Stent implantation in critical stenosis of the celiac trunk: enlarging the frontiers of percutaneous vascular intervention.

Hospital Mãe de Deus e Hospital Moinhos de Vento Porto Alegre Mailing address: Alexandre Schaan de Quadros Av. Ganzo, 677/602 Cep 0150-071 Porto Alegre, RS, Brazil E-mail: [email protected] Received for publication: 02/14/2003 Accepted for publication: 02/27/2004 dL, urea=68mg/dL), normal electrolytes, and fasting glycemia=123 mg/dL. Electrocardiogram at rest demonstrated sinus rhythm, HR=64 bpm, left ventricular overload pattern with ST segment depression in leads V5 and V6. A chest X-ray demonstrated cardiomegaly without signs of pulmonary venocapillary congestion. Epigastric pain assessment was performed with digestive endoscopy, which was normal, and with the assessment of the gastroenterologist, severe mesenteric angina was diagnosed. Angio resonance of the abdominal aorta and its branches was performed and demonstrated stenosis of 80% in the origin of the celiac trunk, 50% proximal stenosis in the superior mesenteric artery, inferior mesenteric artery occlusion, and stenosis of 70% in the right renal artery. Abdominal aortography was indicated, as well as visceral arteriography, with intervention in the same procedure, in case the angiography scan findings were confirmed. The patient was taken to the hemodynamic laboratory in good clinical conditions, with neither angina nor heart failure. Puncture of the femoral artery and abdominal aortography were performed in anteroposterior projection and left lateral projection with a pigtail catheter, confirming the findings of the angiographic scan: 70% stenosis in the origin of the celiac trunk, 50% stenosis in the superior mesenteric artery, and occlusion of the inferior mesenteric artery (fig. 1 and 2). Renal arteries did not have significant stenosis. Endovenous 5.000 U heparin was administered, and catheterization of the celiac trunk was selectively performed using a Veripath Lima 7F-guiding catheter (Guidant, Indianapolis, Indiana, USA). The stenosis was surpassed with a 0.014 ACS Hi-Torque Extra Sport guidewire (Guidant, Indianapolis, Indiana, USA). Once in place, a Herculink 6.0 X 18-mm biliary stent (Guidant/Advanced Cardiovascular Systems, Indianapolis, Indiana, USA) was released and pushed against the artery wall by using 18 atm (fig. 3). Normal flow was observed at the end of the procedure, with residual stenosis lower than 10% (fig. 4 and 5). The patient left the laboratory in good condition, and in the first postoperative period, she could eat normally, without abdominal pain. In clinical follow-up, one year after the procedure, the patient remains asymptomatic, without recurrent symptoms and has returned to her normal weight.