A 59-year-old male presented to the emergency department with distressing epigastric pain after seeking medical attention at a nearby clinic three hours prior. Upon examination, the attending physician noticed edematous changes in the proximal segment of the superior mesenteric artery, and a subsequent enhanced computed tomography (CT) scan confirmed the diagnosis of an isolated dissection of the artery. Notably, the true lumen of the vessel was significantly narrowed, raising concerns for potential vascular compromise. After extensive consultation between a vascular surgeon and a radiologist, a decision was made to adopt a conservative management approach. The patient was closely monitored with meticulous bowel rest, hydration management, and carefully curated dietary modifications. Over time, subsequent CT scans revealed progressive enlargement of the true lumen, which was highly reassuring to the medical team. As a result of the expert management and diligent care provided, the patient was eventually discharged home without any adverse events or complications. This case highlights the critical role of a multidisciplinary approach in managing complex vascular pathology and underscores the importance of thoughtful clinical decision-making and meticulous monitoring in achieving favorable outcomes.
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http://dx.doi.org/10.7759/cureus.37852 | DOI Listing |
J Vasc Surg Cases Innov Tech
April 2025
Atrium Health, Sanger Heart and Vascular Institute, Division of Vascular Surgery, Charlotte, NC.
We report a case of mesenteric ischemia after thoracic endovascular aortic repair (TEVAR) for chronic type B aortic dissection performed at a different institution. Computed tomography angiography findings indicated that the previous TEVAR had been deployed distally into the false lumen. To mitigate this, a large fenestration was created between the false lumen and true lumen.
View Article and Find Full Text PDFJ Soc Cardiovasc Angiogr Interv
December 2024
Department of Cardiology, HonorHealth/Scottsdale Shea Medical Center, Scottsdale, Arizona.
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is high risk compared to non-CTO PCI. Iatrogenic coronary artery hematoma formation is a common occurrence during CTO PCI, impairing true lumen visualization. We describe the use of a continuous mechanical suction (CMS) device in 2 applications in which it was used for successful subintimal hematoma decompression and distal vessel re-entry.
View Article and Find Full Text PDFAnn Thorac Surg Short Rep
December 2024
Division of Cardiac Surgery, Inova Heart and Vascular Institute, Inova Health Systems, Falls Church, Virginia.
Background: DeBakey type I aortic dissections (AD) are most frequently treated with hemiarch repair. A subset of patients demonstrates persistent distal end-organ ischemia secondary to persistent true lumen (TL) compression. We describe the use of bare metal stent grafting across the residual arch dissection with the Zenith Dissection Endovascular Stent (ZDES, Cook Medical) in 7 patients with type I AD that was repaired in a hemiarch configuration with a compromised distal TL and organ malperfusion.
View Article and Find Full Text PDFCureus
December 2024
Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Hirosaki, JPN.
Tandem occlusion due to acute cervical carotid artery dissection should be promptly treated with thrombectomy for reperfusion. If the cervical lesion has reached severe stenosis or complete occlusion, balloon angioplasty and, in certain cases, carotid artery stenting should be performed before thrombectomy for the intracranial lesion. Angioplasty or stent placement is performed in the true lumen, but securing the placement is challenging when the true lumen cannot be determined.
View Article and Find Full Text PDFCase Rep Cardiol
December 2024
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
A 48-year-old male with a history of hyperlipidemia presented to the emergency department with chest pain. Electrocardiographic abnormalities indicated an acute coronary syndrome. Urgent coronary angiography revealed nondominant right coronary artery (RCA) occlusion.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!