Acute Mesenteric Artery Occlusion Research Articles

Clinico-Radiological Features of Acute and Chronic Superior Mesenteric Artery Occlusion (SMAO)

Clinico-Radiological Features of Acute and Chronic Superior Mesenteric Artery Occlusion (SMAO)

Acute superior mesenteric arterial thromboembolic occlusion-catheter directed thrombolysis-be on time, still be cautious!

Acute mesenteric ischemia (AMI) is one of the major life-threatening emergencies which require immediate attention and treatment. The most common cause of AMI is superior mesenteric artery (SMA) occlusion secondary to an embolic phenomenon. We present a 55-year-old gentleman with acute SMA thromboembolism, treated by catheter directed thrombolysis (CDT) that helped in avoiding a major surgery. A 55-year-old male, with known diabetes, hypertension and atrial fibrillation, presented with acute abdominal pain and found to have SMA thromboembolism on contrast computed tomography (CT) abdomen. As there were no evidences of bowel ischemia clinically and on the CT imaging, endovascular CDT was performed following which the patient improved and discharged after 10 days of hospital stay. Timely endovascular intervention in appropriate patient population with acute mesenteric arterial thromboembolic occlusion can help avoid major surgeries, reduce the extent of non-viable bowel and decrease the resultant significant morbidity.

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.

Acute mesenteric artery occlusion in hypobaric oxygen environment

Background: Acute mesenteric ischemia represents a challenge in Taif and related districts where hypobaric oxygen may add to other risk factors as prevalence of diabetes mellitus and obesity. The aim of this retrospective study was to record and discuss the underlying risk factors, pattern of presentation, methods of diagnosis and results of treatment of acute mesenteric ischemia in Taif Tertiary Hospitals.Methods: In this chart review and database study, thirty-one patients met the inclusion criteria in the period from January 2009 to December 2017. The outcomes included demographics, risk factors, clinical findings, diagnostic and therapeutic methods, in addition to the mortality and follow up of the study population.Results: The commonest presenting symptom was abdominal pain (100%), of them 45.2% had marked peritoneal signs. Diagnosis was established by CT angiography in 41.9% and after exploratory laparotomy in 58.1% of patients. Mesenteric artery thrombosis was the cause in 64.5% and embolism in 35.5%. In all patient’s necrotic bowel segments were resected followed by revascularization. Reoperation was performed in 32.3% of patients. Perioperative deaths were 41.9% and the overall mortality 58.1%.Conclusions: The findings of this study are not quite different from that performed on population living in normobaric oxygen environment except for a higher incidence of arterial thrombosis. Validation of these findings needs more standardized large prospective studies to avoid the impact of different confounding factors and the limited statistical power related to small sample sizes.

Recanalization of Acute Mesenteric Artery Occlusion by Percutaneous Transluminal Angioplasty Followed by Stent Implantation

Recanalization of Acute Mesenteric Artery Occlusion by Percutaneous Transluminal Angioplasty Followed by Stent Implantation

Acute Superior Mesenteric Arterial Occlusion Caused by a Thoracic Aortic Mural Thrombus in a Patient Without Coagulation Disorder or Aortic Disease: A Case Report

Introduction Aortic mural thrombus (AMT) formation in a patient without hypercoagulability and preexisting aortic disease is very rare, and acute superior mesenteric artery (SMA) occlusion resulting from AMT is clinically infrequent. Case presentation A 70-year-old woman was transferred to our institute with a diagnosis of acute SMA occlusion. Contrast-enhanced computed tomography (CECT) revealed thromboemboli in the SMA and a thoracic AMT. She immediately underwent angiography and subsequent endovascular aspiration and transcatheter infusion, which recanalized the SMA. However, CECT suggested intestinal ischemia; therefore, she underwent intestinal resection, and we administered anticoagulant therapy with heparin and warfarin postoperatively for the thoracic AMT. Although repeat thrombus formation developed in an ileal branch despite anticoagulant therapy, she had no abdominal symptoms; therefore, we continued the anticoagulant therapy. CECT 3 months later confirmed the absence of thoracic AMT and normal ileal findings. Conclusion We report a case of acute SMA occlusion and preceding splenic infarction that resulted from thoracic AMT in a patient without hypercoagulability and preexisting aortic disease. AMT should always be considered as a cause of acute SMA occlusion in patients without heart disease, including atrial fibrillation or severe arteriosclerosis.

Inhibition of ubiquitin-activating enzyme protects against organ injury after intestinal ischemia-reperfusion.

Intestinal ischemia-reperfusion (I/R) occurs in various clinical settings, such as transplantation, acute mesenteric arterial occlusion, trauma, and shock. I/R injury causes severe systemic inflammation, leading to multiple organ dysfunction associated with high mortality. The ubiquitin proteasome pathway has been indicated in the regulation of inflammation, particularly through the NF-κB signaling pathway. PYR-41 is a small molecular compound that selectively inhibits ubiquitin-activating enzyme E1. A mouse model of intestinal I/R injury by clamping the superior mesenteric artery for 45 min was performed to evaluate the effect of PYR-41 treatment on organ injury and inflammation. PYR-41 was administered intravenously at the beginning of reperfusion. Blood and organ tissues were harvested at 4 h after reperfusion. PYR-41 treatment improved the morphological structure of gut and lung after I/R, as judged by hematoxylin and eosin staining. It also reduced the number of apoptotic terminal deoxynucleotidyl transferase dUTP nick end-labeling-positive cells and caspase-3 activity in the organs. PYR-41 treatment decreased the expression of proinflammatory cytokines IL-6 and IL-1β as well as chemokines keratinocyte chemoattractant and macrophage inflammatory protein-2 in the gut and lung, which leads to inhibition of neutrophils infiltrating into these organs. The serum levels of IL-6, aspartate aminotransferase, and lactate dehydrogenase were reduced by the treatment. The IκB degradation in the gut increased after I/R was inhibited by PYR-41 treatment. Thus, ubiquitination may be a potential therapeutic target for treating patients suffering from intestinal I/R. NEW & NOTEWORTHY Excessive inflammation contributes to organ injury from intestinal ischemia-reperfusion (I/R) in many clinical conditions. NF-κB signaling is very important in regulating inflammatory response. In an experimental model of gut I/R injury, we demonstrate that administration of a pharmacological inhibitor of ubiquitination process attenuates NF-κB activation, leading to reduction of inflammation, tissue damage, and apoptosis in the gut and lungs. Therefore, ubiquitination process may serve as a therapeutic target for treating patients with intestinal I/R injury.

Interventional Radiology for Acute Mesenteric Artery Occlusion

Interventional Radiology for Acute Mesenteric Artery Occlusion

急性上腸間膜動脈閉塞症の2例

急性上腸間膜動脈閉塞症の2例

Mesenteric Venous Thrombosis

Mesenteric venous thrombosis (MVT) is a rare but potentially lethal form of mesenteric ischemia. MVT is a difficult condition to diagnose within the spectrum of patients presenting with acute or subacute abdominal pain. The nonspecific symptoms, low incidence, and lack of awareness among clinicians are some of the causes for this. The etiology of this disease results from a heterogeneous group of underlying pathologic disorders and risk factors that make this disease challenging to diagnose and treat. This review discusses the etiology, pathophysiology, clinical presentation, diagnosis, treatment, and outcomes of MVT. Tables outline conditions associated with secondary MVT, distinctions between acute MVT and acute mesenteric arterial occlusion, radiologic findings associated with acute MVT, and risk factors for mortality associated with acute MVT. Figures show acute MVT, transmural and nontransmural bowel ischemia, transhepatic access and venography, venography of the superior mesenteric and portal veins, and bowel appearance at abdominal exploration of a patient with acute MVT. This review contains 6 figures, 4 tables, and 58 references.

Modern treatment of acute mesenteric ischaemia

Diagnosis of acute mesenteric ischaemia in the early stages is now possible with modern computed tomography (CT), using intravenous contrast enhancement and imaging in the arterial and/or portal venous phase. The availability of CT around the clock means that more patients with acute mesenteric ischaemia may be treated with urgent intestinal revascularization. This was a review of modern treatment strategies for acute mesenteric ischaemia. Endovascular therapy has become an important alternative, especially in patients with acute thrombotic superior mesenteric artery (SMA) occlusion, where the occlusive lesion can be recanalized either antegradely from the femoral or brachial artery, or retrogradely from an exposed SMA after laparotomy, and stented. Aspiration embolectomy, thrombolysis and open surgical embolectomy, followed by on-table angiography, are the treatment options for embolic SMA occlusion. Endovascular therapy may be an option in the few patients with mesenteric venous thrombosis who do not respond to anticoagulation therapy. Laparotomy is needed to evaluate the extent and severity of visceral organ ischaemia, which is treated according to the principles of damage control surgery. Modern treatment of acute mesenteric ischaemia involves a specialized approach that considers surgical and, increasingly, endovascular options for best outcomes.

A Case of Simultaneous Anastomosis using a Monitoring Flap in Bowel Resection for Acute Superior Mesenteric Arterial Occlusion

上腸間膜動脈（SMA）の急性閉塞による広範な腸管壊死は現在でも救命率の低い疾患の一つである．予後の改善には腸管大量切除後の残存腸管を長くし消化吸収能を維持することが大切であるが，これにより虚血性変化の進展による残存腸管壊死のリスクが高まる．術式の選択においてはこの相反する問題を念頭に検討すべきである．今回我々は，37歳男性のSMA閉塞症に対してトライツ靭帯から75cmの空腸から右結腸曲までを切除した．再建は一期的に行い残存空腸断端から約5cmの部位で自動吻合器を用いて空腸と結腸を側端で吻合した．さらに盲端とした空腸断端を右側腹部皮膚の小孔より体外に留置固定した．腹壁外に固定した空腸盲端を観察することで残存腸管の血流観察は容易となった．本術式は患者への侵襲を最小限にとどめつつ一期的吻合術を選択した場合のリスクを軽減できる有用な方法と考えられた．

Primary percutaneous aspiration and thrombolysis for the treatment of acute embolic superior mesenteric artery occlusion

To evaluate technical success rate and clinical outcome of patients with acute embolic superior mesenteric artery (SMA) occlusion who were treated with primary percutaneous revascularization. At three medical centers the radiological information system databases were used to identify all patients in whom primary percutaneous revascularization for the treatment of acute embolic SMA occlusion was attempted between 2001 and 2010. Percutaneous treatment was performed in 15 patients (median age 80 years, range 49-88 years). These patients represent the study population. Eleven patients reported abdominal pain. Five patients exhibited peritoneal signs. Revascularization was defined as complete technical success if (1) patency of the SMA with residual stenosis of not more than 30% in diameter and (2) sufficient perfusion of the entire bowel were obtained. Complete technical success was achieved in eleven patients. After percutaneous revascularization laparotomy was performed in six patients and in three of them bowel resection was carried out (length of resected segments 20-80 cm). The 30-day mortality was 33% (five of 15 patients). None of the surviving patients exhibited short-bowel syndrome. Primary percutaneous aspiration and thrombolysis constitutes a promising alternative to surgical revascularization in selected patients with acute embolic SMA occlusion.

Acute Mesenteric Ischemia: Diagnostic Approach and Surgical Treatment

Mortality related to acute mesenteric arterial occlusion remains very high. Patient survival is dependent on prompt recognition and revascularization before ischemia progresses to intestinal gangrene. Biphasic computed tomography angiography has surpassed angiography as the diagnostic test of choice due to its ability to define the arterial anatomy and to evaluate secondary signs of mesenteric ischemia. Unlike chronic mesenteric ischemia, the treatment of acute arterial mesenteric ischemia, either embolic or thrombotic, remains largely surgical. This is due to the emergent need for revascularization combined with a careful evaluation of the intestines. Endovascular techniques remain useful, however, and can save precious time in the treatment of these challenging patients if integrated into a treatment pathway combined with definitive surgical treatment. A new hybrid endovascular-surgical treatment for the treatment of acute mesenteric thrombosis is described.

A case of acute superior mesenteric arterial occlusion with successful emergency simultaneous side-to-end anastomosis

A case of acute superior mesenteric arterial occlusion with successful emergency simultaneous side-to-end anastomosis

Endovascular Therapeutic Approaches for Acute Superior Mesenteric Artery Occlusion

The purpose of this study was to characterize the outcome of attempted endovascular intervention in patients with acute embolic or thrombotic superior mesenteric artery (SMA) occlusion. The records of 21 patients during a 3-year period between 2005 and 2008 were retrieved from the in-hospital registry. The first group included 10 patients (6 women and 4 men; median age 78 years) with acute embolic occlusion of the SMA. The median duration of symptoms from symptom onset to angiography was 30 hours (range 6 to 120). Synchronous emboli (n = 12) occurred in 6 patients. Embolus aspiration was performed in 9 patients, and 7 of these had satisfactory results. Complementary local thrombolysis was successful in 2 of 3 patients. Residual emboli were present at completion angiography in all 7 patients who underwent successful aspiration embolectomy, and bowel resection was necessary in only 1 of these patients. One serious complication occurred because of a long SMA dissection. The in-hospital survival rate was 90% (9 of 10 patients). The second group included 11 patients (10 women and 1 man; median age 68 years) with atherosclerotic acute SMA occlusions. The median time of symptom duration before intervention was 97 hours (range 17 to 384). The brachial, femoral, and SMA routes were used in 6, 7, and 5 patients, respectively. SMA stenting was performed through an antegrade (n = 7) or retrograde (n = 3) approach. Bowel resection was necessary in 4 patients. No major complications occurred. The in-hospital survival rate was 82% (9 of 11 patients). Endovascular therapy of acute SMA occlusion provides a good alternative to open surgery.

Acute Parkinsonism in Uremia and its Prognosis

Basal ganglia lesions in uremic-diabetic patients may present with a favorable outcome along with a complicated clinical course and poor prognosis. In this report, we present a diabetic patient with uremia in whom acute Parkinsonism developed, associated with increase in blood urea nitrogen and serum creatinine levels. T2, flair, and diffusion-weighted scans of cerebral magnetic resonance imaging showed hyperintensity. Ten days after this clinical presentation, she developed acute abdominal pain and mesenteric artery occlusion. Surgical operation was performed to remove gangrenous intestine, but she died 5 days after the operation.

A NOVEL BLOCKING INDEX BASED ON SIMILARITY MEASUREMENT APPLIED IN DISTINGUISHING THE PATTERNS OF BLOOD PRESSURE SIGNALS AT DYNAMICALLY TRANSITIONAL SITUATION

Acute mesenteric arterial occlusion is an abdominal catastrophe that carries high morbidity and mortality. The poor outcomes of this disease process are caused by the delay in initiating therapy because of the difficulties in making an accurate and timely diagnosis. In this study, we tried to conduct patterns analysis on blood pressure (BP) signal under simulated situation using an innovative measurement of similarity. The simulations of intestinal artery occlusion were conducted to two young healthy pigs to generate the recordings of blood pressure signals in dynamically transitional situation. Based on the distance measurement of similarity, non-clamping, non-relaxing, and blocking indexes are defined. Moreover, blocking index (BI) performs a good indicator for verifying the pattern of BP signal under the situation of clamping or relaxing. Finally, the analysis results show the feasibility of pattern analysis for identifying the underlying condition of circularity system.

Investigating complex patterns of blocked intestinal artery blood pressure signals by empirical mode decomposition and linguistic analysis

In this investigation, surgical operations of blocked intestinal artery have been conducted on pigs to simulate the condition of acute mesenteric arterial occlusion. The empirical mode decomposition method and the algorithm of linguistic analysis were applied to verify the blood pressure signals in simulated situation. We assumed that there was some information hidden in the high-frequency part of the blood pressure signal when an intestinal artery is blocked. The empirical mode decomposition method (EMD) has been applied to decompose the intrinsic mode functions (IMF) from a complex time series. But, the end effects and phenomenon of intermittence damage the consistence of each IMF. Thus, we proposed the complementary ensemble empirical mode decomposition method (CEEMD) to solve the problems of end effects and the phenomenon of intermittence. The main wave of blood pressure signals can be reconstructed by the main components, identified by Monte Carlo verification, and removed from the original signal to derive a riding wave. Furthermore, the concept of linguistic analysis was applied to design the blocking index to verify the pattern of riding wave of blood pressure using the measurements of dissimilarity. Blocking index works well to identify the situation in which the sampled time series of blood pressure signal was recorded. Here, these two totally different algorithms are successfully integrated and the existence of the existence of information hidden in high-frequency part of blood pressure signal has been proven.

A Case of Acute Superior and Inferior Mesenteric Arterial Occlusion after Massive Bowel Resection

A Case of Acute Superior and Inferior Mesenteric Arterial Occlusion after Massive Bowel Resection