Abstract
We describe a case of successful surgical treatment for abdominal angina which involved the celiac artery, superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). A 45-year-old woman who had been suffering from intermittent abdominal pain for a year was admitted. We failed to confirm the blood flow of these three arterial trunks on a preoperative angiogram. It showed that the blood supply of intestine was coming from the collateral circulation via the left internal iliac artery. We recognized paleness of the intestine as well as the pulseless thin arteries during the operation. We established a temporary axillo-femoral artery bypass first to preserving the blood flow of mesenterium through the iliac artery. Subsequently we accomplished reconstruction of SMA and IMA, using a Dacron graft (6 mm in diameter) between the infrarenal aorta and these arteries. We also resected the small intestine because its segment still remained pale and was stenotic. Histological examination revealed severe fibrosis and micro-capillary proliferation in the subserosa of the intestine, as well as marked atherosclerosis in these arteries, which strongly suggested the cause and result of long-term ischemia of the intestine. She had a very good clinical course and her abdominal symptoms disappeared postoperatively. Three-dimensional CT scanning showed good graft patency without any deformations such as kinking or compression.
