Superior mesenteric artery dissection as a complication of an endovascular attempt to treat aneurysms of the pancreaticoduodenal arteries

Abstract

A case of iatrogenic dissection of the superior mesenteric artery (SMA) in a 42-year old woman during an attempt of endovascular treatment of aneurysms of the pancreaticoduodenal arteries coexisting with a stenosis of the coeliac trunk is presented. The dissection occurred most probably during insertion of an introducer sheath into the SMA. The patient at that moment reported a short-lasting abdominal pain and after that remained asymptomatic. Due to technical difficulties, the attempt of endovascular management of pancreaticoduodenal aneurysms was abandoned. The completion angiography revealed the occlusion of the SMA. The patient underwent an emergency laparotomy; pancreaticoduodenal aneurysms were excised and SMA dissection was repaired with endarterectomy and a patch closure. Postoperative recovery was uneventful and the patient remained asymptomatic during a 30-month follow-up. The case underscores the importance of completion angiography after endovascular interventions in the SMA since the early period of its occlusion may be asymptomatic.

Two Cases of Duodenal Ulcers That Developed after Transcatheter Procedures for Unruptured Visceral Artery Aneurysms

“…Although the number of articles was limited, similar cases have been previously reported. Dzieciuchowicz et al reported a case of a 42-year-old woman with pancreaticoduodenal artery aneurysms and stenosis of the celiac trunk [ 17 ]. Emergency laparotomy and thromboendarterectomy were performed, and magnetic resonance angiography performed 30 months after surgery showed patency of the superior mesenteric artery.…”

Superior Mesenteric Artery Dissection After Lumbar Puncture

“…LP is considered a relatively safe procedure, often served as an important diagnostic tool for a wide range of neurological conditions [4]. With most cases, the exact level of entry of the spinal needle is determined with the patient standing straight or sitting upright at an intersecting line at L1-L2 to L4-L5 range, usually pointing at a higher spinal level in female and obese patients.…”

Unruptured Giant Aneurysm of The Inferior Pancreaticoduodenal Artery with Superior Mesenteric Artery Stenosis Obstructed by Spontaneous Thrombosis After Superior Mesenteric Artery Angioplasty: A Case Report

“…TAE of the aneurysms should cause SMA ischemia due to occlusion of the collateral pathways in this condition, and we determined that treatment of the SMA stenosis should be undertaken first. Ikoma et al performed TAE of the aneurysm followed by SMA angioplasty [4]; however, we were concerned that we might not be able to accomplish SMA angioplasty without complications such as dissection or occlusion of the SMA [7]. We planned the two-stage treatment of SMA angioplasty followed by TAE of the two IPDA aneurysms.…”