Case Report http://dx.doi.org/10.3349/ymj.2011.52.5.859 pISSN: 0513-5796, eISSN: 1976-2437 Yonsei Med J 52(5):859-862, 2011 Rapidly Aggravated Dissecting Flap by Angiography during Percutaneous Stent Placement for Acute Isolated Superior Mesenteric Artery Dissection Hye Jin Yang, 1 Young Kwon Cho,1 Tae Jun Son, 2 Yoon Young Jung,1 Seung A Choi,1 and Suk Hoon Lee1 Departments of 1Radiology and 2General Surgery, Eulji General Hospital, Eulji University, Seoul, Korea. Received: April 8, 2010 Revised: May 19, 2010 Accepted: May 27, 2010 Corresponding author: Dr. Young Kwon Cho, Department of Radiology, Eulji Medical Center, Eulji University College of Medicine, 14 Hangeulbiseok-gil, Nowon-gu, Seoul 139-872, Korea. Tel: 82-2-2970-8290, Fax: 82-2-970-8346 E-mail: ykchoman@eulji.ac.kr ∙ The authors have no financial conflicts of interest. © Copyright: Yonsei University College of Medicine 2011 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non- Commercial License (http://creativecommons.org/ licenses/by-nc/3.0) which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Acutely aggravated dissecting flap and consequent occlusion of the superior mes- enteric artery (SMA) by simple contrast passage during initial angiography for percutaneous stent placement is a uncommon event, which usually is not reported. After analysis of many factors that underlie development of such complications, we present herein one case of successful treatment of isolated SMA dissection and its complications with favorable outcomes during 25 months follow-up after per- cutaneous stent placement. Key Words: Superior mesenteric artery dissection, percutaneous stent INTRODUCTION Very few cases of acute mesenteric ischemia (AMI) caused by spontaneous dissec- tion of the superior mesenteric artery (SMA) have been reported. There are several therapeutic options including conservative management, surgical repair, implanta- tion, and more recently, endovascular treatment. We report a very rare, contrast injection-induced, acute aggravation of a preexist- ing dissecting flap of a spontaneous SMA dissection during endovascular treatment. CASE REPORT A 43-year-old man with a previous history of hypertension complained of sudden severe epigastric pain that began 6 hours before admission and rapidly progressed to more severe diffuse abdominal pain. Physical examination was consistent with suspected surgical abdomen. The laboratory data showed no significant abnormali- ties. Abdominal computed tomography (CT) showed a focal dissecting flap in the proximal SMA (white arrow) with a severely narrowed true lumen (Fig. 1). The SMA angiogram showed a focal dissection flap 2 cm distally from the origin (ar- row) with a combined dissecting aneurysm (arrowheads) (Fig. 2A). Immediately after contrast injection during SMA angiography, the dissecting flap propagated acutely and rapidly (arrows), and a large amount of thrombus migrated to the en- Yonsei Med J http://www.eymj.org Volume 52 Number 5 September 2011 859