Stent Placement in the Superior Mesenteric Artery for Mesenteric Ischemia with Stanford type B Acute Aortic Dissection

Keiichi Ishida, Hirono Satokawa, Shinya Takase, Hiroki Wakamatsu, Yuki Seto, Hiroyuki Kurosawa, Akihiro Yamamoto, Tsuyoshi Fujimiya, Satomi Matsumoto, Hitoshi Yokoyama

Department of Cardiovascular Surgery, Fukushima Medical University, Fukushima, Japan

Date, time and location: 2018.05.26 17:00, Congress Hall, 2F–A

Abstract

Objective:

Superior mesenteric arterial ischemia is major complication with high mortality rate (up to 90%) in patients with Stanford type B acute aortic dissection (StB AAD). Our first choice for mesenteric ischemia is stent placement in the superior mesenteric artery (SMA) because of life-saving, though the treatment for complicated StB AAD is mainly thoracic endovascular aortic repair (TEVAR) for the entry closure. The objective is to assess the effectiveness of primary stent placement in the SMA with ischemia.

Methods:

Between August 2015 and June 2017, four patients underwent stent placement in the SMA for suspected superior mesenteric arterial ischemia caused by StB AAD. The procedure was performed under general anesthesia in case of TEVAR.

Results:

The mean age was 66.5±13.5 years. All patients were male. Three patients had abdominal pain. One had melena. One had liver dysfunction. Four had progressed acidosis. In all cases preoperative enhanced computed tomography (CT) showed DeBakeyⅢb aortic dissection. SMA was also dissected and the true lumen was stenosed due to compression by the false lumen with thrombosis. In all cases SMART stent was placed in the SMA. Among them, in two cases no additional procedure was done because of improved acidosis. In one case laparoscopy was performed and showed no mesenteric ischemia. In the other case with melena and liver dysfunction, laparotomy was performed and showed massive bowel necrosis, which was inoperable. Among four patients, one was dead, and the others had no eventful course and discharged alive. Postoperative enhanced CT of the three showed patency of SMA.

Conclusions:

Stent placement in the SMA for mesenteric ischemia with Stanford type B acute aortic dissection is feasible and safe. This technique seems effective in improving stenosis of SMA in the acute phase.