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Figure 6d. Percutaneous treatment of AA with stent placement in a vascular anomaly of the SMA. The patient was a 74-year-old woman with typical symptoms of AA. (a) Panoramic 3D VR image shows a hypertrophic collateral circulation between the IMA and SMA via the Riolan arcade (arrow). The anatomy shows a variant: The right hepatic artery originates from the SMA, and the celiac trunk splits into the left hepatic artery, the splenic artery, and other pancreaticoduodenal branches. (b) Coronal MIP image of the SMA shows a stenosis just proximal to the origin of the anomalous hepatic artery. (c) Paraaxial curved MPR image shows a high-grade stenosis of the celiac trunk. (d-g) Sagittal MIP (d, f) and paraaxial curved MPR (e, g) images of the SMA obtained before (d, e) and after (f, g) stent placement show restoration of patency. The "stent jail" of the right hepatic artery in the celiac trunk was well tolerated by the patient, probably because of the vast collateral circulation that developed in response to the high-grade stenoses of the SMA and celiac trunk.
