| Successful Revascularization
Using Cardiopulmonary Bypass in a Case of Angina Abdominalis
due to Acute Superior Mesenteric Arterial Embolism |
(Department of Cardiovascular Surgery, Ohsumi Kanoya
Hospital, Kanoya, Japan)
| Yoshihiro Nakayama |
Noritoshi Minematsu |
Kiyokazu Koga |
|
An 89-year-old man with a past history
of paroxysmal atrial fibrillation was urgently admitted to our
hospital because of sudden-onset pain in the left forearm. The
pulse of the left brachial artery had disappeared. Angiography
demonstrated left brachial artery occlusion due to a thrombus.
The day after an emergency thrombectomy, abdominal pain occurred
after eating. Enhanced computed tomography and aortography revealed
that the superior mesenteric artery (SMA) was occluded with collateral
circulation from the inferior mesenteric artery (IMA). Under
a diagnosis of angina abdominalis, the bypass procedure, using
a saphenous vein graft (SVG) from the abdominal aorta to the
SMA, was carried out under the support of cardiopulmonary bypass.
To maintain antegrade alignment of the SVG, the SVG was anastomosed
proximally to the infrarenal abdominal aorta. Severe atherosclerotic
changes were observed in the main trunk of the SMA. However,
no intestinal necrosis occurred because of the well-developed
collateral flow from the IMA. The mechanism of angina abdominalis
is probably due to thromboembolism in the SMA which had preexisting
stenotic organic lesions.
Jpn. J. Cardiovasc. Surg. 33: 201-204 (2004) |
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