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Superior mesenteric artery

Case - 1 : A middle aged lady, known case of aortoarteritis , had repeated attacks of pain in abdomen especially after eating food. The features are suggestive of mesenteric angina which results when at least two of the three arteries of the Gastrointestinal Tract get blocked or severely compramised.
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 CT angiogram showed occlusion of Coeliac axis artery at origin and occlusion of superior mesenteric artery just after its origin. Distally superior mesenteric artery was reformed through collateral from inferior mesenteric artery.
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Selective superior mesenteric angiogram shows complete occlusion just after its origin. 
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Large collateral artery is arising from Inferior mesenteric artery which is reforming distal superior mesentric artery.
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A guidewire has been manipulated across the occlusion
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Catheter has been passed over the guidewire into distal superior mesenteric artery.
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Angioplasty is being performed.
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Angioplasty in progress
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Postangioplasty , there is good reformation of superior mesenteric artery.

 

Case - 2 : Elderly gentleman presented with intestinal ischemia

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Selective superior mesenteric angiogram shows atherosclerotic occlusion of superior mesenteric artery with calcification.
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Only microwire could cross the occlusion. Angioplasty was performed using coronary angioplasty balloon to create some lumen.
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Post plasty pictuer shows tight stenosis just after origin with a large filling defect in distal SMA suggestive of thrombus.
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Balloon expandable stent was deployed across proximal SMA stenosis.
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Post stenting angiogram shows good restoration of lumen of proximal SMA . However distal flow was sluggish due to thrombus load. It was treated by injecting  thrombolytic medicine

 

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