiacomeseteric arteriogram showed good blood flow through the stent, however, the aneurysmally dilated false lumen had recurred (Fig. 2E). To prevent the progression of the arterial dissection, another 10x50-mm self-expandable stent (S.M.A.R.T., Cordis, Miami, FL, U.S.A.) was placed within the Wallstent to cover the opening of the intimal flap (Fig. 2F).