Superior Mesenteric Artery Stenosis Research Articles

A case of hybrid surgery for a pseudoaneurysm after pancreaticoduodenectomy in a patient with celiac axis and superior mesenteric artery stenosis

A case of hybrid surgery for a pseudoaneurysm after pancreaticoduodenectomy in a patient with celiac axis and superior mesenteric artery stenosis

Incidental abnormal CT scan findings during transcatheter aortic valve implantation assessment: incidence and implications

ObjectivesThe aim of this retrospective series is to describe the prevalence and clinical significance of the incidental findings found during pre–transcatheter aortic valve implantation (TAVI) work-up and to ascertain the...

Renal Transplant from Living Donor in a Patient of Very High Surgical Risks Due to Takayasu Disease and Several Course of Vascular Thrombosis

Introduction Takayasu arteritis is a vasculitis of large vessels that produces inflammation and stenosis of medium and large caliber arteries affecting mainly the aorta. It is an uncommon cause of terminal kidney disease. Patient and Methods A 33-year-old man with Takayasu's disease diagnosed in 2000. He presented hypertensive emergency that required left renal autotransplantation in 2002 with early thrombosis wich required nephrectomy. Angioplasty on right renal artery in 2005. Critical stenosis of the celiac trunk, superior mesenteric and right renal artery pseudoaneurysm with aorto-aortic bypass with superior mesenteric reimplantation and right aorto-renal bypass with placement of PTFE prostheses with thrombosis that required thrombectomy. Thrombosis of the aorto-renal bypass resolved by fibrinolysis. Aortic prosthesis rupture with thrombosis of right aorto-renal bypass and critical stenosis of superior and inferior mesenteric artery and of the celiac trunk resolved by aortic-aortic endoprosthesis implantation and by right common iliac artery to superior mesenteric and from this to right renal. In the postoperative period, he presented with acute renal failure, remaining in a pre-dialysis situation. In October 2016, a kidney transplant was performed from a living donor (mother) to the right iliac fossa with vascular anastomosis from the end to the external iliac. Results When channeling the central line, he presented complete atrio-ventricular block with escape rhythm. He required atropine, isoproterenol, cardiopulmonary resuscitation and pacemaker implantation. Immunosuppressed with thymoglobulin, tacrolimus, mycophenolate and steroids with decreased creatinine in the immediate post-transplant. Given the antecedents, prior to transplantation, low molecular weight heparin was started, which was maintained for a month, and subsequently antiaggregation with acetylsalicylic acid. One year later, she presented a functioning graft with creatinine of 1.3 mg / dl and Doppler ultrasound with good renal perfusion and normal spectral recording. Conclusion Live donor transplantation should be an alternative to assess in patients with high surgical risk. Adequate antithrombotic prophylaxis and individualized immunosuppressive regimen is necessary in these patients.

Correlation between the stenosis degree of aorto-iliac artery and superior mesenteric artery in patients with lower extremity atherosclerotic occlusive disease by CT angiography

To investigate the correlation between the stenosis degree of superior mesenteric artery (SMA) and each artery within the scope of aorto-iliac artery in patients with lower extremity atherosclerotic occlusive disease (LEAOD). Images of 70 patients who had undergone the aorta-iliac-femoral arteries CT angiography (CTA) examination and had a definite diagnosis of LEAOD due to intermittent claudication or resting pain admitted to Tianjin Hospital from January to December in 2017 were enrolled. The arteries in the aorta as well as iliac were surface-reconstructed, which were analyzed by advanced vascular analysis (AVA) combined with the original images, including SMA trunk, abdominal aorta (AA), left and right common iliac artery (LCIA, RCIA), left and right internal iliac artery (LIIA, RIIA), left and right external iliac artery (LEIA, REIA). The normal reference plane and the maximal stenosis plane were selected, and the stenosis rate of each artery in the reconstruction range was automatically calculated with software. The patient's imaging data were divided into groups with two methods: (1) according to the degree of SMA stenosis, the patients were divided into group I (stenosis degree ≤70%) and group II (stenosis degree > 70%); (2) LEAOD patients with different gender were respectively divided into three groups: middle-aged group (45-59 years old), pre-elderly group (60-74 years old) and elderly group (75-89 years old). The comparison between the stenosis degree of SMA and each artery within the scope of aorto-iliac artery was analyzed with Pearson simple correlation analysis. The incidence of SMA stenosis in all LEAOD patients was 100%. Correlation analysis showed that there was no correlation between the stenosis degree of SMA and AA, LCIA, RCIA, LIIA, RIIA, LEIA, or REIA in group I (n = 64) and group II (n = 6), respectively (r value was -0.021, 0.023, 0.023, -0.137, 0.182, -0.113, 0.141, respectively, in group I, and it was 0.020, -0.560, 0.010, 0.306, -0.204, -0.381, 0.393, respectively, in group II, all P > 0.05). In 52 male patients, there was no correlation between the stenosis degree of SMA and AA, LCIA, RCIA, LIIA, RIIA, LEIA, or REIA in middle-aged group (n = 16), pre-elderly group (n = 27) and elderly group (n = 9), respectively (r value was -0.032, 0.024, 0.324, 0.146, 0.312, 0.008, 0.344, respectively, in middle-aged group, it was -0.108, -0.116, -0.040, -0.249, -0.082, -0.052, 0.096, respectively, in pre-elderly group, and it was 0.182, 0.311, 0.400, 0.360, 0.688, 0.498, 0.406, respectively, in elderly group, all P > 0.05). In 18 female patients, there was also no correlation between the stenosis degree of SMA and above each artery within the scope of aorto-iliac artery in pre-elderly group (n = 11) and elderly group (n = 6), respectively (the r value was -0.170, 0.040, -0.019, 0.152, 0.508, 0.042, 0.456, respectively, in pre-elderly group, and it was -0.660, 0.008, -0.055, -0.056, -0.213, 0.344, 0.011, respectively, in elderly group, all P > 0.05). The correlation in middle-aged group was not analyzed because there was only 1 patient. Although the atherosclerotic changes in LEAOD patients can affect SMA and aorto-iliac artery at the same time, there was no correlation between the stenosis degree of SMA and each artery within the scope of aorto-iliac artery which may due to the differences in the histological structure and hemodynamics among different arteries. SMA atherosclerotic stenosis and occlusion is a relatively independent disease process for LEAOD.

IF08. Fate of the Unstented Superior Mesenteric Artery in Fenestrated Endovascular Aortic Aneurysm Repair

The objective of this study was to evaluate the patency of the unstented superior mesenteric artery (SMA) after fenestrated EVAR (F-EVAR) using duplex ultrasound (DUS) and computed tomography angiography (CTA). Patients with SMA fenestrations or crossing struts were identified from a database of patients who underwent F-EVAR at our institution between 2011 and 2017 as part of an investigational device exemption clinical trial (NCT01538056). Mesenteric DUS and CTA data were obtained at baseline and at 30 days, 6 months, and annually out to 5 years. The DUS parameter of SMA peak systolic velocity (PSV) of 275 cm/s was used to detect 70% SMA stenosis. CTA was used to evaluate the patency of the SMA when DUS PSV was elevated or if DUS was not performed. There were 107 patients who underwent endograft placement involving the SMA in association with F-EVAR. There were 87 SMA fenestrations and 20 bare-metal struts crossing the SMA; 79 patients had baseline and at least 30-day follow-up DUS SMA PSV measurements (64 fenestrations, 15 struts). Mean follow-up was 18.6 months (range, 30 days-5 years). SMA PSVs are listed in the Table. Mean PSVs remained well below the threshold velocity of 275 cm/s for native atherosclerotic 70% SMA stenosis. Nine patients had at least one SMA PSV >275 cm/s during follow-up. All were observed and showed no subsequent clinical sequelae. All patients had at least 30-day follow-up with CTA, and all had widely patent SMAs at last follow-up. Mean total seal zone length was 41.4 mm. There was a single secondary intervention for asymptomatic SMA stenosis requiring stent placement 1 year after F-EVAR. There were no Type IA endoleaks and no endoleaks related to SMA fenestrations. Five patients of the entire cohort (4.7%) required SMA stenting at the index procedure. Three of these patients had prior EVAR (n =2) or open repair (n = 1), One patient had a pre-existing critical SMA stenosis and underwent planned SMA stenting, and in one patient, the graft was deployed imprecisely and low, and the SMA was successfully stented from a brachial approach. The unstented SMA in association with F-EVAR remains widely patent in the presence of fenestrations or struts and is not associated with endoleaks. The need for adjunctive SMA stenting may be related to prior aortic intervention and case complexity. Follow-up DUS and CTA surveillance confirms that SMA patency remains in the normal or <70% stenosis range after F-EVAR regardless of whether it is encompassed by a large fenestration or crossing struts.TableSuperior mesenteric artery (SMA) peak systolic velocity (PSV)Fenestrations (n = 64)Struts (n = 15)Overall mean PSV (N = 79)Baseline128 ± 57153 ± 41133 ± 5530 Days115 ± 56155 ± 63123± 596 Months121 ± 80128 ± 82122 ± 801 Year131 ± 7799 ± 55124 ± 732 Years138 ± 89124 ± 58134 ± 813 Years145 ± 11399 ± 63129 ± 1004 Years134 ± 112120 ± 61129 ± 965 Years96 ± 61191 ±147122 ± 90Values are reported as mean ± standard deviation. Open table in a new tab

Calcification score versus arterial stenosis grading: comparison of two CT-based methods for risk assessment of anastomotic leakage after esophagectomy and gastric pull-up.

PurposeAnastomotic leakage is a major surgical complication following esophagectomy and gastric pull-up. Specific risk factors such as celiac trunk (TC) stenosis and high calcification score of the aorta have been identified, but no data are available on their relative prognostic values. This retrospective study aimed to compare and evaluate calcification score versus stenosis quantification with regards to prognostic impact on anastomotic leakage.Patients and methodsPreoperative contrast-enhanced computed tomography scans of 164 consecutive patients with primary esophageal cancer were evaluated by two radiologists to apply a calcification score (0–3 scale) assessing the aorta, the celiac axis and the right and left postceliac arteries. Concurrently, the presence and degree of stenosis of TC and superior mesenteric artery were recorded for stenosis quantification.ResultsAnastomotic leakage was noted in 14/164 patients and 12/14 showed stenosis of TC (n=11). The presence of TC stenosis was found to have a significant impact on anastomotic healing (p=0.004). The odds ratio for the prediction of anastomotic leakage by the degree of stenosis was 1.04 (95% CI, 1.02–1.07). Ten of 14 patients had aortic calcification scores of 1 or 2, but calcification scores of the aorta, the celiac axis and the right and left postceliac arteries did not correlate with the corresponding TC stenosis values and showed no influence on patient outcome as defined by the occurrence of anastomotic insufficiency (p=0.565, 0.855, 0.518 and 1.000, respectively). Inter-reader reliability of computed tomography analysis and absolute agreement on calcium scoring was mostly over 90%. No significant differences in preoperative comorbidities and patient characteristics were found between those with and without anastomotic leakage.ConclusionMeasurement of TC stenosis in preoperative contrast-enhanced computed tomography scans proved to be more reliable than calcification scores in predicting anastomotic leakage and should, therefore, be used in the risk assessment of patients undergoing esophagectomy and gastric pull-up.

Persistent symptom relief after revascularization in patients with single-artery chronic mesenteric ischemia

ObjectiveAn isolated stenosis of the celiac artery (CA) or the superior mesenteric artery (SMA) is frequently detected in patients with abdominal complaints. The dilemma is whether these patients suffer from chronic mesenteric ischemia (CMI) and whether they will benefit from revascularization. We evaluated the long-term clinical success rates for single CA or SMA revascularization in patients with gastrointestinal symptoms and confirmed mucosal ischemia. MethodsThis was a retrospective cohort analysis of 59 consecutive patients with gastrointestinal symptoms and a single atherosclerotic mesenteric artery stenosis who were referred to our tertiary care institution between 2006 and 2010 for standardized diagnostic workup of CMI, including measurement of mucosal ischemia with visible light spectroscopy or gastric-jejunal tonometry. Patients with multidisciplinary consensus diagnosis of CMI underwent surgical or endovascular revascularization. The primary outcome was clinical response to revascularization, defined as relief of presenting symptoms as experienced by the patient. ResultsConsensus diagnosis of CMI was obtained in 37 of 59 patients. Isolated CA stenosis was present in 30 of 37 patients (81%) and isolated SMA stenosis in seven patients. After a mean follow-up of 5.0 ± 3.0 years, 27 of 37 patients (73%) experienced sustained symptom relief after revascularization. Response was not related to lesion localization (CA, 73%; SMA, 71%; P = .919). ConclusionsRevascularization of the CA or SMA provides persistent symptom relief in 73% of patients diagnosed with CMI due to single atherosclerotic mesenteric artery stenosis.

Acalculous Cholecystitis: A Rare Manifestation of Chronic Mesenteric Ischemia

Introduction: The most common manifestation of chronic mesenteric ischemia is intestinal angina. We are reporting a case in which acalculous cholecystitis developed as the first manifestation of chronic meseteric ischemia. Case description: An 85-year old woman with history of coronary artery disease and type 2 diabetes was admitted with hematemesis and diffuse, intermittent post-prandial abdominal pain. She was admitted 2 weeks prior to the index admission with nausea, vomiting and abdominal pain. Abdomen ultrasound did not show any evidence of cholecystitis. But on the third day of the first admission, she developed acute abdomen and underwent exploratory laparotomy. Intraoperatively her gallbladder was noted to be inflamed and cholecystectomy was performed. Pathology report of the excised gallbladder was consistent with acalculous cholecystitis. During the index admission, she was hemodynamically stable with normal cardiac and pulmonary examination. Abdomen exam: non-tender, hypoactive bowel sounds, well healed laparotomy wound, no organomegaly. Lab results: hemoglobin - 7.0 gm/dl and hematocrit - 21.6% (baseline hemoglobin and hematocrit was 11.1 gm/dl and 33% respectively). Liver enzymes, amylase, lipase and coagulation studies were normal. Fecal occult blood was positive. Upper endoscopy showed multiple linear, non-bleeding ulcers in the cardia and body of the stomach. In addition, mutliple linear bleeding ulcers were seen in the second and third part of the duodenum. Due to the history of post-prandial abdominal pain and the ulcers noted during upper endoscopy, chronic mesenteric ischemia was suspected. She underwent mesenteric duplex, which showed hemodynamically significant stenosis in the mid superior mesenteric artery with diminished waveforms in the celiac and hepatic arteries, consistent with chronic mesenteric ischemia. Angiogram and stenting were discussed with the patient, but patient decided not to pursue those invasive procedures and eventually died under hospice care. Discussion: Acalculous cholecystitis is a rare manifestation of chronic mesenteric ischemia. We believe that in our case, the acalculous cholecystitis developed as a result of acute on chronic mesenteric ischemia.

Abdominal Arterial Anomalies in Children With Alagille Syndrome: Surgical Aspects and Outcomes of Liver Transplantation.

Angiogenic defects secondary to gene mutations of JAG1 and NOTCH2, causing arterial anomalies in Alagille syndrome (AGS), are well described in the literature. The study analyzes the frequency of abdominal arterial anomalies in children with AGS with an emphasis on outcomes following liver transplantation (LT). Between 1988 and 2013, 242 children with AGS were treated at our institution. We performed a retrospective analysis of 55 who underwent LT during the study period. Preoperative abdominal arterial findings, operative reports, arterial reconstruction technique, and early as well as late complications following LT were reviewed specifically focusing on arterial thrombosis. Twenty-five patients had preoperative imaging available for analysis. Twelve of these patients showed celiac trunk stenosis (48.0%), 2, a superior mesenteric artery stenosis (8.0%) and one a stenosis of both renal arteries. Twenty patients (36.3%) underwent standard hepatic reconstruction using the native recipient hepatic artery. Thirty-five patients (63.7%) underwent aortic conduit reconstruction (ACR) from the infrarenal aorta using donor arterial conduits. Hepatic artery thrombosis occurred in 9 patients (16.3%). This number was higher in the standard arterial anastomosis group 7/20 (35.0%) than in those with ACR 2/35 (5.7%, P = 0.0079). In this series, children with AGS pretransplant have a high prevalence of abdominal arterial anomalies. Preoperative abdominal vascular imaging makes it possible to anticipate whether or not a classical arterial revascularization can be performed or whether an ACR is required.

Concomitant Parallel Endografting and Fenestrated Experience in a Regional Aortic Center

Off-label parallel endografting (PE) has been increasingly criticized in favor of on-label custom fenestrated endografts. There remain limited direct comparisons, however, between concurrent patient populations treated by similarly experienced operators. Hence, we seek to evaluate the relative efficacy of the two techniques in treating complex aortic pathology. All patients treated by PE or with Cook Zenith Fenestrated (Zfen) devices from January 2010 to June 2015 were reviewed, excluding those treated for rupture. Patients were all evaluated for open repair as well as for fenestrated devices since its availability at our center in July 2013. Patients predating fenestrated access or not meeting anatomic indications for use criteria and preferring endovascular therapy were treated with PE. A total of 93 patients were treated during the period reviewed, 54 (58.1%) by PE and 39 (41.9%) with Zfen. The two procedures required similar length of surgery (234min PE vs. 239 min Zfen), blood loss (634cc vs. 409cc), and length of stay (median 6days). PE, however, was associated with less fluoroscopy time (52.8 vs. 64.6min) and contrast volume (103.5cc PE vs. 133cc Zfen). At mean 202days follow-up, Zfen has required three reinterventions (two type III endoleaks and one superior mesenteric artery stenosis causing mesenteric ischemia) and there have been zero branch vessels lost. At mean 427days follow-up, PE patients experienced three stent occlusions (one repaired endovascularly) and required eight additional interventions (two type I endoleaks, two type II endoleaks with sac growth, two type III endoleaks, one graft infection, and one aneurysm rupture). Reintervention rates for PE and Zfen were 17.6% and 7.7%, respectively, with branch patency rates of 98% and 100%. PE and fenestrated repair offer similarly high branch patency and technical success. PE performed for juxtarenal aneurysms has similar reintervention rate to fenestrated repair. The two techniques have similar length of stay, operative time, and blood loss, but fenestrated repair is associated with greater fluoroscopy time and contrast usage.

Does Management of True Aneurysms of Peripancreatic Arteries Require Repair of Associated Celiac Artery Stenosis?

True aneurysms of the gastroduodenal (GDA) and pancreaticoduodenal (PDA) arteries have been attributed to increased collateral flow due to tandem celiac artery stenosis or occlusion. Although GDA and PDA aneurysm exclusion is recommended because of the high reported risk of rupture, it remains uncertain whether simultaneous celiac artery reconstruction is necessary to preserve end-organ flow. We conducted a retrospective analysis of consecutive patients admitted from 1996 to 2015 with true aneurysms of the GDA or PDA. Twenty patients with true aneurysms of the PDA (n= 16) or GDA (n= 4) were identified. Mean age was 61.5 years (range 35 to 85 years) and 11 (55%) were women. Nine (45%) presented with rupture, 8 (40%) presented with pain, and 3 (15%) were asymptomatic. All 9 patients who presented with rupture had contained retroperitoneal hematomas, and none experienced rebleeding. Fifteen (75%) patients had an associated celiac artery >60% stenosis or occlusion, and 2 (10%) had both celiac and superior mesenteric artery stenoses. Thirteen (65%) patients underwent successful endovascular coiling, only 1 of which had a prophylactic celiac artery bypass. Three (15%) patients underwent open aneurysm exclusion and celiac bypass, and 4 (20%) others were observed. There were no aneurysm-related deaths in this series, and none of the patients who underwent coiling without celiac revascularization had hepatic ischemia or other mesenteric morbidity develop during a median follow-up of 6 months (maximum 200 months). Gastroduodenal artery and PDA aneurysms present most commonly with pain or bleeding, and all should be considered for repair, regardless of size. Aneurysm exclusion is safely and effectively achieved with endovascular coiling. Although associated celiac artery stenosis is found in the majority of cases, celiac revascularization might not be necessary.

Duplex ultrasound criteria for in-stent restenosis of mesenteric arteries

ObjectiveDuplex ultrasound (DUS) criteria are well defined for evaluating high-grade stenosis (≥70%) of the native superior mesenteric artery (SMA) and celiac artery (CA). It has been shown that native vessel criteria overestimate the degree of in-stent restenosis (ISR) and that velocity criteria for SMA and CA ISR are not well established. The objective of this study was to define DUS velocity criteria for high-grade ISR of the SMA and CA. MethodsA retrospective review of all patients who underwent SMA or CA stenting from a single institution was performed from 2004 to 2013. Patients were excluded if they did not have a DUS examination <4 months before angiography to assess stent patency or adequate angiographic visualization of the ISR. ResultsThere were 103 paired DUS scans and angiograms analyzed: 66 SMA studies and 37 CA studies. The average peak systolic velocity (PSV) for SMAs was 367 cm/s with <70% ISR and 536 cm/s with ≥70% ISR. The average PSV for CAs was 302 cm/s with <70% ISR and 434 cm/s with ≥70% ISR. For an ISR ≥70% in the SMA, a PSV ≥445 cm/s produced the highest sensitivity (83%) and specificity (83%), with a positive predictive value of 81% and a negative predictive value of 86%. For an ISR ≥70% in the CA, a PSV ≥289 cm/s produced the highest sensitivity (100%) and specificity (57%), with a positive predictive value of 79% and negative predictive value of 100%. ConclusionsIncreasing PSV correlates with an increasing degree of ISR for both the SMA and CA. Stented vessels have increased PSV, and therefore native PSV criteria are unreliable for the determination of ISR. The PSV criteria for ≥70% stenosis are higher for ISR than for native visceral vessel stenosis. The proposed new velocity criteria define ≥70% ISR as ≥445 cm/s in stented SMAs and ≥289 cm/s in stented CAs.

Middle Aortic Syndrome with Mesenteric artery stenosis- successful percutaneous endovascular reconstruction

Chronic mesenteric ischemia (CMI) is a challenging problem especially when both the superior mesenteric artery (SMA) and celiac artery (CA) are involved. We report a case 65-year-old female with hypertension, type II diabetes, and dyslipidemia who presented with exertional angina for 11-months duration and abdominal angina with weight loss for 5-months. Coronary computed tomographic (CT) angiogram revealed critical discrete lesion of mid right coronary artery (RCA). A contrast CT angiogram revealed a high grade, long segment stenosis of supra-renal abdominal aorta which was mildly calcified, mild ostial stenosis of celiac artery, and critical ostial stenosis of superior mesenteric artery (SMA) suggesting middle aortic syndrome with mesenteric artery stenosis. RCA was revascularised by deployment of 3.5x18 mm Xience prime Everolimus eluting stent (Abott Vascular; USA) at 13 atm pressure achieving TIMI III flow through left transbrachial approach. Aorta was stented transfemorally using two overlapping Epic self-expanding stents (Boston scientific, USA) - 12x60 mm proximally and 10x40 mm distally. SMA was stented with 6x18 mm stent (Herculink, Boston, USA) after predilatation achieving complete revascularization.

Superior mesenteric artery outcomes after fenestrated endovascular aortic aneurysm repair

The Zenith (Cook Medical, Bloomington, Ind) fenestrated endovascular graft may be designed with single-wide scallops or large fenestrations to address the superior mesenteric artery (SMA). Misalignment of the SMA with an unstented scallop or a large fenestration is possible. This study assessed SMA outcomes after fenestrated endovascular aortic aneurysm repair (FEVAR). During an 18-month period, 47 FEVARs were performed at a single institution. For analysis, patients were grouped according to unstented (n= 23) vs stented (n= 24) SMA scallops/fenestrations. The Institutional Review Board approved this single-institution observational study. Because this was a retrospective review of the data, patient consent was unnecessary for the study. Technical success for FEVAR was 100%. The median follow-up period was 7.7months (range, 1-16months). Nine of 21 patients (43%) in the unstented group had some degree of misalignment of the SMA (range, 9%-71%). Among these, four patients (44%) developed complications: three SMA stenoses and one occlusion. The mean peak systolic velocity in patients with and without SMA misalignment was 317.8cm/s vs 188.4cm/s (P< .08), respectively. No misalignment occurred in the stented group, and only one of 19 patients (5%) developed an SMA stenosis that required angioplasty. Overall, patients with unstented SMAs had significantly more adverse events directly attributable to SMA misalignment than the stented group (44% vs 5%, respectively; P< .05). Misalignment of the SMA with the use of unstented unreinforced scallops or fenestrations occurs frequently. Routine stenting of single-wide and large fenestrations, when feasible, may be a safer option for patients undergoing FEVAR.

Elective Bypass Surgery Using a Saphenous Vein Graft for Ruptured Riolan Artery Aneurysm with a Stenosis of Superior Mesenteric Artery

Elective Bypass Surgery Using a Saphenous Vein Graft for Ruptured Riolan Artery Aneurysm with a Stenosis of Superior Mesenteric Artery

Celiac artery thrombosis and superior mesenteric artery stenosis

Acute thrombosis of the celiac artery trunk or elsewhere in mesenteric blood supply is a rare cause of acute abdominal pain. Celiac artery thrombosis carries high mortality and morbidity rates if the diagnosis and treatment are delayed. It is frequently associated with other cardiovascular events. The most common etiology is atherosclerosis. The main goal of the treatment is to revascularize and start the diminished or stopped mesenteric blood flow and to avoid end-organ ischemia. Thrombolysis with urokinase followed by anticoagulation with heparin in an emergency situation can save the life of the patient before surgical intervention.

上腸間膜動脈狭窄にステント留置を先行し切除した十二指腸乳頭部癌の1例

上腸間膜動脈狭窄にステント留置を先行し切除した十二指腸乳頭部癌の1例

Unruptured Giant Aneurysm of The Inferior Pancreaticoduodenal Artery with Superior Mesenteric Artery Stenosis Obstructed by Spontaneous Thrombosis After Superior Mesenteric Artery Angioplasty: A Case Report

Unruptured Giant Aneurysm of The Inferior Pancreaticoduodenal Artery with Superior Mesenteric Artery Stenosis Obstructed by Spontaneous Thrombosis After Superior Mesenteric Artery Angioplasty: A Case Report

Mesenteric Artery Stenosis Presenting as Severe Erosive Gastroduodenitis: A Rare Case Report With Long Term Follow-Up

Superior Mesenteric artery ischemia is a rare condition with serious clinical consequences. It may be caused by either mechanical or non mechanical obstruction of the artery. These patients usually present with recurrent abdominal pain usually occurring after meals. We report a 45 yr old male, who presented with pain abdomen and epigastric burning sensation which increases with food consumption from the past 6 months. Patient was evaluated and was found to have severe erosive Gastroduodenitis which was secondary to superior mesenteric artery stenosis diagnosed on CT Abdomen. Patient underwent successful Superior Mesenteric Artery (SMA) stenting. Repeat upper gastrointestinal endoscopy during follow up after 1 year showed complete resolution of the duodenal mucosa and was asymptomatic. Key words: Superior mesenteric artery stenosis, Duodenal ischemia, Pain abdomen, Stenting.

Revascularization of the superior mesenteric artery alone for treatment of chronic mesenteric ischemia

Symptomatic patients with chronic mesenteric ischemia (CMI) should be treated without much delay because symptoms of CMI are present in 43% patients who present with acute mesenteric ischemia. There are few reported series with large numbers of patients undergoing surgery for CMI, and many controversies persist regarding the optimal surgical treatment. These controversies include the type of surgical repair (antegrade vs. retrograde bypass), and the number of arteries that should be treated (single- vs. multiple-vessel reconstruction). It was the aim of presented study to report our experience and long-term results with single-vessel bypass grafting from infrarenal aorta to superior mesenteric artery. Patients who were admitted because of mesenteric ischemia at the surgical clinics of University Clinical Center Maribor between January 1999 and January 2009 were identified with a computerized medical data registry. Patients who underwent revascularization for CMI with retrograde synthetic aortomesenteric bypass were included in the study. Demographics, clinical characteristics, imaging, and operative data were obtained from the medical records. Significant superior mesenteric artery stenosis (> 70% diameter stenosis) was confirmed by spiral computed angiography. All patients underwent retrograde aortomesenteric arterial bypass with synthetic bypass graft originating from the infrarenal aorta. Doppler sonography combined with color Doppler was used to evaluate disease progression in patients at 3-month interval during the first year and from then at 6-month intervals. Endpoints of the study were occlusion of graft or death by any cause. Data are presented for a cohort of 19 women and 8 men with a mean age at admission 73 years (range 56-88 years). The mean duration of follow-up was 71 months (range 1-118 months). There was one early death (4%). Four patients died during the follow-up period, and three were lost for follow-up. None of the deaths was connected with mesenteric ischemia. During follow-up period none of the patients developed restenosis, and no occlusions were observed. There were no reinterventions. Symptom improvements were noted in 25 patients (93%). One patient (4%) referred to persistent pain despite successful revascularization, although during follow-up period weight gain was observed. At 71 months, freedom from recurrent symptoms, restenosis, and reinterventions was 78% ± 13.9%. Surgery for CMI can be safely performed with retrograde approach and single vessel anastomosis. Mortality rates and long-term survival compare favorably with other surgical approaches to treatment of CMI.