Superior Mesenteric Artery Diameter Research Articles

Mesenteric sparing approach for advanced nodal extent in small intestinal neuroendocrine tumors. Is there a limit to the vascular resection in order to avoid creating a short small bowel syndrome? An anatomic research study.

By selectively perfusing the first three jejunal arteries (JA), we aim to assess the individual perfusion length of small bowel (SB) and its impact on nodal resection in stage III-up small-intestinal neuroendocrine tumors (SI-NET). Our anatomical research protocol implies a midline laparotomy and three measures of the SB length. We then perform a classical anterior approach of the superior mesenteric vessels. We carry on with the complete dissection and checking of the superior mesenteric artery (SMA) in order to identify the first three JA. Then we selectively perfuse each artery with colored latex solutions and measure the length of small bowel perfused respectively. We conducted our protocol on six cadaveric subjects. Mean(SD) SB length was 413(5.7), 535(13.2), 485(15), 353(25.1), 730(17.3) and 525(16° cm respectively from subject one to six. Most JA originated from the left side of the SMA. The first JA originated from its posterior wall in two subjects. Mean(SD) distance of origin of the first three JA was 4.6(1.3)cm, 6(1.1)cm and 7.1(0.9)cm respectively. Mean(SD) diameter of SMA was 10.8(3.3)mm. Mean diameter of the three first JA was 4(1.4)mm, 4(1.5)mm and 5(1.2)mm respectively. Mean(SD) SB length perfused by first and second JA was 224(14.9)cm, 175(8.6)cm, 238.3(7.6)cm, 84.3(5.1)cm, 233.3(5.8)cm and 218.3(10.4)cm respectively from subject one to six. We observed a trend suggesting that the first and second JA may sustain a SB length beyond the viable 1.5m limit, implying the feasibility of stage III-up SI-NET resection with just two JA.

Clinical characteristics and misdiagnosis of spontaneous isolated superior mesenteric artery dissection

BackgroundSpontaneous isolated superior mesenteric artery (SMA) dissection (SISMAD) is a rare disease with a potentially fatal pathology. Due to the lack of specificity of clinical characteristics and laboratory tests, misdiagnosis and missed diagnosis are often reported. Therefore, the aim of this study was to investigate the clinical characteristics and misdiagnosis of SISMAD.MethodsIn a registry study from January 2013 to December 2020, 110 patients with SISMAD admitted to the First Affiliated Hospital of Wenzhou Medical University were enrolled. Descriptive methods were used to analyse clinical characteristics, laboratory data, diagnostic method or proof, misdiagnosed cases, plain computed tomography (CT) findings and dissection features. To study the relationship between dissection features and treatment modality, the selected patients were classified into the conservative group (n = 71) and the non-conservative group (n = 39). The Chi-square test and Student’s t-test were used to compare the conservative and non-conservative groups.ResultsOne hundred ten patients with SISMAD, including 100 (90.9%) males and 10 (9.1%) females, with a mean age of 52.4 ± 7.6 years, were enrolled in the study. Relevant associated comorbidities included a history of hypertension in 43 cases (39.1%), smoking in 46 cases (41.8%), and alcohol consumption in 34 cases (30.9%). One hundred four patients (94.5%) presented with abdominal pain. Abnormalities in the C-reactive protein lever, white blood cells count and D-dimer lever were the 3 most common abnormal findings. There were 32 misdiagnosis or missed diagnosis. Fourteen cases were misdiagnosed because of insufficient awareness. Twelve cases were misdiagnosed because of disease features. Twenty cases were misdiagnosed as SMA embolism. Among them, There were 15 cases of Yun type IIb SISMAD. Sixty-six patients underwent plain CT. The maximum SMA diameter was 12.1 (11.3–13.1) mm, and the maximum SMA diameter was located on the left renal vein (LRV) plane in 68.2% of cases. Dissection features observed on contrast-enhanced CT (CECT), CT angiography (CTA), or digital subtraction angiography (DSA) showed that there were 70 cases (63.6%) of Yun type IIb SISMAD, the maximum SMA diameter was 13.0 ± 2.4 mm, the location of the maximum SMA diameter was on the LRV plane in 64.5% of cases, and 7.3% of cases were complicated with intestinal obstruction, including bowel necrosis in 3.6% of cases. There were differences between the conservative group and non-conservative groups in the residual true lumen diameter or degree of true lumen stenosis and the presence of intestinal obstruction or bowel necrosis (all P < 0.05).ConclusionFor SISMAD, misdiagnosis and missed diagnosis were usually caused by insufficient awareness and disease features. SISMAD should be considered in the differential diagnosis of patients presenting with unexplained abdominal pain, especially males, patients in the 5th decade of life, patients with hypertension, and patients with an enlarged SMA diameter or a maximum SMA diameter located on the LRV plane on plain CT. Mesenteric CTA or CECT should be recommended for the investigation of these conditions.

The ratio of superior mesenteric artery diameter to superior mesenteric vein diameter based on non-enhanced computed tomography in the early diagnosis of spontaneous isolated superior mesenteric artery dissection.

Spontaneous isolated superior mesenteric artery (SMA) dissection (SISMAD) is a rare cause of abdominal pain. The aim of the study is to investigate the role of a new parameter, the ratio of the SMA diameter to the superior mesenteric vein (SMV) diameter (SMA/SMV) based on non-enhanced computed tomography (CT), in the early diagnosis of SISMAD. In a registry study from December 2013 to June 2021, 97 abdominal pain SISMAD patients (SISMAD group) admitted to our hospital were enrolled. Meanwhile, the matched sex and age abdominal pain non-SISMAD patients at 1:2 were collected in reverse chronological order as the control group. Student's t-test, Wilcoxon rank-sum test, and Chi-square test were used to compare differences between the SISMAD and control groups. MedCalc was used to generate receiver operating characteristic (ROC) curve. A total of 291 abdominal pain patients, including 97 SISMAD patients and 194 non-SISMAD patients, were included in the current study. The maximum SMA diameter, perivascular exudation, and SMA/SMV based on non-enhanced CT were significant between the two groups (all P<0.05). ROC curves showed that for the maximum SMA diameter, the area under the curve (AUC), cut-off, sensitivity, and specificity were 0.926, 9.80, 93.8%, and 79.4%, respectively. For SMA/SMV, its AUC, cut-off, sensitivity, and specificity were 0.956, 0.83, 88.7%, and 92.3%, respectively. The diagnostic efficiency of SMA/SMV was better than that of the maximum SMA diameter (P<0.05). The combined parameters of SMA/SMV and maximum SMA diameter had the best diagnostic efficiency (AUC=0.970). SMA/SMV may be a potential marker for SISMAD.

Variations in the Ventral Branches of Abdominal Aorta by Computed Tomography: A Cross-sectional Study

Introduction: Computed Tomography is an advanced imaging technique of radiography which gives good information regarding vascular anatomy. Abdominal aorta and its branches show variations in their origin. This study may facilitate the clinicians and surgeons for planning treatment and thus post-treatment complications may be reduced. Aim: To find out the variations in the origin of ventral branches of abdominal aorta in relation to vertebrae and diameters of these arteries at their level of origin. Materials and Methods: A descriptive cross-sectional study was done on Contrast Enhanced Computed Tomography scan films of abdomen of 300 patients. The duration of study was of two years from September 2020 to January 2022. To determine the level of origin of ventral branches of abdominal aorta, every branch was divided into four types (Type I to IV) depending on the level of origin in relation to intervertebral disc, upper 1/3rd, middle 1/3rd and lower 1/3rd of body of corresponding vertebra. Diameter of each branch was measured at its level of origin. Results: Statistical analysis of data had shown that the most common origin of Celiac Trunk (CT) was at the level of T12 vertebra (44.33%), for Superior Mesenteric Artery (SMA), the most common origin was at the level of L1 vertebra (64%) and for Inferior Mesenteric Artery (IMA), the most common origin was at the level of L3 vertebra (68.67%). Mean diameter of CT, SMA and IMA was 5.91±0.48 mm, 5.86±0.40 and 3.13±0.44 respectively. Variations in the level of origin have significant correlation to vertebra (Pearson correlation coefficient=0.01). Conclusion: The CT, SMA and IMA have shown variations in their level of origin and significant inter-correlation with each other in relation to corresponding vertebra. This knowledge can be helpful to the clinicians and surgeons while planning treatment of abdominal organs.

Measurement of Superior Mesenteric Artery using Computed Tomography Angiography

A number of diseases are accompanied by the altered size of various abdominal vassals, including aneurysms, atherosclerosis, and infection conditions. Computed tomography (CT) has played an important role in helping physicians and surgeons for taking normal anatomical measurements and establishing a diagnosis. The present study attempts to measure the normal superior mesenteric artery (SMA) for the healthy Sudanese population using computed tomography angiography. A total of 113 CT abdominal angiography cases were retrospectively investigated in spinning from February 2020 to May 2021. Both 32-slice CT units (Siemens Medical Systems) were used to examine patients at two hospitals in Khartoum, Sudan. All measurements were calculated manually using the standard clinical method. The study shows that SMA length and diameter were 101.1±24.6 mm and 5.274±1.5 mm, retrospectively. The distance between the celiac trunk and SMA was 4.6±1.4 mm. Furthermore, the angle between the abdominal aorta and SMA was 66.1±29.5 mm. In conclusion, this study had established baseline measurements for SMA for the healthy Sudanese population. Furthermore, it found that CTA of abdomin is the best for investigation of the SMA and can provide a guide for the clinicians to manage SMA abnormalities.

Clinical Significance of Celiac Trunk and Superior Mesenteric Artery Diameter Following Computed Tomography

Clinical Significance of Celiac Trunk and Superior Mesenteric Artery Diameter Following Computed Tomography

Sonographic criteria for the evaluation of dietary compliance of children with celiac disease

Aim: Although the only known way to avoid complications like iron deficiency anemia, short stature in celiac disease is a strict gluten-free diet, it is a known fact that not all patients follow the diet. Diet compliance is practically evaluated with serum antibodies, such as tissue transglutaminase antibody. The aim of this study was to evaluate the contribution of less invasive ultrasound and Doppler ultrasound in evaluating dietary compliance in celiac patients.Materials and Methods: Twenty-five male and 47 female cases aged five to 17 years were included in the study. Seventy-two patients diagnosed with celiac disease and followed up were divided into two groups according to dietary compliance based on the results of tissue transglutaminase IgA antibody. Pericardial fluid, hepatosteatosis, mesenteric lymphadenopathy, intraabdominal free fluid, small intestine diameter, small intestine wall thickness and gallbladder volume, superior mesenteric artery (SMA) diameter, portal vein diameter, SMA peak systolic velocity, and portal vein velocity were measured on ultrasound. The differences between the groups were statistically compared.Results: The frequency of mesenteric lymphadenopathy, superior mesenteric artery diameter, SMA peak systolic velocity, and portal vein velocity were increased in children who did not follow the recommended diet. There was no significant difference between the groups in terms of hyperperistalsis, gallbladder volume, and portal vein diameter. Pericardial fluid, fatty liver, small intestine dilatation, and increased intestinal wall thickness were not detected in either group.Conclusion: Ultrasound can play an important role in the follow up of children with celiac disease. It can provide clinicians with an insight into the dietary compliance of these cases.

Clinical Significance of Celiac Trunk and Superior Mesenteric Artery Diameter Following Computed Tomography

Introduction: The celiac trunk and superior mesenteric arteries are the first and second anterior branches of the abdominal aorta. Knowledge of the anatomy and dimensions of these vessels is mandatory for interventional radiologists and vascular surgeons. There are a number of anatomical variations of the celiac trunk. Aim: To evaluate whether there is an alteration in the dimension of the celiac trunk and the distance between celiac trunk and Superior Mesenteric Artery (SMA) in the presence of anatomical variants. Materials and Methods: This cross-sectional study was conducted on 150 patients who were referred to the Radiology Department for Contrast Enhanced Computed Tomography (CECT) of the abdomen between September 2019 to February 2020. The diameter of the celiac trunk, SMA and the distance between celiac trunk and SMA were measured. Those who had previous history of any abdominal surgeries or mass lesions were excluded from the study. Results: Celiac trunk variants were observed in 39 patients in our study. The mean diameter was 6.57±1.35 mm in those with normal celiac axis anatomy as compared to a mean of 6.82±1.53 mm in patients with variants (p=0.33). The mean diameter of the SMA was 14.28±7.07 mm in females whereas in males it was 11.88±5.21 mm. The distance between the celiac trunk and SMA was 21.92±7.96 mm in those with normal celiac trunk anatomy and 22.29±5.95 mm in those with a variant anatomy (p=0.79). Conclusion: There is no difference in the dimension of the celiac trunk and distance between celiac trunk and SMA in the presence of anatomical variants. This is important for planning interventional procedures involving cannulation, stenting and anastomosis of the vessel.

Clinical implications of perivascular fat stranding surrounding spontaneous isolated superior mesenteric artery dissection on computed tomography.

Patients with spontaneous isolated superior mesenteric artery (SMA) dissection (SISMAD) usually present with acute or chronic abdominal pain and are admitted to the emergency or digestive diseases department to undergo auxiliary examinations, typically abdominal plain CT or contrast-enhanced CT (CECT). Plain CT is the most crucial examination in emergency radiology. An enlarged SMA diameter and perivascular fat stranding (PFS) on plain CT, though non-specific, may be the only indications for SISMAD. These results may be easily overlooked and the diagnosis of SISMAD may be missed. However, PFS around the SMA on CT may be the only indicator of the possible presence of SISMAD, particularly during the early stage when there are no massive changes in the vascular wall. The present study aimed to determine whether PFS surrounding the SMA on CT may help with the diagnosis of SISMAD by indicating the requirement for further examination. The data of 161 consecutive patients with SMA dissection who underwent abdominal CECT or underwent SMA CT angiography (CTA) after abdominal plain CT between February 2015 and February 2018 were retrospectively reviewed. SMA diameter, classification, PFS, complications, comorbidities and treatments were analyzed. The results demonstrated that SISMAD with PFS was significantly associated with admission type (emergency), clinical manifestations (abdominal pain), diagnostic modality and dissection subtype. On plain CT, PFS surrounding the SMA may be a marker for SISMAD, particularly in the emergency setting, and indicates the requirement for CTA examination.

Superior Mesenteric and Inferior Mesenteric Artery Diameters in Colorectal Cancer.

To compare the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) diameters in colorectal cancer compared to control. Observational study. Taizhou Hospital, Zhejiang University, Taizhou, China, from March 2019 to June 2020. A total of 203 diagnosed colorectal cancer patients and 40 patients as control subjects were reviewed. Patients were divided into three groups based on tumor location as the right colon, left colon, and rectal groups. The diameters were measured on axial computed tomography images independently by two observers. The SMA diameter did not differ between the right colon and control groups (p=0.626). The IMA diameter was significantly higher in the left colon group than in the control group (p=0.002), but there was no significant difference in the IMA diameter between the different tumour stages (p=0.263). The IMA diameter was significantly higher in the rectal group than in the control group (p<0.001). There was a significant increase in the IMA diameter from stage I to stage II rectal cancers (p=0.022) and from stage II to stage III rectal cancers (p=0.003). The IMA diameter did not differ between stage III and IV rectal cancers (p=0.600). In locoregional rectal cancer patients, there was a significant correlation between the IMA diameter and tumour-node-metastasis stage (p<0.001, rs = 0.494). Patients with rectal cancer and left colon cancer have a wider IMA diameter than patients without colorectal cancer. IMA diameter can be a potential marker for locoregional staging of rectal cancer. Key Words: Superior mesenteric artery, Inferior mesenteric artery, Colorectal cancer, Markers, Diameter.

Serial Doppler velocimetry of mesenteric and portal flow in very-low-birth-weight preterm neonates with and without patent ductus arteriosus.

Very-low-birth-weight (VLBW) preterm neonates are vulnerable to patent ductus arteriosus (PDA), which might be related to high-resistance flow in the superior mesenteric artery (SMA), with decreased diastolic flow in situations of marked intestinal hypoperfusion. No previous studies have evaluated the portal vein and superior mesenteric vein (SMV) parameters to assess the PDA hemodynamic repercussions. To assess mesenteric and portal flow in VLBW preterm neonates with or without PDA using serial Doppler ultrasonography (US). We conducted a prospective longitudinal study on 61 VLBW preterm neonates submitted to 161 Doppler US exams, from 2days to 20days of age. All infants exhibited a progressive daily increase in the mean of the SMA diameter and systolic velocity, the portal vein diameter, the peak velocity, the mean velocity and the flow volume and of SMV diameter (P<0.05). The incidence of PDA was 37.7% (n=23) and infants with the disease revealed a smaller diameter, greater systolic velocity, lower diastolic velocity, and higher resistivity and pulsatility indices on SMA compared to those without PDA (P<0.05). Additionally, 47.8% (n=11) of infants with PDA exhibited absent or reversed end-diastolic flow in the SMA, and its resolution was seen among 54.5% (n=6) of these. Infants with PDA also exhibited lower values of portal vein diameter and flow volume and of SMV diameter (P<0.01). Doppler US enhances the understanding of mesenteric and portal flow, including the effects of PDA. The study of SMV and portal vein flow is proposed as a new parameter in PDA evaluation.

Non-occlusive mesenteric ischaemia: CT findings, clinical outcomes and assessment of the diameter of the superior mesenteric artery.

Review of the experience of a tertiary care centre for almost 10 years in the CT diagnosis of non-occlusive mesenteric ischaemia (NOMI). Analysis of CT findings, correlation with clinical outcomes and evaluation of the usefulness of measuring the superior mesenteric artery (SMA) diameter for the diagnosis of NOMI. 106 patients were diagnosed with NOMI in a biphasic CT examination from 2008 to 2017 in our hospital. Clinical outcomes and CT findings were reviewed. In 55 patients, the diameter of the SMA was compared with a previous CT scan where NOMI was not the diagnosis, and statistical analysis using paired t-test was performed. 81 patients (76%) had findings consistent with small bowel ischaemia and the ileum was the segment most commonly involved (47%). Lack of wall enhancement, pneumoperitoneum, pneumatosis intestinalis and portal venous gas were all considered signs of bowel necrosis and surgery was performed promptly. 70 patients had signs of vascular narrowing of the SMA branches and in the 55 cases with a previous CT scan, there were statistically significant differences regarding the SMA diameter with a mean reduction of the artery calibre and standard deviation of 1.93 ± 1.1 mm between the NOMI and non-NOMI scans (p < 0.001). Acknowledgment of characteristic bowel necrosis CT findings is crucial for determining the therapeutic attitude and the use of previous CT scans to compare the SMA diameter may help the radiologist to achieve an early diagnosis of NOMI in an often critically ill patient population. Advances in knowledge: Diagnosis of NOMI can be difficult in cases of partial mural ischaemia, thus objective data (diameter of the SMA) should be useful for the radiologist to include NOMI as the first diagnostic option in the differential diagnosis.

Early Detection of Superior Mesenteric Artery Dissection by Ultrasound: Two Case Reports

Superior mesenteric artery (SMA) dissection is a rare disease. Some of the cases are isolated type, the others are associated with aortic dissection. Most of the cases are diagnosed by contrast-enhanced computed tomography (CECT). The use of emergent bedside ultrasound has been described to diagnose aortic dissection. However, there is limited literature regarding the use of bedside ultrasound to identify superior mesenteric artery dissection, a known high-risk feature of aortic dissection. We present one case of isolated SMA dissection and one case of SMA dissection complicated with aortic dissection. Both of them were diagnosed by bedside ultrasound first and confirmed by CECT Case report and literature review. Case one: A 46-year-old male patient without past history of hypertension. He suffered from intermittent epigastralgia for 3 days. Laboratory data, ECG, KUB showed no specific finding. Bedside ultrasound found faint intimal flap in SMA. The diameter of SMA was 15.4mm. Color duplex revealed thrombosis or false lumen in SMA. Cardiovascular specialist was informed and SMA dissection was proved by CECT. Patient’s symptom improved after anticoagulant usage. Case two: A 46-year-old male patient with past history of hypertension and old ischemic stroke. He had sudden onset of consciousness change and recurrent stroke was impressed initially. However, due to relative low systolic blood pressure (97mmHg), we performed bedside ultrasound to the patient and found intimal flap in abdominal aorta and SMA. The diameter of SMA was 10.5mm. Cardiovascular specialist was consulted immediately. Patient’s consciousness recovery to clear after endografting surgery. These two cases illustrate that bedside ultrasound can be used to early detect SMA dissection. The normal diameter of SMA was reported as 5.7-7.3mm. The aneurysm is considered more than 1.5 times of normal diameter. Intimal flap of SMA dissection may not be easily seen in ultrasound due to poor image quality. However, the diameter of SMA > 10 mm should warrant clinician the high suspicion of SMA dissection and further image study or specialist consultation should be considered.

Reperfusion in non-occlusive mesenteric ischaemia (NOMI): effectiveness of CT in an emergency setting.

To investigate the CT features of reperfusion (presence/absence) in non-occlusive mesenteric ischaemia (NOMI) and their prognostic value in an emergency setting. A revision was undertaken of imaging from 20 patients (16 males/4 females) with a dismissal summary of NOMI. All patients had previously undergone a minimum of one multidetector CT examination, and consequently underwent surgery (n = 8), autopsy (n = 2), angiography (n = 1) or endoscopy (n = 9). An evaluation of the CT scans was conducted to determine vessels, mesentery, bowel and peritoneal cavity features. The superior mesenteric artery (SMA) average diameter of NOMI cases were compared with 30 controlled cases. Kappa, Kolmogorov-Smirnov (K-S) and Fisher's exact tests were used for statistical analysis. A mean SMA diameter significantly smaller than that of the controlled cases was found for patients with NOMI (K-S test: D = 0.75, p = 3.7 × 10-08). Fisher's exact tests showed a strong connection between the presence of reperfusion and mesenteric fat stranding (p = 0.026), bowel wall thickening (p = 3.2 × 10-05) and a high attenuation of the bowel wall on unenhanced CT images (p = 2.8 × 10-04). A reduction in mortality was significantly linked to the combination of normal mesenteric vessels and wall thickening (p = 0.034). Analysis of not only vessels findings but also mesentery and bowel CT features will support the identification of NOMI with or without a reperfusion event in an emergency setting. A strong correlation between some CT features and lower mortality exists. CT features of NOMI with or without reperfusion are demonstrated. Correctly assessing the presence of reperfusion in NOMI, may allow better management of these conditions in the emergency setting.

Feasibility of measuring superior mesenteric artery blood flow during cardiac surgery under hypothermic cardiopulmonary bypass using transesophageal echocardiography: An observational study.

Background:Abdominal complications being rare but results in high mortality, commonly due to splanchnic organ hypoperfusion during the perioperative period of cardiac surgery. There are no feasible methods to monitor intraoperative superior mesenteric artery blood flow (SMABF). Hence, the aim of this study was to evaluate the feasibility and to measure SMABF using transesophageal echocardiography (TEE) during cardiac surgery under hypothermic cardiopulmonary bypass (CPB).Methodology:Thirty-five patients undergoing elective cardiac surgery under CPB were enrolled. Heart rate, mean arterial pressure (MAP), cardiac output (CO), SMABF, superior mesenteric artery (SMA) diameter, superior mesentric artery blood flow over cardiac output (SMA/CO) ratio and arterial blood lactates were recorded at three time intervals. T0: before sternotomy, T1: 30 min after initiation of CPB and T2: after sternal closure.Results:SMA was demonstrated in 32 patients. SMABF, SMA diameter, SMA/CO, MAP and CO decreased significantly (P < 0.0001) between T0 and T1, increased significantly (P ≤ 0.001) between T0 and T2. Lactates increased progressively from T0 to T2.Conclusion:Study shows that there is decrease in SMABF during CPB and returns to baseline after CPB. Hence, it is feasible to measure SMABF using TEE in patients undergoing cardiac surgery under hypothermic CPB. TEE can be a promising tool in detecting and preventing splanchnic hypoperfusion during perioperative period.

Management strategy of isolated spontaneous dissection of the superior mesenteric artery.

Isolated spontaneous dissection of the superior mesenteric artery (SMA) is very rare among of the visceral artery dissection and its treatment is not established. In this paper we present our experiences and consider the treatment of isolated SMA dissection. A retrospective review of our cases from 2005 was performed. Clinical symptoms, radiologic findings and results were evaluated. There were 14 cases of visceral artery dissection, in which all cases were with SMA dissection. There were 12 males and 2 females with a mean age of 57 years (range 41-78 years). We categorized SMA dissection into the six types according to the Sakamoto's and Zerbib's classification. One patient with type VI underwent emergent endovascular surgery with stent. One patient with type VI received thrombectomy and intimectomy with open surgery. One patient with type II underwent aneurysmectomy due to enlarged dissected SMA 3 months later from onset. The other eleven patients were managed conservatively. At follow-up, the diameter of SMA did not enlarged and the length of the dissection significantly decreased to 20.7 ± 15.7 mm from 38.0 ± 15.1 mm at onset (p <0.01). After treatment, imaging indicated the following changes in classification: type I, one patient; type II, 4 patients; type IV, 4 patients; complete remodeling, one patient, all without any event during the follow-up period of 5-82 months. Most patients with isolated visceral artery dissection occurred in superior mesenteric artery and can be treated conservatively; however, endovascular or surgical procedures including laparotomy are indicated when there is suspicion of severe mesenteric ischemia. Because the dissection configuration will change, long term follow-up is necessary. (English translation of Jpn J Vasc Surg 2013; 22: 695-701).

Effects of Lactose‐Containing vs Lactose‐Free Infant Formula on Postprandial Superior Mesenteric Artery Flow in Term Infants

Dietary dextrose and fructose may promote vascular inflammation and endothelial dysfunction. In certain infant populations, altered postprandial mesenteric hyperemia (PPH) may increase risk for feeding intolerance. To compare superior mesenteric artery (SMA) PPH following feeds of lactose-containing (LC) formula vs lactose-free (LF; dextrose + sucrose) formula. In a 2 × 2 crossover study with 6 term newborns, 3 received LC first followed by LF 3 hours later. The remaining 3 received the reverse order. Ultrasound measures of pre- and postprandial SMA flow, diameter, and resistance were taken 5 minutes preprandial and 10, 30, and 40 minutes postprandial. Mean ± SD age and weight (n = 6) were 24.1 ± 2.3 hours and 3.1 ± 0.21 kg. Formula intake was similar for LC and LF (22.5 ± 2.8 mL and 25 ± 1.8 mL, respectively; P = .076). Both formulas increased SMA flow at 10 and 30 minutes. However, postprandial flow was greater for LC overall (P = .004) and especially at 30 minutes (LC 103 ml/min, 52% increase vs LF 92.7 ml/min, 31% increase; P = .014). For both formulas, vasodilation was seen at 10 and 30 minutes and was overall significantly greater following LC than following LF (9.1% VS 6.5%; P = .028). Both formulas elicited significant decreases in sma vascular resistance over the 10- to 30-minute period (overall P = .016). However, decreases did not differ across formulas (P = .672). The LC formula elicited a greater SMA PPH response than did LF. SMA flow for both formulas was within normal limits; thus, differences are likely inconsequential for a term newborn. However, in a vulnerable preterm infant, differences may become significant.

Usefulness of multidetector-row CT (MDCT) for the diagnosis of non-occlusive mesenteric ischemia (NOMI): Assessment of morphology and diameter of the superior mesenteric artery (SMA) on multi-planar reconstructed (MPR) images

Objective The purpose of this study was to assess the efficacy of multidetector-row CT (MDCT) for the diagnosis of non-occlusive mesenteric ischemia (NOMI) by analyzing morphology and diameter of superior mesenteric artery (SMA). We assessed whether MDCT was as useful as angiography for the diagnosis of NOMI. Materials and methods Four patients who were diagnosed with NOMI were retrospectively analyzed. All patients had 8-row MDCT followed by laparotomy. Two of them underwent angiography after MDCT. The morphology and diameter of SMA of these cases was analyzed on multi-planar reconstructed (MPR) images. The mean diameter of SMA of NOMI cases was compared to that of 13 control cases. Results MPR images of all NOMI cases showed irregular narrowing of the SMA, spasm of the arcades of SMA, and poor demonstration of intramural vessels. MPR images of two patients who had angiography were concordant with their angiograms. The mean diameter of SMA of NOMI patients was 3.4 ± 1.1 mm, which was statistically smaller than that of 13 control patients, 6.0 ± 1.5 mm ( P < 0.05, Wilcoxon rank sum tests). Conclusion Angiography has been recognized essential for the diagnosis of NOMI. This study shows the possibility of MDCT to be an equivalently useful modality compared to angiography for the diagnosis of NOMI by interpreting morphologic appearance and diameter of SMA. Introduction of MDCT in the decision tree of NOMI treatment may bring the benefit of prompt diagnosis and subsequent early and efficient initiation of therapy, which may improve the mortality.

Doppler Waveform Characteristics in the Celiac and Superior Mesenteric Arteries in Normal Children and Adults with the Use of Duplex Ultrasound

Purpose To compare and contrast the flow patterns in celiac artery (CA) and superior mesenteric artery (SMA) in normal children to those in normal adults with the use of duplex ultrasound techniques. Methods Thirty male subjects were entered prospectively to the study. Peak systolic velocities and diameter at the origin of CA and SMA were recorded while the subject was fasting for at least 4–6 hr. The Human Ethics Committee at the Faculty of Allied Health Sciences-Kuwait University approved the study. Informed consent form was obtained from all subjects. Results There were 15 healthy male adults. Their average age (yr ± SD) was 22.7 ± 4.7 and their average body mass index (kg/m2 ± SD) was 23.5 ± 2.1. There were 15 healthy male children. Their average age (yr ± SD) was 7.2 ± 2.92, and their average body mass index (kg/m2 ± SD) was 18.5 ± 4.8. The average diameters (cm ± SD) of CA and SMA in adults were 0.73 ± 0.8 and 0.76 ± 0.11, and the average peak systolic velocities (cm/s ± SD) were 113 ± 17.5 and 145 ± 25.8, respectively. However, the average diameter (cm ± SD) of CA and SMA in children was 0.52 ± 0.06 and 0.53 ± 0.06, and the average peak systolic velocities (±SD, cm/s) of CA and SMA were 179.5 ± 39.5 and 175 ± 31.7. respectively. Paired student's t-test showed no statistical significance between the two groups. Coefficient of variation for diameter calculation and velocity measurement was &lt;10%. Conclusion The peak systolic velocities in normal children at the superior mesenteric artery and celiac artery are slightly greater than in normal adults but it did not exceed 200 cm/sec in CA and 275 cm/sec in SMA. The Doppler waveforms are still within normal range in both groups despite the caliber of the vessels being smaller in children. Most probably greater velocities in children are caused by the high pressure of the transducer in superficially located vessel inducing flow disturbances.

Superficial femoral artery transposition repair for isolated superior mesenteric artery dissection

Isolated dissection of the superior mesenteric artery is an uncommon event, but many new cases have been reported recently, reflecting the progress of imaging and suggesting that this pathology is not as rare as previously thought. Here we report a case of superior mesenteric artery dissection where we performed, after failure of conservative medical management, an original surgical technique for mesenteric revascularization using a superficial femoral artery transposition. To the best of our knowledge, this is the first report of the use of this technique for complex mesenteric revascularization.