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(Circulation. 1996;93:1940-1941.)
© 1996 American Heart Association, Inc.

Articles

Percutaneous Balloon Angioplasty With Adjunctive Stent Placement in the Mesenteric Vessels in a Patient With Takayasu's Arteritis

Erol Ozdil, MD; Zvonimir Krajcer, MD; Paolo Angelini, MD

From the Department of Adult Cardiology, Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Tex.

	Introduction

Top Introduction

 
A 49-year-old woman from Italy with a history of Takayasu's arteritis presented with worsening hypertension and symptoms consistent with mesenteric ischemia. The patient had previously undergone aortobifemoral bypass for Leriche's syndrome and peripheral angioplasty of the right subclavian artery. At the present hospital admission, peripheral angiography revealed multiple arterial stenoses: 90% stenosis in the left renal artery, 80% in the right renal artery, 90% in the celiac trunk (Fig 1A), and 99% in the superior mesenteric artery (Fig 2A and B). Pressure gradients were 130 mm Hg across the celiac ostium, 145 mm Hg across the superior mesenteric ostium, 135 mm Hg across the right renal artery, and 45 mm Hg across the left renal artery. The patient underwent percutaneous balloon angioplasty, with excellent results in the renal arteries. The mesenteric vessels, however, did not respond adequately to angioplasty because of persistent elastic recoil, despite prolonged inflation of the balloon. Therefore, an 8x40-mm balloon was used to place a Palmaz P204 (Johnson & Johnson) intraluminal stent in the ostium of the superior mesenteric artery (Fig 2C and 2D). Similarly, an 8x30-mm balloon was used to place a Palmaz P154 stent in the ostium of the celiac trunk (Fig 1B). No residual stenosis or pressure gradient was noted after stent placement. The patient tolerated the procedure well and was discharged. At 8-month follow-up, the patient reported no abdominal pain and had no hypertension on medical therapy.

View larger version (82K): [in this window] [in a new window]   Figure 1. Selective injection in the anteroposterior view (A) demonstrating a critical lesion in the ostium of the celiac artery. B (anteroposterior view) demonstrates successful percutaneous transluminal angioplasty and adjunctive placement of a Palmaz stent in the ostium of the celiac artery.

View larger version (163K): [in this window] [in a new window]   Figure 2. Selective injection in the anteroposterior view (A) and lateral view (B) demonstrating a critical lesion in the ostium of the superior mesenteric artery (sma). C (anteroposterior view) and D (lateral view) demonstrate successful percutaneous transluminal angioplasty and adjunctive placement of a Palmaz stent in the ostium of the superior mesenteric artery; no residual lesion is visible.

Dense fibrotic lesions are often present during the late occlusive phase of Takayasu's arteritis. High inflation pressures may be required to dilate these lesions, which are associated with significant elastic recoil, especially in the ostial locations. Stents may be beneficial in treating lesions in which persistent elastic recoil prevents adequate results with balloon angioplasty.

	Footnotes

 
Reprint requests to Paolo Angelini, MD, PO Box 20206, Houston, TX 77225.

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner, MC 4-265, Houston, TX 77030.

This article has been cited by other articles:

				A. R. Forauer and G. K. McLean Primary Stenting of the Superior Mesenteric Artery for Treatment of Chronic Mesenteric Ischemia: A Case Report Angiology, January 1, 1999; 50(1): 63 - 67. [Abstract] [PDF]

This Article Extract Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ozdil, E. Articles by Angelini, P. Search for Related Content PubMed PubMed Citation Articles by Ozdil, E. Articles by Angelini, P.