Retrograde Stenting Under Transmesenteric Angiographic Guidance of an Occluded Superior Mesenteric Vein to Treat Life-Threatening Hemorrhage

Ann Vasc Surg. 2016 Feb;31:209.e11-5. doi: 10.1016/j.avsg.2015.09.020. Epub 2015 Dec 2.

Abstract

Midgut carcinoid tumors (MCTs) are responsible for a range of mesenteric vascular complications and may rarely manifest with gastrointestinal (GI) hemorrhage. Endovascular approaches are particularly useful for this population, as surgery is often technically difficult. We report a case of life-threatening upper GI bleeding in a 50-year-old man previously diagnosed with an MCT in the small bowel mesentery. Computed tomography angiogram revealed an MCT obstructing the superior mesenteric vein (SMV) associated with multiple large collateral vessels. The patient underwent retrograde stenting of the obstructed SMV using a combined open and endovascular approach to successfully terminate the persistent GI bleeding.

Publication types

  • Case Reports

MeSH terms

  • Carcinoid Tumor / complications*
  • Carcinoid Tumor / diagnosis
  • Collateral Circulation
  • Endovascular Procedures / instrumentation*
  • Gastrointestinal Hemorrhage / diagnostic imaging
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / physiopathology
  • Gastrointestinal Hemorrhage / therapy*
  • Humans
  • Intestinal Neoplasms / complications*
  • Intestinal Neoplasms / diagnosis
  • Male
  • Mesenteric Vascular Occlusion / diagnostic imaging
  • Mesenteric Vascular Occlusion / etiology
  • Mesenteric Vascular Occlusion / physiopathology
  • Mesenteric Vascular Occlusion / therapy*
  • Mesenteric Veins / diagnostic imaging*
  • Mesenteric Veins / physiopathology
  • Middle Aged
  • Phlebography / methods*
  • Radiography, Interventional / methods*
  • Splanchnic Circulation
  • Stents*
  • Tomography, X-Ray Computed*
  • Treatment Outcome

Supplementary concepts

  • Carcinoid Tumors, Intestinal