Percutaneous Balloon Angioplasty With Adjunctive Stent Placement in the Mesenteric Vessels in a Patient With Takayasu’s Arteritis
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 8×40-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 8×30-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.
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.
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