Percutaneous stenting of an iatrogenic superior mesenteric artery dissection complicating suprarenal aortic aneurysm repair

Purpose: To report endovascular repair of an iatrogenic superior mesenteric artery (SMA) dissection caused by a balloon occlusion catheter. Case Report: A 68-year-old man with a suprarenal aortic aneurysm underwent conventional prosthetic replacement, during which visceral artery back blee ding was controlled with balloon occlusion catheters. Six hours postoperati vely, the patient experienced an episode of bloody diarrhea with abdominal pain and tenderness and mild metabolic acidosis. Colonoscopy revealed colit is (grade I) without necrosis of the right and left colon. An emergent abdo minal computed tomographic scan showed signs of mesenteric ischemia with bo wel dilatation and SMA wall hematoma; angiography identified a dissection 1 cm distal to the SMA origin. An Easy Wallstent was deployed percutaneously , successfully reestablishing SMA patency. The postoperative course was une ventful, and the patient remains asymptomatic with a patent SMA stent and a ortic graft at 1 year. Conclusions: latrogenic SMA dissection should be suspected after suprarenal aortic aneurysm repair if signs of mesenteric ischemia arise. Prompt and t horough imaging studies are necessary to confirm the diagnosis and assess t he potential for an endoluminal treatment.