[MO-47] Presentation Awards
A case of intestinal ischemia caused by plaque shift in SMA ostium after endovascular aortic aneurysm repair (EVAR).
Plaque shift is one of the complications associated with stent placement during endovascular procedures. We experienced a case of plaque shift in SMA ostium occurring after EVAR. A 80 year old man was referred to our vascular center due to abdominal aortic aneurysm (AAA). EVAR was performed using Zenith Flex (Cook, Inc, Bloomington, IN, US). After EVAR, he had vomiting, diarrhea, and hematochezia. Plain CT showed no specific findings indicating ischemia or inflammatory change of the gastrointestinal (GI) tract. The symptoms did not improve and contrast-enhanced CT (CECT) was performed 5 days after EVAR. CECT demonstrated no findings in GI tract itself, but severe stenosis in the ostium of SMA. There had been 50% stenosis due to atheromatous plaque before EVAR, but the degree of stenosis exacerbated to 90%. The suprarenal bare stent of Zenith apparently compressed the ostial plaque, causing plaque shift and stenosis of SMA. In order to improve the stenosis, endovascular treatment (EVT) was performed.
Approaching from the left brachial artery, a bare nitinol stent was placed in the ostium of SMA. After EVT, his symptom immediately disappeared. When SMA has plaque burden in the ostium, this possible complication should be kept in mind during planning of EVAR. Stentgrafts with infrarenal fixation system might be suitable for this particular occasion.
Approaching from the left brachial artery, a bare nitinol stent was placed in the ostium of SMA. After EVT, his symptom immediately disappeared. When SMA has plaque burden in the ostium, this possible complication should be kept in mind during planning of EVAR. Stentgrafts with infrarenal fixation system might be suitable for this particular occasion.