Retrograde Open Mesenteric Stenting Failure Requiring Aorto-Mesenteric Bypass in Acute-on-Chronic Mesenteric Ischemia: A Case Report

Figures

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  Fig. 1. Preoperative CTA demonstrating multivessel mesenteric arterial occlusive disease. (A) Sagittal and axial CTA images demonstrating flush occlusion of the celiac trunk at its origin, associated with marked ostial atherosclerotic calcification. (B) Sagittal and axial CTA images demonstrating flush occlusion of the SMA at its origin, with distal reconstitution through a well-developed collateral network, indicating a suitable distal target for revascularization. (C) Sagittal and axial CTA images demonstrating occlusion of the IMA at its origin, with distal reconstitution through collateral circulation. A previously implanted right renal artery stent remains patent. CTA, computed tomography angiography; IMA, inferior mesenteric artery; SMA, superior mesenteric artery

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  Fig. 2. Intraoperative view showing the placement of an introducer into the SMA using the open retrograde mesenteric revascularization (ROMS), in conjunction with segmental necrosis of the terminal ileal loops and a necrotic appearance of the jejunum. ROMS, retrograde open mesenteric stenting; SMA, superior mesenteric artery

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  Fig. 3. Arteriographic assessment using ROMS. ROMS, retrograde open mesenteric stenting

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  Fig. 4. Sagittal section of a CT angiogram of the abdominal aorta showing thrombosis of the SMA stent. SMA, superior mesenteric artery

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  Fig. 5. Intraoperative view showing the creation of an aorto-mesenteric bypass via a subduodenal approach in a case of complicated CMI. CMI, chronic mesenteric ischemia

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  Fig. 6. Aorto-mesenteric bypass using an 8-mm PTFE graft: a surgical technique. PTFE, polytetrafluoroethylene