Abstract
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.
