Purpose: To describe technical tips for recanalization of long-segment flush superior mesenteric artery (SMA) occlusions. Technique: Ultrasound-guided left brachial artery access was gained in 2 patients with a 7F 90-cm sheath being advanced to the supraceliac aorta. The SMA stump was visualized using a selective inferior mesenteric artery (IMA) catheterization via femoral approach. A combination of a 7F 100-cm Multipurpose (MPA) guide and a 5F 125-cm MPA catheter was utilized to provide support for selective catheterization. Subsequently, a 0.018-inch wire and catheter were advanced crossing the area of occlusion. Predilatation was performed, followed by placement of covered stent. Both patients had uncomplicated course and resolution of symptoms. Conclusion: Flush SMA occlusions are challenging lesions but may be treated by antegrade percutaneous recanalization with good results. Technical aspects that facilitate recanalization include brachial approach, use of a stiff system (sheath, guide, and catheter) and concomitant injection to facilitate visualization of the SMA stump.
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