Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.210157
Jornal Vascular Brasileiro
Therapeutic Challenge

Tratamento combinado na dissecção de artéria mesentérica superior: desafio terapêutico

Combination treatment for superior mesenteric artery dissection: therapeutic challenge

Guilherme Borgo Ficagna; Cristiano do Carmo Galindo; Jean Paulo Niero Mazon; Gustavo Galvan Debiasi; Amanda Bogo Vargas; Laura Sahd Bernz

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Resumo

Resumo: A dissecção da artéria mesentérica superior é uma causa rara de dor abdominal, com quadro clínico variável. Seu diagnóstico é difícil, e não existe consenso sobre suas opções terapêuticas; elas variam em torno de tratamento conservador, correção aberta, endovascular ou combinada. Descrevemos o caso de um homem de 45 anos com dissecção isolada da artéria mesentérica superior, com quadro de dor abdominal persistente após tentativa de tratamento conservador. Ele foi submetido à revascularização cirúrgica aberta devido à localização e complexidade da dissecção. O tratamento com endarterectomia, arterioplastia com remendo de pericárdio bovino e acesso retrógrado para abertura da mesentérica com stent foi realizado com sucesso. A angina abdominal foi totalmente resolvida após estabilização do quadro. A combinação de abordagem aberta e endovascular deve ser considerada como terapia para casos de dissecção complexa isolada da artéria mesentérica superior.

Palavras-chave

artéria mesentérica superior, dissecção, endarterectomia, angioplastia

Abstract

Dissection of the superior mesenteric artery is a rare cause of abdominal pain, with a variable clinical picture. It is difficult to diagnose and there is no consensus on treatment options, which range from conservative treatment to open, endovascular, or combination repair. We describe the case of a 45-year-old man with isolated dissection of the superior mesenteric artery and persistent abdominal pain after conservative treatment had been attempted. He underwent open surgical revascularization due to the location and complexity of the dissection. Treatment consisting of endarterectomy, arterioplasty with bovine pericardium patch, and retrograde access to open the mesenteric artery with a stent was successful. Abdominal angina was completely resolved after the condition had stabilized. A combination of open and endovascular approaches should be considered as treatment for cases of isolated complex dissection of the superior mesenteric artery

Keywords

superior mesenteric artery; dissection; endarterectomy; angioplasty.

References

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Submitted date:
08/02/2021

Accepted date:
11/22/2021

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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