Endovascular Stent Grafting via the Left Radial Artery for a Spontaneous Isolated Dissecting Rupture of the Superior Mesenteric Artery

A 56-year-old man presented with abrupt onset epigastric and back pain for 4 hours. Computed tomography angiography (CTA) revealed a dissection at the proximal part of the superior mesenteric artery (SMA) without a limitation in distal flow or bowel ischemia (Fig. 1A). However, an 1-week follow-up CTA showed progression of the SMA dissection down to the distal jejunal branch (Fig. 1B). Thus, we decided to perform endovascular interventional treatment. A 6-Fr introducer sheath was inserted into the left radial artery. A 6-Fr multi-purpose angiographic 1 guiding catheter (Cordis, Miami, FL, USA) was then used to pass a 0.014-inch floppy guidewire into the true lumen of the SMA. A subsequent angiography (Fig. 1C, arrow indicates dissecting inlet) and intravascular ultrasound (IVUS) examination (Fig. 1D, arrow indicates dissecting inlet) showed a huge communicating dissecting rupture at the proximal portion of the SMA. We confirmed blood flow to the false lumen through the dissecting inlet by IVUS Chroma-flow imaging (Fig. 1E, arrow indicates dissecting inlet). Two stent-grafts (Jostent®, Abbott Laboratories, Inc., Abbott Park, IL, USA) (3.5×19 mm followed by 3.5×16 mm) with overlap were deployed consecutively in the proximal SMA to cover the dissection. The follow-up CTA at 9 months (Fig. 1F) Images in Cardiovascular Medicine