Successful stenting to superior mesenteric artery (SMA) after endovascular aneurysm repair (EVAR) of abdominal aorta

SummaryA 70-year-old man complained of abdominal angina after endovascular aneurysm repair (EVAR). He had a history of successful treatment of abdominal aortic aneurysm with Zenith endovascular graft 12 months prior to the index abdominal symptoms. The endovascular graft had been placed with special attention for keeping blood flow of major abdominal branches to the intestine. However, both duplex sonographic study and enhanced computed tomography (CT) revealed a critical stenosis at the ostium of the superior mesenteric artery (SMA). The limited intestinal blood flow seemed to be a cause of his symptoms. Palmatz stent was selected to dilate the stenosis. A right trans-femoral artery approach was selected to avoid interaction with the Zenith stent graft because it was landed at the left external iliac artery. There was no difficulty in passing of the stent through the uncovered Z-stent area at the proximal end of the graft. Three-dimensional-CT image was useful for the precise ostial stenting. In treatment of SMA ostial stenosis after EVAR, percutaneous trans-catheter treatment with stent could be a feasible and effective strategy to be considered.