Mesenteric artery stenosis

Successful Recanalization of the Superior Mesenteric Artery in Acute Mesenteric Ischemia

   The article describes a clinical case of recanalization of the superior mesenteric artery during acute mesenteric ischemia in an 81-year-old patient who was admitted to the emergency hospital in Ryazan with a clinic for “acute” abdomen. As a result of a diagnostic study, collection of anamnestic data and clinical picture, a diagnosis was made: “Embolism of mesenteric vessels.” Taking into account the early diagnosis (less than 4 hours from the onset of the disease), as well as the extremely complicated somatic status, selective angiography with mesentericography was performed, which revealed the patency of the main trunk of the superior mesenteric artery and complete occlusion of the distal segment of the intestine. Revascularization was performed ischemic area of the superior mesenteric artery. In the postoperative period, positive dynamics was observed, with complete relief of the clinical manifestations of mesenteric ischemia. On the 12th day, the patient was discharged for outpatient treatment under the supervision of a surgeon at her place of residence in satisfactory condition.

Superior Mesenteric Artery Stenosis Presenting as Chest Pain: Danger in Disguise

Chronic mesenteric ischemia (CMI), often known as abdominal angina, is a syndrome caused by a severe reduction in arterial flow to the digestive loops. It is an uncommon and underdiagnosed entity with potential severe adversities, such as acute mesenteric ischemia (AMI). Patients with coronary artery disease (CAD) are shown to also have mesenteric artery stenosis (MAS). By identifying risk variables, it may be possible to screen for mesenteric artery involvement in patients with CAD who exhibit an elevated risk. Here, we present a unique case of a person with severe retrosternal chest pain with postprandial angina, which turned out to be superior mesenteric artery (SMA) ostial stenosis.

Collateral circulation develops in stenosis of the celiac trunk and superior mesenteric artery

PURPOSE

Mesenteric circulation is provided by the celiac trunk (CT), superior mesenteric artery (SMA), and inferior mesenteric artery (IMA). The collateral circulation between CT and SMA and between SMA and IMA plays a protective role against intestinal ischemia in case of narrowing or occlusion of the mesenteric vessels. In our study, it is aimed to determine the CT and SMA stenosis rates in patients with CT and SMA stenosis from angiography images, the occurrence of the collateral variations, and the frequency of these variations.

METHODS

A total of 408 non-selective or selective CT and SMA angiographic images were taken of 215 patients (130 males, 85 females) who were admitted to Akdeniz University Hospital with symptoms of chronic mesenteric ischemia (CMI) were included. The angiography images were analyzed in regards to CT and SMA stenosis rates, and the collateral variations between mesenteric vessels.

RESULTS

Stenosis of CT was observed in 14 patients, whereas the stenosis of the SMA was observed in 12 patients. The most common collateral vessel in these patients was the gastroduodenal artery. Both stenoses of CT and SMA were found in 9 patients. The Riolan arch was the most common type of collateral vessel in these patients.

CONCLUSION

It was observed that mesenteric circulation was mainly provided by gastroduodenal artery in patients with isolated CT or SMA stenosis or occlusion while in patients with stenosis or occlusion of both CT and SMA, mesenteric circulation was mainly provided by the Riolan arch. A significant increase was observed in the prominence of collateral vessels in patients with stenosis of more than 70%.