Abdominal Ischemia Research Articles

Aortic Dissection: Classification, Etiology, Pathogenesis and Clinical Picture

Aortic dissection is a pathological process in which the aortic wall is divided into inner and outer layers under the action of hemodynamic forces. The process can be localized in various parts of the aorta, and also can be cause of blood supply disorders not only of organs which are located along the vessel (orthograde), but also organs which are located retrogradely. Risk factors for aortic dissection may include age, gender, atherosclerosis, inflammatory diseases, chest injuries, heart surgery, hereditary predisposition, congenital defects of the cardiovascular system and hereditary connective tissue disorders. The most often complication of aortic dissection is malperfusion syndrome, which can manifest itself as symptoms of upper and lower limb ischemia, syncope, ischemic stroke, prerenal azotemia (with decreased renal perfusion), abdominal ischemia syndrome (with occlusion of mesenteric arteries), spinal ischemic stroke. Knowledge of the totality of etiological factors, risk factors, pathogenesis, various manifestations and complications of aortic dissection allows you not to miss the beginning of the pathological process and provide timely assistance.

Эндоваскулярное лечение пациентки с синдромом хронической абдоминальной ишемии: клинический случай

Эндоваскулярное лечение пациентки с синдромом хронической абдоминальной ишемии: клинический случай

СИНДРОМ СРЕДИННОЙ ДУГООБРАЗНОЙ СВЯЗКИ (СИНДРОМ ДАНБАРА) КАК МУЛЬТИДИСЦИПЛИНАРНАЯ ПРОБЛЕМА. КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ И ЛИТЕРАТУРНАЯ СПРАВКА

Introduction. Median arcuate ligament syndrome (MALS, Dunbar syndrome) is a rare vascular compression syndrome caused by extravascular compression of the celiac trunk (CT) and celiac plexus by the median arcuate ligament of the diaphragm and is one of the causes of chronic abdominal ischemia and neuropathic pain syndrome. Clinical observation. A woman, 36 years old, was hospitalized with complaints of abdominal pain of moderate intensity, diarrhea up to 10 times a day, weight loss of 11 kg over the past year. Inflammatory bowel disease, gluten enteropathy, lymphoma of the small intestine, malabsorption syndrome, pathology of the endocrine system was excluded. Abdominal high-resolution computed tomography (HRCT) angiography was performed. Signs of extravascular compression of CT up to 90% with a thickened median arcuate ligament with the formation of a U-shaped deformation were revealed. Laparoscopic decompression surgery was performed with simultaneous transluminal angioplasty, which led to a decrease in compression and disappearance of clinical symptoms. After 18 months, clinical improvement persisted, diarrhea disappeared. HRCT angiography and ultrasound duplex examination (USDE) showed sufficient blood flow in the CT system. During the follow-up period, the patient had moderate neuropathic pain and anxiety and depressive disorders requiring appropriate correction. Conclusion. The diagnostic and therapeutic approach to MALS should be patient-centered and requires the involvement of a team of specialists. Laparoscopic decompression is an effective treatment and can provide immediate symptoms relief. The results of the intervention can be assessed by HRCT angiography and USDE (methods supplementing each other). Correction of neuropathic pain syndrome and anxiety-depressive disorder is of great importance for improving the patient's quality of life.

Impact of Initial Operative Urgency on Short-Term Outcomes in Patients Treated with ECMO Due to Postcardiotomy Cardiogenic Shock.

The outcomes of patients with PCS and following ECMO therapy are associated with several preoperative risk factors. Our aim was to compare clinical presentation, ECMO-related data and in-hospital outcomes of patients treated with ECMO due to PCS after cardiac surgery, in regard to elective or emergent cardiac surgery procedures. Between April 2006 and October 2016, 164 consecutive patients that received VA-ECMO therapy due to PCS were identified and included in this retrospective cohort study. The patients were divided into groups based on the urgency of the initial procedures performed: elective group (ELG; n = 95) and an emergency group (EMG; n = 69). To compare the unequal patient groups, a propensity score-based matching (PSM) was applied (ELG, n = 56 vs. EMG, n = 56). The EMG primarily received ECMO intraoperatively (p ≤ 0.001). In contrast, the ELG were needed ECMO support more frequently postoperatively (p < 0.001). In-hospital mortality accounted for 71% (n = 40) in the ELG and 76% (n = 43) in the EMG (p = 0.518). Outcome data showed no major differences in the (abdominal ischemia (p = 0.371); septic shock (p = 0.393): rhythm disturbances (p = 0.575); emergency re-thoracotomy (p = 0.418)) between the groups. The urgency of the initial procedures performed is secondary in patients suffering PCS and following ECMO. In this regard, PCS itself seems to trigger outcomes in cardiac surgery ECMO patients substantially.

Clinic, diagnosis and treatment of dunbar syndrome in children

Aim: To determine the clinical, diagnostic and therapeutic features of Dunbar syndrome in children. Methods: Scientific work was carried out based on the "Republican Children's Clinical Hospital" and the "City Children's Clinical Hospital", Cheboksary. The basis of this study was a survey of 200 children with celiac artery compression syndrome. The results obtained in the course of the work were analyzed on the basis of the Department of Children's Diseases of the I.N. Ulianov Chuvash State University. In addition to routine diagnostic methods, Instrumental methods have been adopted: ultrasound Doppler scanning (Hitachi Vision Avius, Japan), CT angiography (SOMATOM Emotion, SIEMENS (China), Revolution EVO, GE (Russia)) and Magnetic resonance angiography (Optima MR450w 1.5, USA). The duration of the study is short (after surgery) and long-term (up to 2 years). Results: Dunbar syndrome is more often observed in girls, which in 75% of cases is accompanied by signs of chronic abdominal ischemia. Significant and prolonged stenosis of the celiac artery can cause the development of a number of complications (pancreatic-duodenal artery aneurysms, etc.).

Reverse \u201ccheese wire\u201d fenestration for abdominal aortic dissection repair: a case report and literature review

BackgroundAortic dissection is one of the most common emergency condition leading to internal organs or lower limb ischemia and aortic rupture. Herein, we described a reverse “cheese wire” endovascular fenestration repair (CWFER) in a patient with complicated abdominal aortic dissection which had never been reported.Case presentationA 62-year-old male presented abdominal tear-like pain and acute ischemia of the right lower extremity during the endovascular treatment of celiac trunk aneurysms. Computed tomography angiography (CTA) and digital subtraction angiography (DSA) showed abdominal aortic type B dissection with acute ischemia of the right lower extremity preoperatively. After a detailed preoperative examination, the patient then was performed a reverse CWFER. So far, the patient has been followed-up for 6 months, postoperative CTA demonstrated good stent-graft expansion and perfusion of bilateral common iliac arteries; also, no endoleak was detected.ConclusionsThe right iliac artery in this patient supplied by false lumen, which lead to acute ischemia of the right lower extremity, needed to be treated as an emergency and dealt with promptly. CWFER is a very high-risk treatment that requires the rich experience of vascular surgeon and accurate assessment of aortic dissection. After interventional treatment, the patient recovered uneventfully after 6 months’ follow-up.

Компрессионный стеноз чревного ствола в практике педиатра

The purpose — to analyze the Russian and foreign scientific literature on the features of compression stenosis of the abdominal trunk (CSAT) in the practice of a pediatrician, to conduct a clinical and laboratory examination of patients with chronic abdominal ischemia syndrome. Material and methods. This study included: group A (control) — 47 children without impaired blood flow in the abdominal trunk, group B (clinical) — 75 patients with chronic abdominal ischemia syndrome. The groups were comparable by the patients’ age and gender, which ensured the comparability of the data obtained. All children included in the study underwent ultrasound scanning of the abdominal trunk in triplex mode: two-dimensional image combined with color Doppler mapping and spectral Dopplerography mode. In 30 patients with CSAT, the changes detected during the USDG of the abdominal trunk were compared with the data of computed tomography in angioregime with intravenous administration of a contrast agent (ultravist 350). The images obtained underwent a 3D reconstruction. The procedure was performed on a Siemens Somatom 16 and GE Revolution EVO tomography devices. The processing was carried out using the Statistica 10.0 software. The critical level of significance when testing statistical hypotheses was p < 0.05. Results. Statistically significant differences in the frequency of pain were revealed between the examined groups. It was found that pain in children increased after eating and physical activity (mainly sports), as well as in stressful situations (21.33% of patients). In a clinical examination of patients with CSAT, a body weight deficiency was detected in 42.67% of cases, whereas in the control group it was observed only in 14.89% of children, i.e. significantly less frequently (p < 0.05). Conclusions. One of the causes of abdominal pain in children and adolescents is CSAT; this should be taken into account during the differential diagnostics and treatment with the most effective means.

Laparoscopic dissection in children with celiac artery compression syndrome

BACKGROUND: A cause of abdominal pain in children may be compression stenosis of the celiac trunk (Dunbars syndrome). This disease occurs when the median arcuate ligament of the diaphragm compresses the celiac trunk, thereby creating compression stenosis, causing the arterial hemodynamics in the artery to suffer and provide adequate blood circulation to the abdominal cavity organs. Medical statistics indicate that 10% to 15% of children and adolescents suffering from chronic abdominal pain have compression stenosis of the celiac trunk.
 AIM: This study aims to improve the diagnostic results and identify the indications for the surgical treatment of children with compression stenosis of the celiac trunk.
 MATERIALS AND METHODS: From 2015 to 2020 at the N.F. Filatov Childrens Hospital, 64 patients, aged 4 to 17 years underwent surgical treatment for compression stenosis of the celiac trunk. There are 42 boys (66%) and 22 girls (34%). The leading clinical manifestation in all patients was abdominal pain. Associated surgical pathology was observed in 34 of them. The diagnosis was based on anamnesis, examination, ultrasound examination with Doppler and celiac trunk blood flow measurements, multispiral computed tomography, and angiography.
 RESULTS: After completing the examination, 61 patients underwent laparoscopic decompression of the celiac trunk, and three children were operated on using the laparotomic approach. In all cases, the leading cause of compression stenosis of the celiac trunk was the median arcuate ligament of the diaphragm combined with the neurofibrous tissue of the celiac plexus. The average duration of the operation was 50 minutes. Intraoperative blood loss did not exceed 530 ml. One conversion completed. There were no postoperative complications in the early postoperative period. The patients were discharged in satisfactory condition. The control examination was conducted in the period from six months to three years. In 97% of patients, clinical symptoms of abdominal ischemia were not detected.
 CONCLUSION: Our experience indicates the possibility of diagnosing compression stenosis of the celiac trunk in children at early disease stages and laparoscopic treatment success of patients with this disease.

Short-term experience with aspiration embolectomy using a ACE68 reperfusion catheter to treat embolic superior mesenteric artery occlusion.

We report the short-term results with aspiration embolectomy using an ACE68 reperfusion catheter to treat patients with acute embolic superior mesenteric artery (SMA) occlusion. Our study included 4 consecutive male patients ranging in age from 72 to 86years (mean age 79years). In all patients, the main trunk of the SMA was occluded. The technical success rate was 100% for all procedures. There were no major procedure-related complications. One patient underwent laparotomy with intestinal resection after successful recanalization. No patient reported clinical symptoms of abdominal ischemia at follow-up. Our short-term experience shows that percutaneous aspiration embolectomy using an ACE68 reperfusion catheter is an effective treatment for acute mesenteric ischemia.

Functioning arterial or venous riolan arch in localized pancreatic cancer. how it can change tactics?

Background: CT are obligatory before pancreatic surgery. Discovery of functioning arterial or venous Riolan arch (FRA) can have substantial influence on tactics. Aim: To assess importance of FRA discloser for decision making before pancreatic surgery. Patients: Retrospective analysis of 554 patients' consecutive preoperative CT data revealed arterial(n2) and venous(n5) FRA in 7 cases. Modification of treatment were assessed. Results: Arterial FRA was found in pancreatic body cancer(n2). 1.atherosclerotic occlusion of CA and SMA with symptomatic abdominal ischemia; 2.tumor involved CA on the background of endoluminally unreсonstructable SMA occlusion. In the first case CA stenting before distal pancreatectomy eliminated symptoms fully. In the second case after FOLFIRINOXn12 R0 DPCAR without SMA reconstruction was done because of good collateral supply. Uneventful postop period, discharge on days 10 and 13. Venous FRA in all the cases of PDAC of the head±body were the sign of full block of all SMV tributaries and already formed outflow through the splenic(SV) and/or inferior mesenteric(IMV) vein. In all these cases efficient neoadjuvant therapy and venous FRA were the weighty argument for pancreatic resection. Thrice it was done without venous reconstruction, twice with IMV transposition in SV, once with SMA resection. Uneventful postop period, discharge on days 10-19. One patient died 44 month (distant mets), the second died 19 months disease-free (MI), others alive 21,18,13,12 and 11 months after treatment. Conclusion: Delineation of FRA before pancreatic surgery is the indication for tactics change: endovascular treatment for arterial FRA and more aggressive surgery in case of venous FRA.

Compression of the сeliac trunk syndrome. History of the problem

The article presents the main stages of the development of ideas about a fairly rare pathology in clinical practice the syndrome of compression of the ventral trunk. Until the mid-nineteenth century, reports of the clinical picture of chronic abdominal ischemia were more descriptive. Serial pathoanatomic studies, comparison of anatomical features revealed at autopsy with clinical manifestations accompanying these changes, contributed to the isolation of chronic ischemic disease of the digestive system in a separate nosological form. The discovery of angiography contributed to the significant development of vascular surgery and the isolation of the ventral trunk compression syndrome as an independent disease, since it allowed for a lifetime comparison of the detected changes in blood vessels with the clinical manifestations of the disease. The term ventral trunk compression syndrome was first introduced by P. Harjola when describing a case of abdominal pain in a patient with compression of the ventral trunk by the neuroganglionic tissue of the ventral plexus. Later, J. Dunbar confirmed the Association of clinical manifestations of chronic abdominal pain with compression of the ventral trunk by the median arched ligament of the diaphragm. In English-language literature, the disease was named Dunbar syndrome. The effectiveness of eliminating the symptoms of this disease by surgical dissection of compression structures has been proven. Further study of this problem developed in parallel with the development of surgery in General in accordance with the emergence and introduction of new surgical technologies. The purpose of numerous studies was to study the etiopathogenetic mechanisms of the occurrence of a variety of clinical manifestations of this syndrome and improve the results of its treatment by improving known surgical techniques and introducing new ones.

Treatment results in patients with extravasal compression of celiac trunk and its atherosclerotic lesion

Introduction. Extravasal compression of celiac trunk is the cause of chronic abdominal ischemia syndrome (CAIS) along with atherosclerotic lesions of the visceral branches of the aorta. Patients with isolated compression and those in the older age group with compression combined with atherosclerotic lesion are distinguished. At present, the issues of indications for surgical treatment the pattern and technique of surgical intervention as well as the evaluation of decompression results in the early and distant postoperative period remain controversial and unsolved. Aim. The aim of our study was to determine indications and contraindications for surgical intervention, to improve the technique of the surgery, to evaluate and find ways to improve the closest and most distant results of laparoscopic decompression of the celiac trunk. Materials and methods . The article discusses the experience of performing 27 laparoscopic decompressions of the celiac trunk and the results of examination and treatment of 5 patients who underwent endovascular interventions due to a combined lesion -extravasal compression of the celiac trunk and atherosclerotic occlusion. Intraoperative laparoscopic ultrasound was performed in all cases of the celiac trunk decompression to determine the celiac trunk topography and assess the adequacy of its decompression. Results. The average duration of the surgery was 92 minutes. Intraoperative and early postoperative complications were not observed. Intraoperative blood loss didn't exceed 50 ml. Average duration of stay in the hospital was 5 days. According to the data of ultrasound examination, the average degree of celiac trunk compression before the operation was 76%, in the early postoperative period it decreased to 43%, and in the distant period it decreased to 32%. Discussion. Based on our experience, the key to successful management of patients with celiac trunk compression syndrome is a multidisciplinary approach to diagnosis and treatment. Patients need thorough differential diagnosis, including psychoneurologist consultation. Experience in treating patients with atherosclerotic lesions of the celiac trunk combined with extravasal compression has shown good immediate and distant decompression results and adverse results of the first stage of endovascular interventions. Conclusion. Laparoscopic decompression of the celiac trunk is an effective treatment method in patients without atherosclerotic lesions.

Managing acute pain after abdominal surgery: examples from practice

Following abdominal surgery, ischaemia and neuropeptide release cause pain at the trauma site, and there is a high incidence of moderate-to-severe pain. Inadequate pain management leads to complications, delayed recovery and prolonged hospitalisation, and thus, effective management is essential. This article describes an implementation of acute pain management after abdominal surgery. A multidimensional assessment tool collected data on demographics, medical history and surgical situation, as well as interventions used, their administration route and their side effects. Pain level was recorded on a scale of 0–10, both at rest and during physical activity, by postoperative day; patient participation and satisfaction were also recorded. Nine patients met the inclusion criteria for the study. Pharmacological analgesic interventions included opioids (morphine, fentanyl and tramadol) and paracetamol. Administration was either intravenous, epidural or via patient-controlled analgesia. These were combined with non-pharmacological interventions, specifically cold gel packs, massage therapy and music therapy. All patients achieved the adequate management goals of pain at rest below 3/10 and during activity below 4/10, and all participated in pain decision-making, were satisfied with pain treatment, and reported the usefulness of preoperative information. Pain management following abdominal surgery is vital, and the use of a combination of pharmacological and non-pharmacological techniques was effective.

Abdominal ischaemia syndrome as a complication of type A acute aortic dissection

This review addressed the issues of strategies for the diagnosis and management of patients undergoing acute aortic dissection complicated by abdominal malperfusion syndromes. These complications remain a common unresolved task following aortic surgery. The diagnosis and clinical course of acute aortic dissection accompanied by abdominal ischaemia syndrome are com Abdominal ischaemia syndrome as a complication of type A acute aortic dissection.Received 26 August 2019. Revised 11 November 2019. Accepted 12 November 2019.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.

281Impact of complications on VA-ECMO support for cardiopulmonary support: analysis of 8,351 adult patients in Germany from 2007 to 2015

Abstract Background Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for treatment of patients with critical cardiopulmonary failure. However, utilization of VA-ECMO support must be carefully weighed against possible complications. Therefore, we investigated the incidence and impact of complications on VA-ECMO support in one of the largest datasets of VA-ECMO therapy. Material and methods We analyzed complications and outcomes of all VA-ECMO procedures performed in Germany from 2007 to 2015 by using administrative data from the German Federal Health Monitoring System. For the present analyses all cases treated with VA-ECMO between 2007 and 2015 were identified and selected by the primary procedural code (OPS) for VA-ECMO (OPS code 8852.3). Results Among 8,351 patients undergoing VA-ECMO between 2007 and 2015, there were significant changes in complication rates over time such as increase in acute kidney injury (from 35.9% in 2007–2012 to 44.6% in 2013–2015), major bleeding (from 11.3% in 2007–2012 to 19.5% in 2013–2015 and abdominal ischemia (from 4.5% in 2007–2009 to 7.2% in 2013–2015). The incidence of stroke and limb ischemia did not differ over time. Procedure-related and ischemic complications were more frequently observed in non-survivors as compared to survivors (12.2% versus 15.3%, p<0.001) except for major bleeding (20.9% in survivors versus 15.0% in non-survivors, p<0.001). Multivariate analyses retained stroke and acute kidney injury as being significantly associated with 30-day in-hospital mortality, with respective OR [95% CI] of 1.7 [1.0–2.9] and 1.2 [1.1–1.3]. Conclusion In one of the largest registries, major bleeding and ischemic events are the most common complications on VA-ECMO support. Ischemic complications seem to influence outcome more than bleeding complications. However, only stroke and acute kidney injury were independently associated with higher mortality rates. These findings should be incorporated in risk-benefit stratification when initiation of VA-ECMO and in prevention of complications to avoid additional morbidity and mortality in these critically ill patients.

Options and Management of Vascular Reconstruction in the Context of Abdominal Surgery and its Perioperative Care - Selection of Typical Clinical Situations and Cases

Interdisciplinary cooperation between surgeons can help to optimise outcome in the management of complex surgical diseases. The indication for surgical intervention has gradually expanded in advanced multivisceral tumour growth, with iatrogenic vascular injuries in the field of abdominal and oncological surgery and mesenteric ischemia. Appropriate expertise in vascular surgery is then essential, although this is not always available or in all hospitals. Narrative review based on current scientific references in the relevant literature and our own clinical and surgical experiences in decision making, the approach in clinical management and various options of vascular reconstruction in abdominal surgery. Prognosis is still limited in pancreatic cancer. R0 resection is the only curative therapeutic option - thus, the surgeon has to provide specific intraoperative expertise. Arterial reconstruction is still controversial, due to increased postoperative morbidity and limited evidence. But in specific cases, venous reconstruction has been established in clinical practice. In addition, in retroperitoneal sarcoma with advanced/extended tumour growth, reconstruction of the infiltrated inferior V.cava or common iliac artery by means of patch plasty or autologous bypass/segmental vascular prosthesis can become necessary as part of multivisceral resections. During inflammatory processes or with tumour adhesions/infiltrations to surrounding anatomical structures, intraoperative vascular injuries or postoperative vascular alterations can occur, further complicated by anatomical variants. The extremely strict demands on the abdominal surgeons, in particular in mesenteric ischemia, are influenced by i) a competent assessment of the mesenteric vessels based on ii) adequate imaging as well as iii) appropriate time management. Prompt recanalisation can play a decisive role for the prognosis. Vascular reconstructions in abdominal surgery, in particular, in oncological surgery, require great expertise of the surgeon. In this context, competent preoperative diagnostic testing, extensive specific experience in vascular surgery/interventions, appropriate interdisciplinary case management, adequate surgical tactic and technique are all important.

STENOSIS OF THE CELIAC TRUNK – FROM DIAGNOSTICS TO TREATMENT

Compression stenosis of the celiac trunk (CSCT) is a syndrome based on the celiac trunk stenosis of varying degree, sometimes in combination with that of the superior mesenteric artery, caused by the compression of this vessel by the medial arched ligament of the diaphragm, as well as its internal legs and the neurofibrotic tissue of the celiac plexus. CSCT can cause chronic ischemia of the abdominal organs and chronic pain syndrome. The branches of the celiac trunk, supplying the stomach, liver, pancreas to the blood, are connected with the mesenteric arteries of the intestine in a common circle, therefore, with a lack of blood flow along one of the branches, the entire digestive tract suffers . The main clinical manifestation of CSCT is abdominal pain, observed in 97–100% patients. Angiography is the most invasive and, at the same time, the most informative method currently available to assess the extent and degree of the celiac trunk narrowing and to determine indications for surgical treatment. Ultrasound is a harmless, painless and at the same time informative diagnostic method for CSCT. A modern ultrasound technique is ultrasound with the use of echocontrast. Multi-detector CT angiography with multiplanar and 3D reconstruction is the optimal method of X-ray diagnostics of CSCT. MR angiography is successfully used both for preoperative preparation in patients with compression of the celiac trunk, and in the postoperative period. The methods of surgical treatment for abdominal ischemia are divided into palliative, decompressional and reconstructive. Modern diagnostic methods allow non-invasive methods to diagnose CSES in combination with clinical manifestations. The laparoscopic method is optimal for celiac trunk decompression, but the choice of the surgical treatment method should be considered individually.

Possibilities of Laparoscopic Decompression of Celiac Trunk in the Treatment of Dunbar Syndrome

Presented clinical case laparoscopic decompression of celiac trunk syndrome of Dunbar. In most cases, the diagnosis of syndrome of compression of the celiac trunk is by exclusion of other gastrointestinal diseases. Sure, it tells about lack of awareness among the medical community about this specific and rare pathology, as well as a possible skeptical attitude towards it related professionals. The main methods of diagnostics of a syndrome of Dunbar are: ultrasonic duplex scanning of the abdominal aorta, multislice computed tomography and angiography with a respiratory samples. The indication for surgical treatment is the ineffectiveness of conservative therapy, the preservation of the leading symptoms of abdominal ischemia on the ground proved critical in compression of the celiac trunk. Currently, laparoscopic decompression of celiac trunk syndrome Dunbar is the operation of choice. The obvious advantages of laparoscopic surgery are less blood loss, a slight pain syndrome in the postoperative period, short hospital period and better cosmetic effect. In the clinic, where surgeons proficient in the technique of laparoscopic procedures, the surgery can be performed quickly, safely, and efficiently. Additional intervention in the form of endovascular correction is not required in all patients and can be performed in a delayed order.

The diagnostic criteria for chronic abdominal ischemia and the methods for its correction

The diagnostic criteria for chronic abdominal ischemia and the methods for its correction

СИНДРОМ ХРОНИЧЕСКОЙ АБДОМИНАЛЬНОЙ ИШЕМИИ. КЛИНИЧЕСКИЙ СЛУЧАЙ

One possible cause of resistant abdominal pain syndrome is a chronic intestinal ischemia caused by varying degrees of occlusion of the mesenteric vessels. Due to the variety of clinical manifestations, just noticeable their specificity and lack of awareness of general practitioners timely diagnosis of the syndrome of chronic abdominal ischemia is difficult. The method of choice of surgical treatment is percutaneous transluminal angioplasty and stenting of the arteries.