Fig. 1. Lateral aortogram.		Fig. 2. Selective lateral SMA arteriogram after PTA.

Case Reference No. CC-797-03 A 74-year-old woman with a history of coronary artery disease, hypertension, and diabetes mellitus presented to her surgeon with a 50-lb weight loss over 6 months, nausea, vomiting and postprandial abdominal pain after eating only "teaspoons" of soup. This classic presentation of intestinal angina was thought to be due to chronic mesenteric ischemia. Biplane aortography demonstrated tight stenoses of the celiac trunk and SMA, and occlusion of the IMA (Fig. 1). Following 4-mm and 5-mm percutaneous transluminal angioplasty, during which the balloons were fully inflated without evidence of waists, the result was still suboptimal (Fig. 2).

Fig. 3. Visceral arteriogram after placement of a Palmaz stent.

A Palmaz 154 stent was then deployed with a Cordis 7-mm by 2-cm balloon, with an excellent angiographic result. (Fig. 3). The patient was observed overnight, discharged home the next morning, and instructed to take one aspirin daily. The patient has resumed a regular diet with complete resolution of her symptoms.

Questions 1. Is there consensus among interventional radiologists that PTA is the primary treatment of choice for focal stenoses of visceral arteries as stated in chapter in Van Bredaís' text Vascular Disease? 2. Would anyone recommend surgery after the failed PTA as opposed to stent placement? Why? 3. What follow-up regimen is necessary? 4. Would anyone recommend PTA of the celiac trunk?