Incorporation of Celiomesenteric Trunk With Double Kissing Directional Branches During Fenestrated-Branched Endovascular Aortic Repair

Purpose: Common celiomesenteric trunk (CMT) is a rare anatomical variation that occurs in 0.5% to 3.4% of the general population. Its presence may complicate planning and implantation of fenestrated and branched stent-grafts because the wide diameter and short length of the CMT to its bifurcation does not allow sufficient sealing for placement of bridging stents. Case Report: We report a patient with thoracoabdominal aortic aneurysm (TAAA) and CMT treated by fenestrated-branched endovascular aortic repair (FB-EVAR) using double kissing directional branches to incorporate the celiac axis and superior mesenteric artery. Pitfalls of stent design and implantation are outlined. Conclusion: Double kissing directional branches should be considered as an alternative to incorporate vessels with early bifurcation such as a CMT.

Rupture of a Rare Celiomesenteric Trunk Aneurysm following Mechanical Fall

A celiomesenteric trunk (CMT) is an anatomical variation involving a common origin of the celiac trunk (CT) and the superior mesenteric artery (SMA). The prevalence of a celiomesenteric trunk anatomic variation has been found to be in the region of 3.4% but the incidence of aneurysms in this particular visceral artery are unknown [1]. There are only 20 cases of a celiomesenteric anomaly with an associated aneurysm documented in the last 35 years [2]. This article describes the emergency management of such an aneurysm in a frail 65-year-old female who knew about her aneurysm and was considering a recommendation for elective repair. On this occasion, the aneurysm ruptured (see figure 1) after a mechanical fall down some stairs at home. This difficult case was successfully managed with open repair and a 6mm Dacron interposition graft was sutured end-to-end with continuous 6/0 prolene from the SMA-CT common origin to the bifurcation into Splenic Artery and Common Hepatic Artery. She was discharged on post-operative day four. At her two month follow up appointment she had made an impressive recovery with no complications.

Symptomatic Celiomesenteric Trunk: Variable Presentations and Outcomes in 2 Patients

Mesenteric ischemia can be difficult to diagnose without a high degree of suspicion because it presents in a variety of ways. Visceral vascular collaterals between the fore- and midgut often provide protection against ischemia; however, the presence of anatomic variations, such as celiomesenteric trunk, can undermine the expected redundancy. Misdiagnosis can result in prolonged suffering or death, as evidenced in 2 of our patients with celiomesenteric trunk. The first patient with chronic mesenteric ischemia was diagnosed in the clinic and underwent successful surgical correction; the other had overwhelming, acute mesenteric ischemia, which resulted in death. Our cases show that successful diagnosis and management of mesenteric ischemia require astute interpretation of radiologic images.