RESUMO
INTRODUCTION: The use of endovascular technology for mesenteric interventions has become an increasingly accepted treatment modality. We present an unusual case of celiac artery stent placement for coronary ischemia. CASE DESCRIPTION: A 66-year-old male with a history most notable for coronary artery disease and coronary artery bypass grafting (CABG) x 3 utilizing left internal mammary artery to left anterior descending, radial artery to first diagonal and his right gastroepiploic artery (GEA) to posterior descending artery presented with chest pain. His work-up included a cardiac catheterization that revealed a 90% stenosis at the origin of the celiac axis. A subsequent computerized tomography angiogram confirmed this and noted moderate stenosis of his superior mesenteric artery (SMA) as well as severe inferior mesenteric artery (IMA) stenosis. The patient was taken for mesenteric angiography by vascular surgery at which time he underwent balloon-expandable stent placement in the celiac axis. The patient tolerated this procedure well and was noted to have an improvement in his symptoms postoperatively. DISCUSSION: Use of arterial conduits for CABG have proven to be superior to vein. Long-term viability of the GEA as a conduit is dependent in part on the patency of mesenteric circulation. Our findings demonstrate a viable endovascular treatment option for angina pectoris secondary to mesenteric stenosis in this unique patient population.
Assuntos
Angioplastia com Balão/instrumentação , Artéria Celíaca , Ponte de Artéria Coronária/métodos , Artéria Gastroepiploica/cirurgia , Isquemia Mesentérica/terapia , Oclusão Vascular Mesentérica/terapia , Isquemia Miocárdica/terapia , Stents , Idoso , Artéria Celíaca/diagnóstico por imagem , Artéria Celíaca/fisiopatologia , Constrição Patológica , Ponte de Artéria Coronária/efeitos adversos , Estenose Coronária/diagnóstico , Estenose Coronária/fisiopatologia , Estenose Coronária/terapia , Stents Farmacológicos , Artéria Gastroepiploica/fisiopatologia , Humanos , Masculino , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/fisiopatologia , Oclusão Vascular Mesentérica/diagnóstico , Oclusão Vascular Mesentérica/fisiopatologia , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Desenho de Prótese , Fatores de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
A 66-year-old Caucasian man with type 2 diabetes mellitus, peptic ulcer disease, peripheral vascular disease, and a 70% symptomatic carotid stenosis underwent a successful carotid endarterectomy with intraoperative shunting and Dacron patch closure in October 2000. Three months later, he developed a pseudoaneurysm at the site of the surgical repair. This was successfully treated with endovascular covered stents and has continued to remain patent at 9-year follow-up. Carotid artery pseudoaneurysms are secondary to trauma, infection, or previous surgery. Open surgical repair has been the treatment of choice for these pseudoaneurysms. However, open repairs are difficult and carry a high morbidity. Thus, endovascular therapy is a valid treatment for carotid artery pseudoaneurysm. Reviewing the published data, this is the first case report with successful endovascular covered stent placement for a carotid pseudoaneurysm with 9-year follow-up.
Assuntos
Lesões das Artérias Carótidas/terapia , Artéria Carótida Primitiva , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Procedimentos Endovasculares/instrumentação , Stents , Idoso , Angiografia Digital , Lesões das Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/etiologia , Artéria Carótida Primitiva/diagnóstico por imagem , Humanos , Masculino , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
A 72-year-old male with chronic obstructive pulmonary disease and hyperlipidemia presented with acute right upper limb ischemia. Arterial occlusion was found to be secondary to a thrombosed axillary artery aneurysm. An open repair was performed with a polytetrafluoroethylene (PTFE) graft. On further workup, the patient was found to have an asymptomatic axillary artery aneurysm on the left-hand side. Endovascular repair with a covered stent was chosen to treat this aneurysm.