Mesenteric Artery In Patients Research Articles

Nutcracker phenomenon: A new diagnostic method of multislice computed tomography angiography

We evaluated 3-D computed tomography angiography (3-D CTA) in the diagnosis of the nutcracker phenomenon, and its significance in postoperative follow up. Three-dimensional CTA was used to compare the anatomical relations of the left renal vein with the aorta and the superior mesenteric artery in patients with the nutcracker phenomenon and in a control group. Four patients with the nutcracker phenomenon received a surgical procedure of the transposition of the left renal vein. The 3-D CTA was used for all patients during postoperation follow-up testing. The 3-D CTA showed a compression of the left renal vein between the aorta and the superior mesenteric artery (SMA) and the abnormal acute angle between them. The angles and distances between the SMA and the aorta were 39.3 +/- 4.3 degrees and 3.1 +/- 0.2 mm in the patient groups and 90 +/- 10 degrees and 12 +/- 1.8 mm in the control groups, respectively. Differences in angles and distances were statistically significant between the two groups (P < 0.05). Surgical transposition of the left renal vein was performed successfully. Postoperative 3-D CTA revealed the distance between the SMA and the aorta was nearly normal. The reconstruction imaging of the renal vein by means of 3-D CTA revealed that unusual hematuria was due to compression of the left renal vein; therefore it may be a useful alternative imaging technique instead of conventional examinations. The non-invasive 3-D CTA may be a useful tool in the diagnosis of the nutcracker phenomenon and follow-up testing.

Ultrasonographic splanchnic arterial flow measurement in severe acute pancreatitis.

Duplex ultrasonographic technology is now capable of detecting flow signals in the various splanchnic vessels and calculating the concomitant flow velocities using fast-Fourier transformation. To use Doppler sonography to investigate how splanchnic hemodynamics vary during the early stage of severe acute pancreatitis. Six patients with severe acute pancreatitis (age, 59.0 +/- 6.57 years; four men, two women) and seven with mild to moderate acute pancreatitis (age, 60.1 +/- 7.41 years; five men, two women) were examined with Doppler sonography immediately after disease onset. The maximum velocity, minimum velocity, mean velocity, pulsatility index, and resistive index were determined from the Doppler spectra from the proper hepatic artery, celiac artery, and superior mesenteric artery. We also examined 15 healthy subjects (age, 59.3 +/- 4.60 years; 10 men, five women) as controls. The maximum velocity of the proper hepatic artery in patients with severe acute pancreatitis was significantly higher than that in patients with mild to moderate acute pancreatitis (p = 0.011) and in control subjects (p = 0.0047). Similarly, significant increases in both the minimum velocity and the mean velocity of the proper hepatic artery were observed in patients with severe acute pancreatitis. Neither pulsatility index nor resistive index of the proper hepatic artery showed a significant difference among the three groups. There were no significant differences among the three groups with respect to the flow velocity of the superior mesenteric artery. In contrast, the pulsatility index of the superior mesenteric artery in patients with severe acute pancreatitis was significantly lower than that in patients with mild to moderate acute pancreatitis (p = 0.0058) or in control subjects (p = 0.0024). For patients with acute pancreatitis, a significant inverse correlation was obtained between the maximum velocity of the proper hepatic artery and the pulsatility index of the superior mesenteric artery (r = -0.658, p = 0.0145). The increase in the hepatic arterial flow velocity and the decrease in the superior mesenteric arterial pulsatility index may represent early events of the severe type of acute pancreatitis.

Doppler sonography of the inferior mesenteric artery: a preliminary study.

The purposes of this study were to look for the inferior mesenteric artery in patients undergoing abdominal sonography, to determine in what percentage of patients it is visible, and to characterize Doppler flow patterns of the inferior mesenteric artery in fasting patients without intestinal vascular disease. The inferior mesenteric artery was sought in 100 consecutive fasting adults (mean age, 54 years; 63 women, 37 men), as follows: the infrarenal aorta was scanned in a transverse plane; the origin of the inferior mesenteric artery was identified on the left anterolateral surface of the aorta; the inferior mesenteric artery was then traced caudally along the left side of the aorta. The inferior mesenteric artery and the superior mesenteric artery were studied with Doppler sonography in 50 different subjects without clinical or Doppler sonographic evidence of abdominal vascular disease (mean age, 44.9 years; 17 men, 33 women). Pulsed Doppler samples were taken within the inferior mesenteric artery in sagittal planes. The resistive index was calculated from the superior mesenteric artery and the inferior mesenteric artery. The inferior mesenteric artery was detected in all but eight patients (92%). In seven patients obesity prevented visualization. The eighth patient had undergone abdominal surgery on the previous day, limiting the sonographic examination. The diastolic flow in the inferior mesenteric artery was less than that in the superior mesenteric artery in all patients. The resistive index was 0.959 +/- 0.045 in the inferior mesenteric artery and 0.856 +/- 0.046 in the superior mesenteric artery (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

How safe is the use of platinum microcoils for embolization of small mesenteric arteries in patients with gastrointestinal bleeding?

How safe is the use of platinum microcoils for embolization of small mesenteric arteries in patients with gastrointestinal bleeding?

Angiography in Lower Gastrointestinal Bleeding-Reply

In Reply .–The prime objective of thisbrief clinical notewas to reaffirm the principle that, once surgical intervention is decided on, total abdominal colectomy with ileoproctostomy is the only procedure that precludes rebleeding; a secondary objective was to discourage time-consuming angiography, since identifying and resecting a portion of the colon containing the bleeding site will not prevent later rebleeding from another site. Identification of the active bleeding site, therefore, is not entirely pertinent to our disagreement, which centers around the success in controlling diverticular bleeding with intraarterial vasopressin infusion. My own experience at Detroit General Hospital has been less than satisfactory with this technique. Reasons for failure have included inability to cannulate either the superior mesenteric artery or the inferior mesenteric artery in patients with diffuse, occlusive disease, lack of response to a standard vasopressin infusion, and rebleeding after initial success either during or following a vasopressin infusion. Comparable

Effect of bradykinin on portal pressure and protal caliber in the dog. An experimental angiographic study.

Portal pressure and caliber of the portal vein was examined in dogs after bradykinin injection (0.5 mug/kg bodyweitght) into the superior mesenteric artery. Ten experiments were performed. The portal pressure rose from a mean of 10.4 cm H2O to a mean of 21.2 cm H2O after bradykinin injection. The portal vein was dilated in 8 of the 10 experiments. Also the portal circulation time was calculated and decreased after bradykinin injection. Thus, because of the increase in portal pressure and increase in portal circulation care should be exercised when injecting bradykinin into the superior mesenteric artery in patients with portal hypertension and imminent bleeding from oesophageal varices.