Endovascular revascularization of heavily calcified occlusion in superior mesenteric artery using Transcollateral approach

Abstract

Background: Mesenteric ischaemia is often a manifestation of severe vascular disease involving the superior mesenteric artery (SMA). Endovascular revascularization is challenging in a chronic total occlusion (CTO) of SMA. Case presentation: A-73-year-old male patient was referred to our hospital because of a 2-year history of post prandial abdominal angina. Computed tomography (CT) images revealed a heavily calcified CTO in the ostium of SMA and three-dimensional CT (3D-CT) detected pancreaticoduodenal arcade with filling from the celiac artery. Then, endovascular procedure was attempted; however, angiography did not show the collateral route suitable for transcollateral approach. As demonstrated on the CT, we were successful in passing a guidewire through the SMA-CTO via the celiac trunk transcollateral route. After pull-through of the guidewire, two balloon-expandable stents were deployed in the ostium of SMA. During 3 months after stent implantation, the patient had no further episodes of abdominal angina on dual-anti-platelet therapy. Conclusion: We demonstrate a case of a heavily calcified SMA occlusion successfully treated with endovascular stenting employing a transcollateral approach, guided by 3D-CT.