Ultrasound-Guided Transmesenteric Retrograde Recanalization of Ostial Superior Mesenteric Artery Occlusion.

BACKGROUND

Chronic mesenteric ischemia caused by superior mesenteric artery (SMA) occlusion is treated with endovascular or open revascularization. However, complete ostial SMA occlusion without a stump or collaterals poses significant technical challenges, particularly in high-risk patients.

CASE SUMMARY: A 64-year-old woman with multiple autoimmune disorders presented with postprandial abdominal pain and occult gastrointestinal bleeding. Computed tomography angiography demonstrated complete ostial SMA occlusion without a residual stump and absence of the inferior mesenteric artery. Antegrade and collateral retrograde recanalization attempts failed. Modified retrograde open mesenteric stenting (ROMS) was performed via minilaparotomy with ultrasound-guided distal SMA puncture. The patient's symptoms resolved with weight gain and improved nutrition. Stent patency was maintained for 2 years; restenosis at 36 months was treated with drug-coated balloon angioplasty, with 4-year patency.

DISCUSSION: This case highlights an invasive ROMS modification that may provide a salvage option for high-risk patients with complex SMA occlusion unsuitable for standard approaches.

TAKE-HOME MESSAGE: Ultrasound-guided transmesenteric revascularization via minilaparotomy is a salvage option for patients with high-risk SMA ostial occlusion refractory to endovascular therapy and prohibitive risk profiles for conventional ROMS.