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Ide T, Shimamura K, Kuratani T, Shijo T, Sakaniwa R, Watanabe Y, Maeda K, Masada K, Yamashita K, Matsumoto R, Miyagawa S. Impact of the Patency of Inferior Mesenteric Artery on 7-Year Outcomes After Endovascular Aneurysm Repair. J Endovasc Ther 2024; 31:371-380. [PMID: 36120997 DOI: 10.1177/15266028221121748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
PURPOSE The impact of preoperative patent inferior mesenteric artery (IMA) on late outcomes following endovascular aneurysm repair (EVAR) remains unclear. This study aimed to investigate the specific influence of IMA patency on 7-year outcomes after EVAR. MATERIALS AND METHODS In this retrospective cohort study, 556 EVARs performed for true abdominal aortic aneurysm cases between January 2006 and December 2019 at our institution were reviewed. Endovascular aneurysm repairs performed using a commercially available device with no type I or type III endoleak (EL) during follow-up and with follow-up ≥12 months were included. A total of 336 patients were enrolled in this study. The cohort was divided into the patent IMA group and the occluded IMA group according to preoperative IMA status. The late outcomes, including aneurysm sac enlargement, reintervention, and mortality rates, were compared between both groups using propensity-score-matched data. RESULTS After propensity score matching, 86 patients were included in each group. The median follow-up period was 56 months (interquartile range: 32-94 months). The incidence of type II EL at discharge was 50% in the patent IMA group and 19% in the occluded IMA group (p<0.001). The type II EL from IMA and lumbar arteries was significantly higher in the patent IMA group than in the occluded IMA group (p<0.001 and p=0.002). The rate of freedom from aneurysm sac enlargement with type II EL was significantly higher in the occluded IMA group than in the patent IMA group (94% vs 69% at 7 years; p<0.001). The rate of freedom from reintervention was significantly higher in the occluded IMA group than in the patent IMA group (90% vs 74% at 7 years; p=0.007). Abdominal aortic aneurysm-related death and all-cause mortality did not significantly differ between groups (p=0.32 and p=0.34). CONCLUSIONS Inferior mesenteric artery patency could affect late reintervention and aneurysm sac enlargement but did not have a significant impact on mortality. Preoperative assessment and embolization of IMA might be an important factor for improvement in late EVAR outcomes. CLINICAL IMPACT The preoperative patency of the inferior mesenteric artery was significantly associated with a higher incidence of sac enlargement and reintervention with type II endoleak following endovascular aneurysm repair, even after adjustment for patient background. Preoperative assessment and embolization of inferior mesenteric artery might be an important factor for improvement in late EVAR outcomes.
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Affiliation(s)
- Toru Ide
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takayuki Shijo
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryoto Sakaniwa
- Department of Public Health, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshiki Watanabe
- Department of Cardiovascular Surgery, Kinan Hospital, Tanabe, Japan
| | - Koichi Maeda
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenta Masada
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kizuku Yamashita
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryota Matsumoto
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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Spath P, Hamwi T, Stavroulakis K, Fernandez-Prendes C, Stana J, Tsilimparis N. Use of Shockwave Intravascular Lithotripsy in Recanalization of Calcified Visceral and Renal Arteries: A Case Report and Update of the Literature. J Endovasc Ther 2024; 31:485-490. [PMID: 36147019 DOI: 10.1177/15266028221125157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Calcifications of the visceral and renal arteries lead to chronic mesenteric ischemia and renal artery stenosis, and both open and endovascular treatments can be proposed. Intravascular lithotripsy (IVL) has emerged as a novel technique used in peripheral and coronary interventions. CASE REPORT A 73-year-old man presented with chronic postprandial abdominal pain and weight loss. Computed-tomography-angiography (CTA) showed 93% calcified stenosis of the superior mesenteric artery (SMA). The plain old balloon angioplasty (POBA) was affected by immediate recoiling. The patient underwent ShockwaveTM IVL of the SMA via brachial access and stent-graft implantation. At 3-months follow-up, the patient showed symptoms resolution. CONCLUSIONS The use of Shockwave IVL can be an effective treatment for severely calcified SMA stenosis. A similar approach can be employed in both celiac and renal arteries as reported in 11 cases in literature and herein summarized. Intravascular lithotripsy resulted in high technical success and uneventful follow-up. However, given the small number of patients reported, larger studies are needed to confirm these findings. CLINICAL IMPACT This article reports a case of recanalization of superior mesenteric artery with heavily calcified lesion treated with intravascular lithotripsy (IVL) with Shockwave™ Intravascular Lithotripsy Balloon (Shockwave Medical Inc., Santa Clara, CA, USA). Beside, for the first time, we summarize the Literature on the use of IVL in the renal and visceral arteries district, providing indications, applications and useful hints for the endovascular treatment of chronic mesenteric ischemia and renal artery stenosis. This preliminary data show straightforward applicability, high technical success, and uneventful follow-up and IVL can be proposed as an useful tool for challenging revascularization of heavily calcified reno-visceral arteries.
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Affiliation(s)
- Paolo Spath
- Department of Vascular Surgery, Ludwig Maximilians University Hospital and LMU Klinikum, Munich, Germany
| | - Tarek Hamwi
- Department of Vascular Surgery, Ludwig Maximilians University Hospital and LMU Klinikum, Munich, Germany
| | - Konstantinos Stavroulakis
- Department of Vascular Surgery, Ludwig Maximilians University Hospital and LMU Klinikum, Munich, Germany
| | - Carlota Fernandez-Prendes
- Department of Vascular Surgery, Ludwig Maximilians University Hospital and LMU Klinikum, Munich, Germany
| | - Jan Stana
- Department of Vascular Surgery, Ludwig Maximilians University Hospital and LMU Klinikum, Munich, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig Maximilians University Hospital and LMU Klinikum, Munich, Germany
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Qu S, Wen R, Yan M, Qin J, Li J. Early endovascular approaches for treating acute mesenteric arterial occlusive disease in hemodialysis patients. Hemodial Int 2024; 28:241-246. [PMID: 38385856 DOI: 10.1111/hdi.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Among hemodialysis patients, acute superior mesenteric artery (SMA) thrombosis a condition with a high mortality rate. Very few larger case series have been reported. METHOD We reviewed eight hemodialysis patients with diabetes mellitus and SMA thrombosis managed with endovascular therapy in our institution. Demographic, clinical, and radiological data were described. The patency of the SMA was assessed by computed tomography angiography (CTA) at one month after the endovascular procedure. At the last visit, clinical symptoms and check of mortality were recorded. RESULTS Multidetector CTA scan revealed severe stenosis of SMA in 6 patients and SMA occlusion in the other two patients. The severe stenosis of SMA were verified by angiography. Balloon angioplasty without stenting was performed to obtain satisfactory patency of SMA. Seven of eight patients achieved resolution of abdominal pain after the endovascular procedure. One patient died of suspected intestinal necrosis after 6 days of balloon angioplasty. All seven surviving patients did not experience a recurrence of symptoms with a median follow-up of 2 years. No significant residual stenotic or occlusive lesions were noted in follow-up CTA at one month after the endovascular procedure. CONCLUSION SMA thrombosis should be systematically suspected in hemodialysis patients experiencing abdominal pain. Prompt diagnosis of SMA thrombosis as soon as possible and early endovascular therapy are required to obtain a favorable prognosis in the hemodialysis patient with SMA thrombosis.
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Affiliation(s)
- Siyuan Qu
- Department of Rheumatology and Immunology, University of South China Affiliated Changsha Central Hospital, Hunan Province, China
| | - Rui Wen
- Department of Rheumatology and Immunology, University of South China Affiliated Changsha Central Hospital, Hunan Province, China
| | - Mingming Yan
- Department of Orthopaedic Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jiao Qin
- Department of Rheumatology and Immunology, University of South China Affiliated Changsha Central Hospital, Hunan Province, China
| | - Jiali Li
- Department of Rheumatology and Immunology, University of South China Affiliated Changsha Central Hospital, Hunan Province, China
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Kim YW, Choi HC, Yang WJ, Koo BJ, Ahn JK, Lee JP, Na JB, Jo SH, Park SE, Won JH. Microcatheter-Directed Thrombolysis Using Recombinant Tissue Plasminogen Activator for the Treatment of Acute Superior Mesenteric Artery Embolism: A Case Report. Medicina (Kaunas) 2023; 59:1889. [PMID: 38003939 PMCID: PMC10672895 DOI: 10.3390/medicina59111889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023]
Abstract
Background: Acute mesenteric ischemia (AMI) is a life-threatening condition, and in 50% of patients, AMI is caused by acute superior mesenteric artery (SMA) embolism. Endovascular treatment is increasingly being considered the primary modality in selected cases. Many studies have reported that percutaneous aspiration embolectomy using a guiding catheter and thrombolysis with recombinant tissue plasminogen activator (rtPA) are effective in treating SMA embolism. However, no reports on treating SMA embolism using rtPA administered via a microcatheter exist. Case presentation: A 64-year-old man with underlying atrial fibrillation presented with acute SMA embolism revealed using computed tomography (CT). rtPA (total 3 mg) was carefully administered into the occluded SMA through a microcatheter. No complications occurred, and complete revascularization of the SMA was revealed on follow-up CT. Conclusions: Compared with previous reports, this case report reveals that successful revascularization can be achieved using rtPA administered via a microcatheter, with a low dose of rtPA and a short duration of thrombolysis.
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Affiliation(s)
- Yang-Won Kim
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea; (Y.-W.K.); (H.-C.C.); (W.-J.Y.); (B.-J.K.); (J.-K.A.); (J.-P.L.); (J.-B.N.)
| | - Ho-Cheol Choi
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea; (Y.-W.K.); (H.-C.C.); (W.-J.Y.); (B.-J.K.); (J.-K.A.); (J.-P.L.); (J.-B.N.)
| | - Won-Jeong Yang
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea; (Y.-W.K.); (H.-C.C.); (W.-J.Y.); (B.-J.K.); (J.-K.A.); (J.-P.L.); (J.-B.N.)
| | - Byeong-Ju Koo
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea; (Y.-W.K.); (H.-C.C.); (W.-J.Y.); (B.-J.K.); (J.-K.A.); (J.-P.L.); (J.-B.N.)
| | - Jae-Kyeong Ahn
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea; (Y.-W.K.); (H.-C.C.); (W.-J.Y.); (B.-J.K.); (J.-K.A.); (J.-P.L.); (J.-B.N.)
| | - Jeong-Pyo Lee
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea; (Y.-W.K.); (H.-C.C.); (W.-J.Y.); (B.-J.K.); (J.-K.A.); (J.-P.L.); (J.-B.N.)
| | - Jae-Bum Na
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea; (Y.-W.K.); (H.-C.C.); (W.-J.Y.); (B.-J.K.); (J.-K.A.); (J.-P.L.); (J.-B.N.)
| | - Sa-Hong Jo
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea; (S.-H.J.); (S.-E.P.)
| | - Sung-Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea; (S.-H.J.); (S.-E.P.)
| | - Jung-Ho Won
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea; (Y.-W.K.); (H.-C.C.); (W.-J.Y.); (B.-J.K.); (J.-K.A.); (J.-P.L.); (J.-B.N.)
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Girault A, Pellenc Q, Roussel A, Senemaud J, Cerceau P, Maggiori L, Huguet A, Corcos O, Ben Abdallah I, Castier Y. Midterm results after covered stenting of the superior mesenteric artery. J Vasc Surg 2021; 74:902-909.e3. [PMID: 33684478 DOI: 10.1016/j.jvs.2021.02.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Despite the continuing controversy of covered stents (CS) vs bare metal stents, the use of CS in mesenteric occlusive disease (MOD) has been recommended by expert centers. The aim of this study was to report midterm results with CS of the superior mesenteric artery. METHODS Between January 2014 and October 2019, patients with MOD with a severe atheromatous stenosis or occlusion of the superior mesenteric artery treated by mesenteric CS were included. Clinical presentation included both acute mesenteric ischemia (AMI), chronic mesenteric ischemia, and asymptomatic patients planned for major surgery. Demographics, procedure details, and follow-up data were prospectively collected and retrospectively reviewed. Study end points included primary patency, primary assisted patency, and secondary patency. RESULTS During the study period, 86 patients (mean age, 70 ± 9 years; 57% males) were included. Clinical presentation was AMI (n = 42 [49%]), chronic mesenteric ischemia (n = 31 [36%]), and asymptomatic (n = 13 [15%]). The technical success rate was 97%. A total of 96 stents were implanted, including 86 proximal CS (Advanta V12, n = 73; Lifestream, n = 13). The mean length and mean diameter of the CS were 31.5 ± 6.3 mm and 6.9 ± 0.5 mm, respectively. Additional distal bare metal stents were used in 10 patients (12%) to overcome a kinking (n = 9) or a dissection (n = 1) downstream of the CS. All postoperative deaths occurred in patients with AMI (n = 11, 13%). During a median follow-up of 15.6 months (95% confidence interval [CI], 15.6 ± 3.6 months), 12 patients (14%) underwent reinterventions for either stent misplacement (n = 3), stent recoil (n = 3), stent thrombosis (n = 2), de novo stenosis at the distal edge of the CS (n = 2), or gastric ischemia (n = 1). At 1 year, overall the primary patency, primary assisted patency, and secondary patency rates were 83% (95% CI, 83% ± 9%), 99% (95% CI, 99% ± 3%), and 99% (95% CI, 99% ± 3%), respectively. At 2 years, the overall primary patency, primary assisted patency, and secondary patency rates were 76% (95% CI, 76% ± 13%), 95% (95% CI, 95% ± 8%) and 95% (95% CI, 95% ± 8%), respectively. CONCLUSIONS Mesenteric CS provide very satisfactory midterm results in patients with MOD, with an excellent primary assisted patency rate at 2 years, at the price of a significant reintervention rate.
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Affiliation(s)
- Antoine Girault
- Service de chirurgie Vasculaire et Thoracique, Hôpital Bichat, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France.
| | - Quentin Pellenc
- Service de chirurgie Vasculaire et Thoracique, Hôpital Bichat, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France
| | - Arnaud Roussel
- Service de chirurgie Vasculaire et Thoracique, Hôpital Bichat, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France
| | - Jean Senemaud
- Service de chirurgie Vasculaire et Thoracique, Hôpital Bichat, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France
| | - Pierre Cerceau
- Service de chirurgie Vasculaire et Thoracique, Hôpital Bichat, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France
| | - Léon Maggiori
- Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Service de chirurgie viscérale, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France
| | - Audrey Huguet
- Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Service de gastro-entérologie et assistance nutritive, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France
| | - Olivier Corcos
- Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Service de gastro-entérologie et assistance nutritive, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France
| | - Iannis Ben Abdallah
- Service de chirurgie Vasculaire et Thoracique, Hôpital Bichat, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France
| | - Yves Castier
- Service de chirurgie Vasculaire et Thoracique, Hôpital Bichat, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France
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Green J, Ryer E, Borden N, Ali B, Garvin R, Yang A, Hashmi A, Salzler G, Elmore J. Defining Duplex Ultrasound Criteria for In-Stent Restenosis of the Superior Mesenteric Artery. Ann Vasc Surg 2021; 74:294-300. [PMID: 33508454 DOI: 10.1016/j.avsg.2020.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study sought to define duplex ultrasound (DUS) velocity criteria predicting ≥70% stenosis in superior mesenteric artery (SMA) stents by correlating in-stent peak systolic velocity (PSV) with computed tomographic angiography (CTA) measurements of percent stenosis. METHODS A retrospective review of 109 patients undergoing SMA stenting between 2003 and 2018 was conducted at a single institution. Thirty-seven surveillance duplex ultrasound studies were found to have a CTA performed within 30 days of study completion. Bare metal (n = 20) and covered stents (n = 17) were included. Velocities were paired to in-stent restenosis (ISR) measured by mean vessel diameter reduction on SMA centerline reconstructions from CTA. Receiver operating characteristic (ROC) curves was generated and logistic regression models for ≥70% ISR probability were used to define velocity criteria in the stented SMA. RESULTS At a PSV of 300 cm/sec, the sensitivity is 100% and specificity 80% for a ≥70% in-stent SMA stenosis. At a PSV of 400 cm/sec, the sensitivity and positive predictive value (PPV) is 63% and the specificity and negative predictive value (NPV) is 90%. A PSV of 450 cm/sec was consistent with the highest specificity (100%) and PPV (100%) but lower sensitivity (50%) and NPV (87.9%). One patient with a PSV of 441 cm/sec on surveillance DUS died from complications of acute-on-chronic mesenteric ischemia. CONCLUSIONS A PSV of 400 cm/sec on mesenteric DUS can predict ≥70% ISR with high sensitivity and should be considered as a diagnostic threshold for SMA in-stent restenosis.
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Affiliation(s)
- Jessica Green
- Department of Endovascular & Vascular Surgery, Geisinger Medical Center, Danville, PA
| | - Evan Ryer
- Department of Endovascular & Vascular Surgery, Geisinger Medical Center, Danville, PA.
| | - Nicholas Borden
- Department of Endovascular & Vascular Surgery, Geisinger Medical Center, Danville, PA
| | - Bilal Ali
- Department of Endovascular & Vascular Surgery, Geisinger Medical Center, Danville, PA
| | - Robert Garvin
- Department of Endovascular & Vascular Surgery, Geisinger Medical Center, Danville, PA
| | - Andrew Yang
- Department of Endovascular & Vascular Surgery, Geisinger Medical Center, Danville, PA
| | - Ammar Hashmi
- Department of Endovascular & Vascular Surgery, Geisinger Medical Center, Danville, PA
| | - Gregory Salzler
- Department of Endovascular & Vascular Surgery, Geisinger Medical Center, Danville, PA
| | - James Elmore
- Department of Endovascular & Vascular Surgery, Geisinger Medical Center, Danville, PA
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Voutsinas N, Patel RS, Bishay VL, Ranade M, Nowakowski FS, Kim E, Fischman AM, Divino CM, Marin ML, Lookstein RA. Pre-operative endovascular occlusion for unresectable metastatic carcinoid tumor: technique and initial results. Abdom Radiol (NY) 2020; 45:2554-2560. [PMID: 32318762 DOI: 10.1007/s00261-020-02534-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Surgery is the only curative therapy for carcinoid patients; however, many are unresectable due to direct involvement of the superior mesenteric artery (SMA) branches. In these patients, we sought to improve surgical outcomes via arterial skeletonization of the SMA prior to surgical resection. MATERIALS AND METHODS After left radial access, the SMA was catheterized, angiography was performed, and balloon occlusion was achieved in the tumor vessel. Following balloon occlusion of the affected artery, patients were assessed for symptoms of ischemia and angiographic evidence of distal perfusion via collaterals. If patients tolerated occlusion, an endovascular plug was deployed in the affected artery; if not, the procedure was terminated. The next day, all patients underwent exploratory laparotomy and surgical resection of tumor and bowel. RESULTS The procedure was performed 15 times on 14 patients. 13 out of 15 procedures went to embolization, while the other 2 proceeded to surgery without plug deployment. One of the embolized patients had serious post-surgical complications, while both non-embolized patients developed complications including short bowel syndrome and ischemic colitis. Length of stay between embolized and non-embolized patients was equal, but re-admittance within 30 days was 7.7% in the embolized group and 100% in the non-embolized group. DISCUSSION Our initial experience demonstrates feasibility and safety of deploying plugs within branches of the SMA prior to surgical resection and improved surgical outcomes. Palpation of the plug assisted in surgical resection. We have demonstrated that pre-operative endovascular occlusion is a safe, practical procedure, which aids surgical resection of mesenteric carcinoid disease.
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Affiliation(s)
- Nicholas Voutsinas
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, 1 Gustave Levy Place, Box 1234, New York, NY, 10029, USA.
| | - Rahul S Patel
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, 1 Gustave Levy Place, Box 1234, New York, NY, 10029, USA
| | - Vivian L Bishay
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, 1 Gustave Levy Place, Box 1234, New York, NY, 10029, USA
| | - Mona Ranade
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, 1 Gustave Levy Place, Box 1234, New York, NY, 10029, USA
| | - Francis S Nowakowski
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, 1 Gustave Levy Place, Box 1234, New York, NY, 10029, USA
| | - Edward Kim
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, 1 Gustave Levy Place, Box 1234, New York, NY, 10029, USA
| | - Aaron M Fischman
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, 1 Gustave Levy Place, Box 1234, New York, NY, 10029, USA
| | - Celia M Divino
- Department of Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Michael L Marin
- Department of Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Robert A Lookstein
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, 1 Gustave Levy Place, Box 1234, New York, NY, 10029, USA
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Memon S, Janzer S, Kalra S, George JC. Recanalization of superior mesenteric artery chronic total occlusion using hybrid algorithm and dissection reentry device. Catheter Cardiovasc Interv 2020; 95:1314-1319. [PMID: 31925989 DOI: 10.1002/ccd.28704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/04/2019] [Accepted: 12/28/2019] [Indexed: 11/07/2022]
Abstract
Chronic total occlusion (CTO) of mesenteric arteries with associated chronic mesenteric ischemia (CMI) is associated with high morbidity and mortality. Endovascular intervention has been associated with high technical success with high rates of freedom from symptoms and long-term patency. However, to achieve high procedural success, use of optimal vascular access and expertise in CTO hybrid algorithm including advanced dissection reentry strategies are essential. We present a case of CMI from severe celiac artery (CA) stenosis and CTO of superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). After treatment of CA stenosis, we were unsuccessful in our first attempt at recanalization of SMA CTO. On second attempt, left brachial artery (BA) access was obtained and the hybrid algorithm along with use of Stingray Reentry balloon (Boston Scientific) for dissection reentry into true lumen was successful in recanalizing the SMA CTO with placement of balloon expandable covered stents (CS). To the best of our knowledge, this is the first case report utilizing Sting-ray Reentry balloon in the mesenteric arteries.
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Affiliation(s)
- Sehrish Memon
- Division of Interventional Cardiology and Endovascular Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Sean Janzer
- Division of Interventional Cardiology and Endovascular Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Sanjog Kalra
- Division of Interventional Cardiology and Endovascular Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Jon C George
- Division of Interventional Cardiology and Endovascular Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
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9
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Chen FF, Ye XN, Jiang HT, Zhu GX, Miao SL, Yu GF, Qiu YH, Huang JY. Role of Frailty and Comorbidity Status in Predicting Morbidity and Mortality in Patients with Acute Mesenteric Ischemia. Ann Vasc Surg 2020; 67:105-114. [PMID: 32240729 DOI: 10.1016/j.avsg.2020.03.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/21/2020] [Accepted: 03/14/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study was performed to determine the association of frailty and comorbidity status with postoperative morbidity and mortality in patients with acute mesenteric ischemia (AMI). METHODS Patients diagnosed with AMI between April 2006 and September 2019 were enrolled in this study. Frailty was evaluated by sarcopenia which was diagnosed by third lumbar vertebra psoas muscle area (PMA). Comorbidity status was evaluated by the Charlson Comorbidity Index (CCI) score. Univariate and multivariate analyses evaluating the risk factors for postoperative morbidity and mortality were performed. RESULTS Of the 174 patients, 86 were managed conservatively and 88 underwent surgery. In surgically managed patients, 39.8% developed complications within 30 days of surgery. Ten patients died within 30 days of the operation. In the univariate analyses, white blood cell >10 g/L, low PMA, CCI score ≥2, and bowel resection were associated with postoperative complications. Multivariate analysis revealed that low PMA, CCI score ≥2, and bowel resection were independent predictors of postoperative complications. CONCLUSIONS This study demonstrated that low PMA, CCI score ≥2, and bowel resection were independent risk factors for postoperative complications in patients with AMI. Preoperative assessment of frailty using PMA and the evaluation of comorbidity status using CCI may serve as helpful tools in preoperative risk assessment and should be integrated into scoring systems for surgically treated AMI.
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Affiliation(s)
- Fan-Feng Chen
- Department of Vascular Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xiao-Ning Ye
- The First Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Hao-Te Jiang
- The First Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Guan-Xia Zhu
- Department of Oncology, The First Clinical Medical College of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Shou-Liang Miao
- Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Guan-Feng Yu
- Department of Vascular Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yi-Hui Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
| | - Jing-Yong Huang
- Department of Vascular Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
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10
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Andraska E, Haga L, Reitz K, Li X, Ramos R, Avgerinos E, Singh M, Eslami M, Makaroun M, Chaer R. Acute superior mesenteric venous thrombosis results in high rates of readmission and morbidity. J Vasc Surg Venous Lymphat Disord 2020; 8:748-755. [PMID: 32139329 DOI: 10.1016/j.jvsv.2020.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/13/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Superior mesenteric venous thrombosis (MVT) is a poorly understood clinical entity, and as such, outcomes are poorly described. This study aimed to identify predictors of bowel ischemia after MVT and to compare outcomes for patients treated medically (group 1) with those for patients treated with bowel resection (group 2). METHODS This was a retrospective, single-institution study capturing all patients diagnosed with symptomatic acute MVT on computed tomography imaging from 2008 to 2018. Demographics, comorbidities, imaging, laboratory values, and treatment were included. Predictors of bowel resection were analyzed by univariate and multivariate statistics. Outcomes including mortality, readmissions for abdominal pain, and chronic mesenteric venous congestion were compared using χ2 test. RESULTS There were 121 patients included in the study; 98 patients were treated medically (group 1), 19 patients were treated with bowel resection (group 2), and 4 patients were treated with endovascular recanalization (group 3). Group 1 and group 2 were compared directly. Patients requiring bowel resection tended to have higher body mass index (P = .051) and a hypercoagulable disorder (P = .003). Patients who required bowel resection were more likely to present with lactic acidosis (P < .001) and leukocytosis (P < .001) with bowel wall thickening on scan (P < .001). On multivariable analysis, a genetic thrombophilia was a strong predictor of bowel ischemia (odds ratio, 3.81; 95% confidence interval, 1.12-12.37). One-year mortality and readmission rates did not differ between groups. However, readmission rates for abdominal pain were high for both groups (group 1, 44.90%; group 2, 57.89%; P = .317), and a significant proportion of patients exhibited chronic mesenteric venous congestion on repeated scan (group 1, 42.86%; group 2, 47.37%; P = .104). CONCLUSIONS A genetic hypercoagulable disorder is a predictor of bowel ischemia due to MVT. Regardless of treatment, outcomes after MVT are morbid, with high rates of readmission for abdominal pain. An alternative approach to treat these patients is needed, given the poor outcomes with current strategies.
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Affiliation(s)
- Elizabeth Andraska
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Lindsey Haga
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Katherine Reitz
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Xiaoyi Li
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Rafael Ramos
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Efthymios Avgerinos
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michael Singh
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Mohammad Eslami
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michel Makaroun
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Rabih Chaer
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
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11
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Shao T, Kang N, DeAmorim H, Rey J, Bornak A. Staged Treatment for an Unusual Case of Median Arcuate Ligament Syndrome Caused by Compression of the Celiac and Superior Mesenteric Arteries. Ann Vasc Surg 2020; 66:672.e5-672.e7. [PMID: 32027988 DOI: 10.1016/j.avsg.2020.01.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/04/2020] [Accepted: 01/16/2020] [Indexed: 11/17/2022]
Abstract
We report the unusual presentation of a patient with median arcuate ligament syndrome (MALS) and compression of both the celiac artery and the superior mesenteric artery (SMA). He underwent a staged treatment. First, a laparoscopic release of the median arcuate ligament was performed. In the second stage, due to persistent postprandial pain, the SMA was stented, resulting in complete symptom relief. Recognizing this rare anatomical presentation is very important to avoiding MALS misdiagnosis and providing the appropriate staged treatment.
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Affiliation(s)
- Tony Shao
- Division of Vascular and Endovascular Surgery, University of Miami & Miami VAMC, Miami, FL
| | - Naixin Kang
- Division of Vascular and Endovascular Surgery, University of Miami & Miami VAMC, Miami, FL
| | - Hilene DeAmorim
- Division of Vascular and Endovascular Surgery, University of Miami & Miami VAMC, Miami, FL
| | - Jorge Rey
- Division of Vascular and Endovascular Surgery, University of Miami & Miami VAMC, Miami, FL
| | - Arash Bornak
- Division of Vascular and Endovascular Surgery, University of Miami & Miami VAMC, Miami, FL.
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12
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van Dijk LJD, van Noord D, van Mierlo M, Bijdevaate DC, Bruno MJ, Moelker A. Single-Center Retrospective Comparative Analysis of Transradial, Transbrachial, and Transfemoral Approach for Mesenteric Arterial Procedures. J Vasc Interv Radiol 2019; 31:130-138. [PMID: 31771892 DOI: 10.1016/j.jvir.2019.08.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/19/2019] [Accepted: 08/25/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To assess feasibility and safety of transradial access (TRA) compared with transfemoral access (TFA) and transbrachial access (TBA) for mesenteric arterial endovascular procedures. MATERIALS AND METHODS A retrospective cohort analysis was performed including all consecutive patients who underwent a mesenteric arterial procedure in a tertiary referral center between May 2012 and February 2018. Exclusion criteria were absence of data and lost to follow-up within 24 hours after the procedure. During the study period, 103 patients underwent 148 mesenteric arterial procedures (TBA, n = 52; TFA, n = 39; TRA, n = 57). Mean patient age was 64.3 years ± 13.3, and 91 patients (62%) were women. Primary outcomes were vascular access specified technical success rate and access site complication rate, as reported in hospital records. RESULTS Technical success rate specified for the vascular access technique did not differ between the 3 approaches (TBA 96%, TFA 87%, TRA 91%; TRA vs TBA, P = .295; TBA vs TFA, P = .112; TRA vs TFA, P = .524), and overall access site complication rate was not different between the 3 approaches (TBA 42%, TFA 23%, TRA 35%; TRA vs TBA, P = .439; TBA vs TFA, P = .055; TRA vs TFA, P = .208). However, more major access site complications were reported for TBA than for TRA or TFA (TBA 17%, TFA 3%, TRA 2%; TRA vs TBA, P = .005; TBA vs TFA, P = .026; TRA vs TFA, P = .785). CONCLUSIONS TRA is a safe and feasible approach for mesenteric arterial procedures comparable to TFA, but with a significantly lower major access site complication rate than TBA.
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Affiliation(s)
- Louisa J D van Dijk
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands; Department of Radiology, Erasmus MC University Medical Center, 's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands.
| | - Desirée van Noord
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands; Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Minke van Mierlo
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands
| | - Diederik C Bijdevaate
- Department of Radiology, Erasmus MC University Medical Center, 's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands; Department of Radiology, Erasmus MC University Medical Center, 's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands
| | - Adriaan Moelker
- Department of Radiology, Erasmus MC University Medical Center, 's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands
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13
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Liu YR, Tong Z, Hou CB, Cui SJ, Guo LR, Qi YX, Qi LX, Guo JM, Gu YQ. Aspiration therapy for acute embolic occlusion of the superior mesenteric artery. World J Gastroenterol 2019; 25:848-858. [PMID: 30809084 PMCID: PMC6385017 DOI: 10.3748/wjg.v25.i7.848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/20/2019] [Accepted: 01/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Embolic superior mesenteric artery (SMA) occlusion is associated with high mortality rates. Delayed treatment often leads to serious consequences, including intestinal necrosis, resection, and even patient death. Endovascular repair is being introduced, which can improve clinical symptoms and prognosis and decrease the incidence of exploratory laparotomy. Many reports have described successful endovascular revascularization of embolic SMA occlusion. However, most of those reports are case reports, and there are few reports on Chinese patients. In this paper, we describe the technical and clinical outcomes of aspiration therapy using a guiding catheter and long sheath technique which facilitates the endovascular repair procedure.
AIM To evaluate the complications, feasibility, effectiveness, and safety of endovascular treatment for the acute embolic occlusion of the SMA.
METHODS This retrospective study reviewed eight patients (six males and two females) from August 2013 to October 2018 at Xuanwu Hospital, Capital Medical University. The patients presented with acute embolic occlusion of the SMA on admission and were initially diagnosed by computed tomography angiography (CTA). The patients who underwent endovascular treatment with a guiding catheter had no obvious evidence of bowel infarct. No intestinal necrosis was identified by gastrointestinal surgeons through peritoneal puncture or CTA. The complications, feasibility, effectiveness, safety, and mortality were assessed.
RESULTS Six (75%) patients were male, and the mean patient age was 70.00 ± 8.43 years (range, 60-84 years). The acute embolic occlusion of the SMA was initially diagnosed by CTA. All patients had undertaken anticoagulation primarily, and percutaneous aspiration using a guiding catheter was then undertaken because the emboli had large amounts of thrombus residue. No death occurred among the patients. Complete patency of the suffering artery trunk was achieved in six patients, and defect filling was accomplished in two patients. The in-hospital mortality was 0%. The overall 12-mo survival rate was 100%. All patients survived, and two of the eight patients had complications (the clot broke off during aspiration).
CONCLUSION Aspiration therapy is feasible, safe, and beneficial for acute embolic SMA occlusion. Aspiration therapy has many benefits for reducing patients’ death, resolving thrombi, and improving symptoms.
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Affiliation(s)
- Yi-Ren Liu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Zhu Tong
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Cheng-Bei Hou
- Center of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Shi-Jun Cui
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Lian-Rui Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yi-Xia Qi
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Li-Xing Qi
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jian-Ming Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yong-Quan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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14
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Abstract
RATIONALE Superior mesenteric venous thrombosis (SMVT) is a rare condition that carries high mortality. Very few cases have been reported of SMVT, complicating acute appendicitis. Early recognition requires a high index of suspicion and is crucial in successful treatment of such a life-threatening condition. PATIENT CONCERNS A 33-year-old male presents with a 4-day history of right lower abdominal pain, nausea and subjective fever. CT scan showed acute appendicitis and a central filling defect in the superior mesenteric vein. DIAGNOSES Acute appendicitis complicated by SMVT. INTERVENTIONS Intravenous antibiotics, appendectomy, and anticoagulation. OUTCOMES Repeat CT scan showed successful resolution of the SMVT at a 3-month follow up. LESSONS Clinical awareness and high index of suspicion are essential to diagnose and manage SMVT, a serious complication of acute appendicitis.
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Affiliation(s)
- AbdAllah Gad
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Odessa, Texas
- Department of Biostatistics and Cancer Epidemiology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Zakaria Hindi
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Odessa, Texas
| | - Talal Zahoor
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Odessa, Texas
| | - Rémy Zock À Zock
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Odessa, Texas
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15
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Ripoll E, Prieto-González S, Balagué O, Marco-Hernández J, Miró JM, Darnell A, Cid MC, Hernández-Rodríguez J. Occlusive vasculopathy in human immunodeficiency virus (HIV)-associated vasculitis: unusual clinical and imaging course. Clin Exp Rheumatol 2017; 35 Suppl 103:185-188. [PMID: 27974095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/29/2016] [Indexed: 06/06/2023]
Abstract
Human immunodeficiency virus (HIV)-associated vasculitis is a rare secondary systemic vasculitis involving small and medium arteries. We report a 42-year-old man with uncontrolled HIV infection presenting with long-lasting abdominal pain. An abdominal CT angiography revealed multiple microaneurysms and stenoses in intrarenal arteries, with involvement of mesenteric and hepatic arteries. HIV-associated vasculitis was diagnosed and glucocorticoids and raltegravir-based antiretroviral therapy were administered with good initial clinical and virological response. Several episodes of acute intestinal ischaemia were later developed requiring bowel resections of which histological examination showed vascular occlusive fibrotic changes without active vasculitic lesions. Vasculitis persisted in remission and intrarenal microaneurysms disappeared.
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Affiliation(s)
- Enric Ripoll
- Department of Radiology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain
| | - Sergio Prieto-González
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain
| | - Olga Balagué
- Department of Anatomic Pathology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain
| | - Javier Marco-Hernández
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain
| | - Josep M Miró
- Infectious Diseases Service; Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain
| | - Anna Darnell
- Department of Radiology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain
| | - Maria C Cid
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain
| | - José Hernández-Rodríguez
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain.
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16
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Bulut T, Oosterhof-Berktas R, Geelkerken RH, Brusse-Keizer M, Stassen EJ, Kolkman JJ. Long-Term Results of Endovascular Treatment of Atherosclerotic Stenoses or Occlusions of the Coeliac and Superior Mesenteric Artery in Patients With Mesenteric Ischaemia. Eur J Vasc Endovasc Surg 2017; 53:583-590. [PMID: 28254161 DOI: 10.1016/j.ejvs.2016.12.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 12/25/2016] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Over the past decade, primary percutaneous mesenteric artery stenting (PMAS) has become an alternative to open revascularisation for treatment of mesenteric ischaemia. Institutes have presented favourable short-term outcomes after PMAS, but there is a lack of data on long-term stent patency. METHODS One hundred and forty-one patients treated by PMAS for acute and chronic mesenteric ischaemia over an 8 year period were studied. Anatomical success was assessed by duplex ultrasound and/or CT angiography. A stenosis ≥70% was considered to be a failure. RESULTS Eighty-six coeliac arteries (CA) and 99 superior mesenteric arteries (SMA) were treated with PMAS in 141 patients. Nine CAs (10%) and 30 SMAs (30%) were occluded at the time of treatment. Median follow-up was 32 months (IQR 20-46). The overall primary patency rate at 12 and 60 months was 77.0% and 45.0%. The overall primary assisted patency rate was 90.3% and 69.8%. Overall secondary patency was 98.3% and 93.6%. CONCLUSION This study shows excellent long-term secondary patencies after PMAS, comparable with published data on long-term patencies after open surgical revascularisation.
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Affiliation(s)
- T Bulut
- Department of Radiology, Medisch Spectrum Twente, Enschede, The Netherlands.
| | - R Oosterhof-Berktas
- Department of Radiology, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Radiology Martini Ziekenhuis, Groningen, The Netherlands
| | - R H Geelkerken
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands; Faculty Science and Technology, Experimental Centre of Technical Medicine, University of Twente, Enschede, The Netherlands
| | - M Brusse-Keizer
- Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - E J Stassen
- Department of Radiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - J J Kolkman
- Department of Gastroenterology, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Gastroenterology University Medical Centre, Groningen, The Netherlands
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17
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Zhou W, Choi L, Lin PH, Dardik A, Eraso A, Lumsden AB. Percutaneous Transhepatic Thrombectomy and Pharmacologic Thrombolysis of Mesenteric Venous Thrombosis. Vascular 2016; 15:41-5. [PMID: 17382054 DOI: 10.2310/6670.2007.00013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Mesenteric venous occlusion is a rare yet highly morbid condition that is traditionally treated with anticoagulation while surgery serves as the last resort. Percutaneous intervention provides an effective option with relatively low mortality and morbidity. We herein describe use of transhepatic percutaneous thrombectomy and pharmacologic thrombolysis in treating two cases of symptomatic mesenteric venous thrombosis. These cases underscore the fact that transhepatic thrombectomy and thrombolysis are a highly effective strategy for treating acute symptomatic mesenteric venous thrombosis. Several percutaneous techniques are also reviewed.
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Affiliation(s)
- Wei Zhou
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, VA Medical Center, Baylor College of Medicine, 1709 Dryden Street, Houston, TX 77030, USA.
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18
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Yang S, Zhang L, Liu K, Fan X, Ding W, He C, Wu X, Li J. Postoperative Catheter-Directed Thrombolysis Versus Systemic Anticoagulation for Acute Superior Mesenteric Venous Thrombosis. Ann Vasc Surg 2016; 35:88-97. [PMID: 27263813 DOI: 10.1016/j.avsg.2016.02.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 02/03/2016] [Accepted: 02/13/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little data evaluate catheter-directed thrombolysis (CDT) therapy as a sequential treatment of emergent surgery for patients with acute superior mesenteric venous thrombosis (ASMVT). We compared the outcomes of ASMVT patients receiving CDT via superior mesenteric artery (SMA) with those who had systemic anticoagulation after emergent laparotomy. METHODS A single-center retrospective study of ASMVT patients receiving emergent laparotomy from May 2012 to April 2014 was performed. Patients in group I had postoperative systemic anticoagulation and patients in group II underwent postoperative CDT. The demography, etiology, imaging features, clinical outcomes, and complications were compared. Moreover, univariate analysis was performed to identify confounding variables of 30-day mortality. RESULTS Thirty-two patients (20 males, mean age of 44.9 ± 10.6 years) were included, 17 in group I and 15 in group II. No significant differences of demographic data, etiology, baseline value, and perioperative comorbidity were found. The rate of complete thrombus removal was significantly higher in group II than group I (29.4% vs. 80.0%, P = 0.001). The second-look laparotomy and repeat bowel resection (58.8% vs. 13.3%, P = 0.002) were required in fewer patients in group II (20.0% vs. 70.6%, P = 0.001). The incidence of short-bowel syndrome (SBS; 41.2% vs. 6.7%, P = 0.001) and 30-day mortality (41.2% vs. 6.7%, P = 0.001) were lower in group II. The 1-year survival was also better in group II (52.9% vs. 93.3%, P = 0.014). The incidence of massive abdominal hemorrhage requiring blood transfusion and surgical intervention was 11.8% in group I and 20.0% in group II (P = 0.645). The age, serum D-dimer level, SBS, and postoperative CDT were significant risk factors of 30-day mortality in this study. CONCLUSIONS For ASMVT patients receiving emergent surgery and intraoperative thrombectomy, the algorithm with postoperative CDT via SMA is associated with more favorable clinical outcome compared with systemic anticoagulation.
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Affiliation(s)
- Shuofei Yang
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China; Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, P. R. China
| | - Lan Zhang
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Kai Liu
- Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu Province, P. R. China
| | - Xinxin Fan
- Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu Province, P. R. China
| | - Weiwei Ding
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, P. R. China
| | - Changsheng He
- Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu Province, P. R. China
| | - Xingjiang Wu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, P. R. China.
| | - Jieshou Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, P. R. China
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Affiliation(s)
- Daniel G Clair
- From the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (D.G.C.) and the Department of Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic (D.G.C., J.M.B.) - both in Cleveland
| | - Jocelyn M Beach
- From the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (D.G.C.) and the Department of Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic (D.G.C., J.M.B.) - both in Cleveland
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Verma H, Oderich GS, Tripathi RK. Surgical and endovascular interventions for chronic mesenteric ischemia. J Cardiovasc Surg (Torino) 2015; 56:299-307. [PMID: 25644829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of this manuscript was to describe and discuss the rationale and conduct of currently available endovascular and open surgical techniques to treat chronic mesenteric ischemia (CMI) and thus support the process of decision-making in mesenteric revascularization.
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Affiliation(s)
- H Verma
- Narayana Institute of Vascular Sciences, Bangalore, India -
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Cesaretti M, Elghadban H, Scopinaro N, Papadia FS. Portomesenteric venous thrombosis: An early postoperative complication after laparoscopic biliopancreatic diversion. World J Gastroenterol 2015; 21:2546-2549. [PMID: 25741166 PMCID: PMC4342935 DOI: 10.3748/wjg.v21.i8.2546] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/15/2014] [Accepted: 04/23/2014] [Indexed: 02/06/2023] Open
Abstract
The number of bariatric operations, as well as the incidence of perioperative complications, has risen sharply in the past ten years. Perioperative acute portal vein thrombosis is an infrequent and potentially severe postoperative complication that has not yet been reported after biliopancreatic diversion (BPD). Three cases are presented of portal vein thrombosis that occurred following BPD treatment for morbid obesity and type 2 diabetes. The thromboses were detected by abdominal ultrasound and computed tomography with intravenous contrast. The portomesenteric venous thromboses in all three cases presented as unexpected abdominal pain several days after discharge from the hospital. The complications occurred despite adequate perioperative prophylaxis and progressed to bowel gangrene in the diabetic patients only. These cases demonstrate the occurrence of this rare type of complication, which may be observed by physicians that do not routinely treat bariatric patients. Awareness of this surgical complication will allow for early diagnosis and prompt initiation of adequate therapy.
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Huang Y, Jia Z, Wang Q, Chen W, He Z, Zhang J, Wang K, Tian F. [Catheter aspiration alone or combined with thrombolysis in the treatment of superior mesenteric artery embolism]. Zhonghua Wei Chang Wai Ke Za Zhi 2014; 17:1018-1021. [PMID: 25341911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the efficacy of catheter aspiration or combined with thrombolysis in the treatment of superior mesenteric artery embolism(SMAE). METHODS Clinical and imaging data of 25 SMAE patients who underwent catheter aspiration or combined with urokinase thrombolysis in the First People's Hospital and the Second People's Hospital of Changzhou from January 2005 to July 2013 were retrospectively analyzed. RESULTS Twenty patients were confirmed as SMA trunk embolism and 5 as SMA branch artery embolism. The embolic SMA trunks were completely recannulated by catheter aspiration in the above 20 cases, but small emboli embolized distal branch artery in 6 cases. These 6 patients plus above 5 patients with branch artery embolism received catheter aspiration combined with thrombolytic therapy. Among these 11 patients, complete open, partial open and non-open of branch arteries were found in 5, 3, 3 cases respectively, while collateral circulation increased significantly in non-open patients. During the follow-up period of (4.1±2.2) months, clinical symptom relief and digestive function recovery were observed in 24 cases. Only one case underwent bowel resection because of intestinal necrosis 24 hours after treatment and developed short bowel syndrome. CONCLUSION Catheter aspiration or combined with thrombolysis is a safe and effective method in treating SMAE.
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Affiliation(s)
- Yuanquan Huang
- Department of Interventional Radiology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Jiangshu Changzhou 213003, China.
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Li WD, Li XQ, Meng QY, Qian AM, Sang HF, Zhu LW, Zhang YQ, Rong JJ, Wang WB, Zhao TJ. [Endovascular therapy of superior mesenteric artery embolism]. Zhonghua Yi Xue Za Zhi 2013; 93:3752-3754. [PMID: 24548390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To explore the safety and immediate efficacy of endovascular treatment for superior mesenteric artery embolism. METHODS From November 2007 to October 2012, 18 cases of superior mesenteric artery embolism were treated by thrombus extraction and/or catheter-directed thrombolysis. There were 13 males and 5 females with an age range of 44-91 years. The concurrent conditions included atrial fibrillation (n = 8) and rheumatic valve disease (n = 3). All diagnoses were made with abdominal enhanced computed tomography (CT) examination. Embolism was predominantly located at 3 to 10 cm away from opening. The procedures included thrombus extraction plus system thrombosis (n = 3), thrombus extraction and catheter-directed thrombolysis (n = 6), catheter-directed thrombolysis (n = 5) and thrombus extraction, catheter-directed thrombolysis and PTA (n = 2). RESULTS The technical success rate was 100%. Two cases had new embolism in popliteal artery. Another case with peritoneal irritation syndrome died after automatic discharge. The other 17 patients obtained satisfactory results and were followed up after 6 months by color Doppler ultrasound or abdominal enhanced CT. It showed that superior mesenteric arteries were unobstructed, but local stenosis occurred in 2 cases. CONCLUSION Endovascular interventional therapy is both safe and efficacious in the treatment of superior mesenteric artery embolization. And its immediate effect is satisfactory.
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Affiliation(s)
- Wen-dong Li
- Department of Vascular Surgery, Second Affiliated Hospital of Soochow University, Suzhou 215001, China
| | - Xiao-qiang Li
- Department of Vascular Surgery, Second Affiliated Hospital of Soochow University, Suzhou 215001, China.
| | - Qing-you Meng
- Department of Vascular Surgery, Second Affiliated Hospital of Soochow University, Suzhou 215001, China
| | - Ai-min Qian
- Department of Vascular Surgery, Second Affiliated Hospital of Soochow University, Suzhou 215001, China
| | - Hong-fei Sang
- Department of Vascular Surgery, Second Affiliated Hospital of Soochow University, Suzhou 215001, China
| | - Li-wei Zhu
- Department of Vascular Surgery, Second Affiliated Hospital of Soochow University, Suzhou 215001, China
| | - Ye-qing Zhang
- Department of Vascular Surgery, Second Affiliated Hospital of Soochow University, Suzhou 215001, China
| | - Jian-jie Rong
- Department of Vascular Surgery, Second Affiliated Hospital of Soochow University, Suzhou 215001, China
| | - Wen-bin Wang
- Department of Vascular Surgery, Second Affiliated Hospital of Soochow University, Suzhou 215001, China
| | - Tie-jun Zhao
- Department of Vascular Surgery, Second Affiliated Hospital of Soochow University, Suzhou 215001, China
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Kim HK, Chun JM, Huh S. Anticoagulation and delayed bowel resection in the management of mesenteric venous thrombosis. World J Gastroenterol 2013; 19:5025-5028. [PMID: 23946612 PMCID: PMC3740437 DOI: 10.3748/wjg.v19.i30.5025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/20/2013] [Accepted: 06/19/2013] [Indexed: 02/06/2023] Open
Abstract
Acute mesenteric venous thrombosis is potentially lethal because it can result in mesenteric ischemia and, ultimately, bowel infarction requiring surgical intervention. Systemic anticoagulation for the prevention of thrombus propagation is a well-recognized treatment modality and the current mainstay therapy for patients with acute mesenteric venous thrombosis. However, the decision between prompt surgical exploration vs conservative treatment with anticoagulation is somewhat difficult in patients with suspected bowel ischemia. Here we describe a patient with acute mesenteric venous thrombosis who presented with bowel ischemia and was treated with anticoagulation and delayed short-segment bowel resection.
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Abstract
The prevalence of mesenteric venous thrombosis has increased over the past 2 decades with the routine use of contrast-enhanced computed tomography (CT) in patients presenting with abdominal pain and those with portal hypertension. Concurrent with increasing recognition, routine and frequent use of anticoagulation has reduced the need for surgical intervention and improved outcome in these patients. Acute thrombosis often presents with abdominal pain, whereas chronic disease manifests either as an incidental finding on CT or with features of portal hypertension. Contrast-enhanced CT diagnoses about 90% of cases. The presence of collateral circulation and cavernoma around a chronically thrombosed vein differentiates chronic from acute disease. The superior mesenteric vein is often involved, whereas involvement of the inferior mesenteric vein is rare. Associated portal venous thrombosis can be seen if the disease originates in the major veins instead of the small vena rectae. Thrombophilia and local abdominal inflammatory conditions are common causes. Management is aimed at preventing bowel infarction and recurrent thrombosis. Anticoagulation, the mainstay of management, has also been safely used in patients with cirrhosis and portal hypertension. This review discusses the pathogenesis of thrombosis of mesenteric veins, the diagnosis and differentiation from arterial ischemia, the emergence of the JAK2 (Janus kinase 2) sequence variation as a marker of thrombophilia and myelodysplastic neoplasms, and new anticoagulants. Algorithms for the management of acute and chronic mesenteric venous thrombosis are provided to help readers understand and remember the approach to the management of acute and chronic mesenteric venous thrombosis.
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Affiliation(s)
- Ashwani K Singal
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
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Abstract
While the clinical findings of cocaine-induced enteropathy from mesenteric ischemia are fairly well understood, there is a paucity of imaging description and detail in the literature that describes these findings. Imaging characteristics of cocaine-induced mesenteric ischemia on CT examination include bowel edema, mucosal enhancement, venous engorgement, mesenteric free fluid, and dilatation of the small bowel lumen. A thorough history, physical examination, and laboratory testing are critical for the diagnosis and prompt surgical intervention may be necessary. We present a case of cocaine-induced mesenteric ischemia in a 49 year old male which resolved within 24 hours of supportive therapy.
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Affiliation(s)
- Wesley Angel
- University of Tennessee Health Science Center, Regional Medical Center, Memphis, TN, USA.
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Clifton WL, Kneitz A, Cohn WE, Delgado RM. Weight loss caused by visceral artery disease. Tex Heart Inst J 2013; 40:320-322. [PMID: 23914031 PMCID: PMC3709204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Dramatic unintentional weight loss can be caused by a spectrum of diseases ranging from very serious to benign and treatable. We describe the case of a 70-year-old woman with an extensive history of cardiovascular disease who presented with unintentional weight loss. Although she was diagnosed and treated for colitis, the patient continued to lose 50 pounds over 8 months, which prompted an angiogram. The angiogram revealed occlusion of her superior and inferior mesenteric arteries just distal to their origins, together with high-grade (80%-90%) stenosis at the origin of the celiac axis. After a stent was placed in the ostium of the celiac axis, the patient immediately began to regain weight. We suggest that clinicians consider chronic mesenteric ischemia when treating patients with undiagnosed unintentional weight loss and a history of atherosclerotic disease.
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Affiliation(s)
- William L Clifton
- Department of Cardiovascular Surgery, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA
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28
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Popa RF, Strobescu C, Baroi G, Raza A. Surgical revascularization in chronic mesenteric ischemia. Rev Med Chir Soc Med Nat Iasi 2013; 117:153-159. [PMID: 24505908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Chronic mesenteric ischemia (CMI) is a disease causing death either by starvation or enteromesenteric infarction. Diagnosis is often delayed before the patient is referred to a vascular surgery unit. Atherosclerosis is the main cause of CMI. Arteriography is essential in diagnosing CMI and delineating the atherosclerotic lesions. The revascularization procedure consists in an aortomesenteric bypass reconstructing 1-3 visceral arteries. This paper presents two consecutive CMI cases treated at the Vascular Surgery Unit of the Iaşi "Sf Spiridon" Hospital during 2010. Both patients had symptoms suggestive of mesenteric and aortoiliac diseases. CT angiography revealed specific lesions both for aortoiliac disease and stenotic or occlusive lesions in the celiac trunk and mesenteric arteries. Both cases benefited from aortobifemural bypass surgery using a synthetic graft associated with aortic-superior mesenteric artery bypass with reversed vein graft (in the first case both mesenteric arteries were revascularized). Immediate and remote results were favorable, with remission of intestinal symptoms and weight gain. Bypass patency was followed-up by CT angiography and Doppler ultrasound. CMI is a diagnostic and therapeutic challenge. Open surgery provides symptom remission in 90% of cases. Permeability at 5 years is 80-90% for open surgery, higher than by endovascular therapy. Average permeability of the two types of intervention is 70% at 5 years, similar to the infraaortic bypasses.
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Affiliation(s)
- R F Popa
- Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, Iaşi
| | - Cristina Strobescu
- Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, Iaşi
| | - Genoveva Baroi
- Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, Iaşi
| | - A Raza
- Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, Iaşi
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Kalra M, Ryer EJ, Oderich GS, Duncan AA, Bower TC, Gloviczki P. Contemporary results of treatment of acute arterial mesenteric thrombosis: has endovascular treatment improved outcomes? Perspect Vasc Surg Endovasc Ther 2012; 24:171-176. [PMID: 23698701 DOI: 10.1177/1531003513490033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Acute mesenteric ischemia is an uncommon but highly complex clinical problem and carries a high mortality. Traditional treatment has yielded only modest improvements in mortality and an endovascular first treatment paradigm has been adopted by selected centers over the past decade. However, the technique does not allow for immediate assessment of intestinal viability and availability of the expertise and equipment is mostly limited to tertiary referral centers. Experience gained with endovascular treatment thus far suggests that careful patient selection, procedure planning, and meticulous technique are the key to further improving results. Most important, prolonged attempts at percutaneous intervention should not be allowed to delay laparotomy and bowel assessment. In patients requiring urgent laparotomy, intraoperative retrograde superior mesenteric artery recanalization remains an attractive option and should be given due consideration. Liberal use of second-look laparotomy is to be encouraged for continued bowel assessment and eventual reestablishment of bowel continuity. Early recognition of the problem with expeditious implementation of the appropriate treatment is likely to improve outcomes of this challenging problem in the future.
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Wang Y, Wang MQ, Liu FY, Wang ZJ, Duan F, Song P. [Transradial approach for transcatheter selective superior mesenteric artery urokinase infusion therapy in patients with acute extensive portal and superior mesenteric vein thrombosis]. Zhonghua Yi Xue Za Zhi 2012; 92:1448-1452. [PMID: 22944028 DOI: 10.3760/cma.j.issn.0376-2491.2012.21.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
OBJECTIVE To evaluate the feasibility and efficacy of urokinase infusion therapy via a transradial approach for transcatheter superior mesenteric artery (SMA) in patients with acute extensive portal and superior mesenteric venous thrombosis. METHODS During a period of 8 years, 47 patients with acute extensive thrombosis of portal vein (PV) and superior mesenteric veins (SMV) received urokinase infusion therapy by transcatheter selective SMA via radial artery. Their mean age was 44 ± 13 years (range: 19 - 65). Through radial sheath, a 5F catheter was placed into SMA and subsequently the infusion of urokinase was given for 5 - 11 days (mean: 7.1 ± 2.5). Adequate anticoagulation was initiated during treatment, throughout hospitalization and post-discharge. Follow-up contrast-enhanced computed tomography (CT) was performed in each patient every 3 days and before the removal of infusion catheter. Termination of urokinase infusion therapy was decided on the basis of clinical and radiographic findings. RESULTS Technical success was achieved in all patients. Two patients had worsening abdominal pain, developed the signs of peritonitis at 24 hours after interventional treatment and underwent eventual laparotomy with the resection of necrotic bowel. Substantial clinical improvement was observed in 45 (95.7%) of them after the procedure. Minor complications at the radial puncture site were observed in 7 patients (14.9%) and infusion therapy continued. Follow-up CT scans at pre-discharge demonstrated a nearly complete disappearance of PV-SMV thrombosis in 29 patients (64.4%) and partial recanalization of PV-SMV thrombosis in 16 patients (35.6%). They were discharged at 9 - 20 days (mean: 12 ± 6) post-admission. The mean post-discharge duration of follow-up was 48 ± 20 months. Recurrent episodes of PV and SMV thrombosis were observed in 2 (4.4%) patients at 6 months and 5 years respectively post-discharge and they were treated successfully with urokinase infusion. CONCLUSION The transcatheter SMA urokinase infusion therapy via a transradial approach for plus anticoagulation is both safe and effective for the management of patients with acute extensive PV-SMV thrombosis.
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Affiliation(s)
- Yan Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, China
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Hannawi B, Lam WW, Younis GA. Pressure wire used to measure gradient in chronic mesenteric ischemia. Tex Heart Inst J 2012; 39:739-743. [PMID: 23109783 PMCID: PMC3461673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Chronic mesenteric ischemia is a rare disorder in the United States. Frequently, its symptoms correlate poorly with the angiographically apparent degree of mesenteric artery stenosis. Measuring the pressure gradient with a small-caliber catheter is an established means of determining whether a particular stenosis is flow-limiting, thus guiding the interventional decision when stenoses are of indeterminate angiographic significance. Using a 0.014-in guidewire, however, is potentially more accurate because it eliminates any measurement error attributable to the use of a larger, potentially obstructive catheter. We present a case of chronic mesenteric ischemia in a 70-year-old woman who had abdominal pain with multiple possible causes. We used a 0.014-in pressure wire to calculate pressure gradients and guide our decision to stent tandem lesions in the superior mesenteric artery. After revascularization, the patient's symptoms improved dramatically. To the best of our knowledge, this is the first published case in which a pressure wire was used to measure a pressure gradient in chronic mesenteric ischemia.
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Affiliation(s)
- Bashar Hannawi
- Division of Adult Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA
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Wang MQ, Liu FY, Duan F, Wang ZJ, Song P, Fan QS. Acute symptomatic mesenteric venous thrombosis: treatment by catheter-directed thrombolysis with transjugular intrahepatic route. ACTA ACUST UNITED AC 2011; 36:390-8. [PMID: 20652243 PMCID: PMC3146977 DOI: 10.1007/s00261-010-9637-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: To assess the feasibility and effectiveness of transjugular intrahepatic route aspiration thrombectomy and catheter-directed thrombolytic therapy in patients with acute superior mesenteric venous thrombosis. Materials and methods: During a period of 8 years, 12 patients with acute thrombosis of the superior mesenteric vein (SMV) were treated by transjugular intrahepatic approach. The mean age was 41.2 years. After access to the portal system via the transjugular approach, the pigtail catheter fragmentation of the thrombus, local urokinase injection, and manual aspiration thrombectomy were used for treatment of the SMV thrombosis initially, followed by continuous thrombolytic therapy via an indwelling infusion catheter in the SMV, which was performed for 2 to 6 days (4.2 ± 1.8 days). The adequacy of anticoagulation was performed during treatment, throughout hospitalization, and after discharge. Results: Technical success was achieved in all 12 patients. Substantial clinical improvement was seen in these patients after the procedure. Minor complications at the jugular puncture site were observed in 4 patients, but the thrombolytic therapy was not interrupted. Contrast-enhanced computed tomography (CT) scan before discharge demonstrated nearly complete disappearance of SMV thrombosis in all patients. The 12 patients were discharged 5–10 days (7.6 ± 2.0) after admission. Mean duration of follow-up after hospital discharge was 37.7 months, and no recurrent episodes of SMV thrombosis developed during that time period. Conclusion: Catheter-directed thrombus aspiration, mechanical fragmentation, and local thrombolytic infusion via the transjugular intrahepatic route is a safe and effective therapy for the management of patients with acute symptomatic SMV thrombosis.
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Affiliation(s)
- Mao Qiang Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China.
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Mai CM, Liao GH. Septic thrombophlebitis of the superior mesenteric vein caused by acute suppurative appendicitis. J Trauma 2011; 71:E17. [PMID: 21818007 DOI: 10.1097/ta.0b013e3181be786e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Chen-Ming Mai
- Department of Surgery, Huailien Armed Forces General Hospital, Huailien, Taiwan
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Zhang XT, Zhang HY, Zhang W, Hong D, An JL, Xia YH, Xu K. [Acute superior mesenteric ischemia: a contrast study on short-and mid-term result between stent implantation and pharmaceutical thrombolysis]. Zhonghua Yi Xue Za Zhi 2011; 91:473-476. [PMID: 21418979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To compare the short-term and medium-term result of stent implantation with pharmaceutical thrombolysis in patients with acute superior mesenteric artery occlusion. METHODS From January, 2004 to December, 2008, thirty-five patients diagnosed acute superior mesenteric ischemia, 12 patients treated with stent implantation (interventional therapy group) and 23 patients with pharmaceutical thrombolysis (thrombolytic therapy group). Interventional therapy group treated with balloon dilatation and stent implantation assisted with anticoagulation, antiplatelet and vascular dilation agents. Thrombolytic therapy group used urokinase combined with anticoagulation, antiplatelet and vascular dilation agents. All patients had taken clopidogrel and aspirin orally after discharged and followed up. The clinical effects of both groups were evaluated separately and the Fisher exact test was used to analysis the significant differences. RESULTS In the 23 cases of thrombolytic therapy group, 7 cases was effective, 16 cases was ineffective (7 cases aggravated or died, 9 cases turn to surgical operation). In the 12 cases of interventional therapy group, 10 cases treated with stent implantation (1 case died of acute cardiac infarction 3 days after interventional operation), 2 cases failed in recanalizing. All patients were followed up after discharged (range 1 - 48 months, mean 15 ± 12 months), 1 case in thrombolytic therapy group was stable, 6 cases died of the recurrence of acute superior mesenteric artery occlusion; 7 cases in interventional therapy group was stable, 1 case died of acute cardiac infarction 20 months after interventional operation (intestinal ischemia not appeared), 1 case had intestinal ischemia reoccurred and recovered by superior mesenteric artery thrombolysis. CONCLUSIONS In the treatment of acute superior mesenteric ischemia, stent implantation was obviously superior to pharmaceutical thrombolysis in improving intestinal ischemia and survival, therefore it could provided a reliable choice for the patients who had not appeared intestinal necrosis.
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Affiliation(s)
- Xi-tong Zhang
- Department of Interventional Radiology, the First Hospital of China Medical Univercity, Shenyang 110001, China.
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Battistelli S, Coratti F, Gori T. Porto-spleno-mesenteric venous thrombosis. INT ANGIOL 2011; 30:1-11. [PMID: 21248667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Porto-spleno-mesenteric (PSM) venous thrombosis is a rare clinical condition that, while being mostly unrecognized, is nonetheless often severe with a high morbidity and mortality. PSM venous thrombosis is the cause of as many as 5-10% of all abdominal ischemic events, and it presents with a highly variable and non-specific pattern of abdominal symptoms. Such complex and non-specific presentation can delay diagnosis, determining the poor clinical outcome of this condition. This review article discusses the information available on the pathogenesis, clinical presentation, diagnosis and general management of PSM venous thrombosis, with a focus on a number of some clinical issues that remain unaddressed. In particular, the current understanding of the predisposing factors and the heterogeneous clinical manifestations of this condition are described in detail. The recent advances in imaging techniques, which are leading to an improved diagnostic accuracy and facilitate an early diagnosis are also presented. Further, the indications and limits of both pharmacological and surgical treatment options are discussed.
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Affiliation(s)
- S Battistelli
- Department of General and Specialistic Surgery, University of Siena, Italy.
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Anzengruber F, Ramzan Z, Carasquillo J, Nunes F. Mesenteric ischemia. Isr Med Assoc J 2011; 13:66. [PMID: 21446243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Florian Anzengruber
- Department of Gastroenterology, Pennsylvania Hospital, affiliated with University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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Santora RJ, Lie ML, Grigoryev DN, Nasir O, Moore FA, Hassoun HT. Therapeutic distant organ effects of regional hypothermia during mesenteric ischemia-reperfusion injury. J Vasc Surg 2010; 52:1003-14. [PMID: 20678877 DOI: 10.1016/j.jvs.2010.05.088] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 05/06/2010] [Accepted: 05/16/2010] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Mesenteric ischemia-reperfusion injury (IRI) leads to systemic inflammation and multiple organ failure in clinical and laboratory settings. We investigated the lung structural, functional, and genomic response to mesenteric IRI with and without regional intraischemic hypothermia (RIH) in rodents and hypothesized that RIH would protect the lung and preferentially modulate the distant organ transcriptome under these conditions. METHODS Sprague-Dawley rats underwent sham laparotomy or superior mesenteric artery occlusion (SMAO) for 60 minutes with or without RIH. Gut temperature was maintained at 15°-20°C during SMAO, and systemic normothermia (37°C) was maintained throughout the study period. At 6 or 24 hours, lung tissue was collected for (1) histology, (2) myeloperoxidase activity, (3) bronchoalveolar lavage (BAL) fluid protein concentrations, (4) lung wet/dry ratios, and (5) total RNA isolation and hybridization to Illumina's Sentrix BeadChips (>22,000 probes) for gene expression profiling. Significantly affected genes (false discovery rate <5% and fold change ≥1.5) were linked to gene ontology (GO) terms using MAPPFinder, and hypothermia-suppressed genes were further analyzed with Pubmatrix. RESULTS Mesenteric IRI-induced lung injury, as evidenced by leukocyte trafficking, alveolar hemorrhage, and increased BAL protein and wet/dry ratios, and activated a proinflammatory lung transcriptome compared with sham. In contrast, rats treated with RIH exhibited lung histology, BAL protein, and wet/dry ratios similar to sham. At 6 hours, GO analysis identified 232 hypothermia-suppressed genes related to inflammation, innate immune response, and cell adhesion, and 33 hypothermia-activated genes related to lipid and amine metabolism and defense response. Quantitative real-time polymerase chain reaction validated select array changes in top hypothermia-suppressed genes lipocalin-2 (lcn-2) and chemokine ligand 1 (CXCL-1), prominent genes associated with neutrophil activation and trafficking. CONCLUSIONS Therapeutic hypothermia during SMAO provides distant organ protection and preferentially modulates the IRI-activated transcriptome in the rat lung. This study identifies potential novel diagnostic and therapeutic targets of mesenteric IRI and provides a platform for further mechanistic study of hypothermic protection at the cellular and subcellular level.
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Affiliation(s)
- Rachel J Santora
- Department of Surgery, The Methodist Hospital and Research Institute, Houston, Tex, USA
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38
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Giannetti A, Biscontri M, Randisi P, Cortese B, Minacci C, Stumpo M. Contrast-enhanced sonography in the diagnosis of acute mesenteric ischemia: case report. J Clin Ultrasound 2010; 38:156-160. [PMID: 20013893 DOI: 10.1002/jcu.20657] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Acute mesenteric ischemia is a serious condition associated with high mortality. Multislice CT and magnetic resonance angiography have proved accurate in diagnosing this pathology, which requires a prompt diagnosis to start appropriate therapy. We report the case of an 87-year-old woman with acute mesenteric ischemia, in whom contrast-enhanced sonography visualized the occluded superior mesenteric artery and the infarcted portion of the intestine.
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Affiliation(s)
- Andrea Giannetti
- Department of Gastroenterology, Misericordia Hospital, Grosseto, Italy
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39
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Gong JF, Zhu WM, Wu XJ, Li N, Li JS. [Damage control surgery for acute mesenteric ischemia]. Zhonghua Wei Chang Wai Ke Za Zhi 2010; 13:22-25. [PMID: 20099155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To examine the outcome of damage control surgery (DCS) in patients with acute mesenteric ischemia (AMI). METHODS Clinical data of 15 consecutive AMI cases treated with DCS from May 2001 to March 2009 at the Research Institute of General Surgery, Jinling Hospital were retrospectively analyzed. Eleven patients had acute superior mesenteric vein thrombosis (MVT) on admission, and 4 suffered from acute mesenteric arterial embolism/thrombosis (MAE/MAT). The staged damage control approach included immediate resection of the involved bowel (but no attempts to restore gastrointestinal continuity), open thrombectomy, transfer of the patients to ICU for resuscitation, and thrombolysis prior to the planned definitive reconstructive procedure. RESULTS Of 15 patients, 10 (66.7%) survived. The mean remnant small bowel length was (209.0+/-53.8) cm (120 to 280 cm). None of the survived patients was parenteral nutrition-dependent. Of the 5 deaths, 2 died of recurrence of thrombosis and necrosis of the remaining bowel,1 of massive gastrointestinal bleeding. One patient abandoned treatment intra-operatively, and another with total small bowel resection abandoned treatment postoperatively. CONCLUSIONS Damage control approach improves the survival of patients with AMI. Thrombectomy and thrombolysis are necessary for AMI management to prevent progression or further development of the thrombosis.
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Affiliation(s)
- Jian-Feng Gong
- Department of General Surgery, Jinling Hospital, Nanjing 200000, China
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40
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Alekseev TV, Movchan KN, Beznosov AI, Lozovskiĭ IF, Sidorenko VA. [Ways for optimization of treatment of patients with mesenterial thrombosis in municipal medical institutions of small towns and rural area]. Vestn Khir Im I I Grek 2010; 169:92-95. [PMID: 20552800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
An analysis of 199 cases has shown that verification of mesenterial thrombosis in municipal medical institutions is 5.6% at the prehospital period, 23% in the admission rooms of hospitals, 30%--in surgical departments before operation. The index of postoperative lethality remains high reaching 91.3% in municipal hospitals of Leningrad oblast. In order to improve results of treatment of patients with mesenterial thrombosis in municipal medical institutions of small towns and rural area it is necessary to develop technology and organization of medical aid in municipal medical institutions.
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41
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Sudah M, Kaukanen E, Grönlund S, Manninen H. [Endovascular treatment of mesenterial ischaemia]. Duodecim 2010; 126:957-968. [PMID: 20597340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Mesenteric ischaemia is an uncommon but an important diagnosis because of its high mortality rate. The outcome is dependent upon high index of clinical suspicion and rapid management. Modern computed tomography plays a major role in the diagnosis of this disease. Open surgical revascularization is associated with high mortality and morbidity but high rate of symptom relief in chronic ischaemia. Endovascular revascularization is increasingly used in the treatment of the disease and is an acceptable alternative to open surgery in selected patients, due to lower in-hospital complications and mortality. Restenosis after endovascular therapy of chronic ischemia is an issue of concern with more frequent reinterventions needed to maintain patency.
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Affiliation(s)
- Mazen Sudah
- Pohjois-Karjalan keskussairaala, Röntgenliikelaitos, Tikkamäentie 16, 80210 Joensuu
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42
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Florian A, Jurcut R, Lupescu I, Grasu M, Croitoru M, Ginghină C. Mesenteric ischemia--a complex disease requiring an interdisciplinary approach. A review of the current literature. Rom J Intern Med 2010; 48:207-222. [PMID: 21528746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Mesenteric ischemia is caused by a reduction in intestinal blood flow with potential catastrophic clinical consequences: sepsis, bowel infarction, and death. In the recent years, the incidence of mesenteric ischemia increased, now accounting for 0.1% of hospital admissions. Among the multiple factors responsible for this change is the heightened awareness for the diagnoses, the advanced mean age of the population and the increasing number of critically ill patients. Acute mesenteric ischemia is a potentially fatal vascular emergency, with overall mortality of 60-80%; prompt diagnosis and treatment are paramount. A high index of suspicion in the setting of a compatible history and physical examination serves as the cornerstone to early diagnosis of mesenteric ischemia. Restoration of intestinal blood flow, as rapidly as possible, is the main goal of treatment in patients with acute mesenteric ischemia. This may be achieved by medical means, endovascular procedures and by surgery. Chronic mesenteric ischemia is an uncommon process that occurs only when severe atherosclerotic narrowing of a major splanchnic vessel exists in association with occlusion of one or two of the remaining vessels. Its diagnosis is mainly based on the characteristic clinical picture, on the presence of an occlusive lesion in the splanchnic vessels and on the absence of other common causes of abdominal pain. The means available for mesenteric revascularization are the surgical techniques of flow restoration and the more recently developed percutaneous transluminal procedures.
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Affiliation(s)
- Anca Florian
- Cardiology Department, Prof. Dr. C.C. Iliescu Institute of Emergency for Cardiovascular Diseases, Bucharest, Romania
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43
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Jain P, Gandhi V, Marar S, Nagral A, Nagral S. Chronic abdominal pain--a radiological solution. J Assoc Physicians India 2010; 58:50-53. [PMID: 20649103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Chronic mesenteric ischaemia is not an uncommon disorder. It is associated with high morbidity and mortality. It presents with chronic abdominal pain and the diagnosis is often missed because of nonspecific clinical findings and limitations of diagnostic studies. Although surgery has been considered to be the mainstay of treatment, it is associated with significant morbidity. We report two cases of chronic mesenteric ischaemia managed effectively with endovascular therapy with no morbidity and good long term pain relief.
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Affiliation(s)
- Paresh Jain
- Department of General Surgery, Jaslok Hospital and Research Centre, Mumbai
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44
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Fan HL, He NS, E YJ. Endovascular stenting in isolated dissection of superior mesenteric artery. Chin Med J (Engl) 2009; 122:3099-3102. [PMID: 20137511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- Hai-Lun Fan
- Department of Radiology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
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45
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Hoffer EK, Krohmer S, Gemery J, Zaki B, Pipas JM. Endovascular recanalization of symptomatic portomesenteric venous obstruction after pancreaticoduodenectomy and radiation. J Vasc Interv Radiol 2009; 20:1633-7. [PMID: 19854066 DOI: 10.1016/j.jvir.2009.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Revised: 08/24/2009] [Accepted: 09/01/2009] [Indexed: 01/21/2023] Open
Abstract
Intraoperative radiation therapy (RT) may improve outcomes after pancreaticoduodenectomy for periampullary cancer; however, there is a 20% risk of late portomesenteric venous obstruction. This retrospective study evaluated the percutaneous treatment of portomesenteric venous obstruction that occurred a mean of 10 months after pancreaticoduodenectomy and intraoperative RT. Five patients with medically refractory ascites and portomesenteric obstruction on computed tomographic angiography had successful recanalization with elimination of the pressure gradient and no procedural complications. One patient showed no improvement clinically. Recurrent ascites after stent occlusion was successfully treated in two patients. Percutaneous transhepatic recanalization appears to be a safe and effective therapy in this population.
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Affiliation(s)
- Eric K Hoffer
- Section of Vascular and Interventional Radiology, Dartmouth-Hitchcock Medical Center and Norris Cotton Cancer Center, One Medical Center Drive, Lebanon, NH 03756, USA.
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46
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Kougias P, Huynh TT, Lin PH. Clinical outcomes of mesenteric artery stenting versus surgical revascularization in chronic mesenteric ischemia. INT ANGIOL 2009; 28:132-137. [PMID: 19367243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM Endovascular stenting of atherosclerotic lesions has become a common practice and widely accepted treatment strategy in the treatment of arterial occlusive disease. This study examines the clinical outcome of mesenteric stenting and open mesenteric revascularization for chronic mesenteric ischemia (CMI). METHODS Hospital records and clinical data of all patients undergoing surgical or endovascular interventions for CMI were reviewed during a recent 10-year period. Clinical outcomes were analyzed between the two groups. RESULTS Endovascular treatment was performed in 48 patients (58 vessels), and open repair was performed in 96 patients (157 vessels) during the study period. The mean age in the endovascular group was greater than the open group (74+/-9 vs 62+/-7 years, P<0.05). There was no difference in comorbidities, symptom duration, or treatment indications between the two groups. Among patients treated with surgical revascularization, operative strategies included bypass grafting (N.=72, 75%); transaortic endarterectomy (N.=19, 20%), or patch angioplasty (N.=5, 5%). In the open group, one-vessel and two-vessel revascularization was performed in 36% and 64% of patients, respectively. In the endovascular cohorts, one-vessel and two-vessel balloon angioplasty and/or stenting were performed in 79% and 21% of patients, respectively. The hospital length of stay was shorter in the endovascular group (3 vs 12 days, P<0.03). There was no difference in 30-day mortality, in-hospital complication, or three-year cumulative survival rate. Cumulative freedom from recurrent symptoms at three years were significantly greater in the open group (66%) compared to the endovascular group (27%, P<0.02). CONCLUSIONS Endovascular treatment offers a benefit of shorter hospitalization compared to the open revascularization, while both groups had similar morbidity and mortality rates. Patients treated with surgical reconstruction were more likely to experience long-term symptomatic relief compared to endovascular cohorts, possibly due to higher incidence of two-vessel surgical revascularization. Long term durability of endovascular intervention may be improved with two-vessel revascularization.
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Affiliation(s)
- P Kougias
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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47
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Chen YX, Liu CW, Liu B. [Clinical features and therapeutic strategies of isolated superior mesenteric artery dissection: a meta-analysis of 101 cases]. Zhonghua Yi Xue Za Zhi 2008; 88:3345-3348. [PMID: 19257966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To summarize the clinical characters and therapeutic strategies of isolated superior mesenteric artery dissection, a rare disease. METHODS The clinical data of 101 patients of isolated superior mesenteric artery dissection, including 2 cases treated in the Peking Union Medical College Hospital and 99 cases collected from the literatures were analyzed. RESULTS 84.16% of the patients were males. The average age of the patients was 53.95. 70% conservative treatment was successful in 70% of the patients. The symptoms were alleviated in 52 patients, of which 36 had undergone surgeries and 16 had endovascular therapy. The restenosis rate of endovascular therapy was 12.50%. CONCLUSION Surgery and endovascular therapy are more effective than conservative treatments for isolated superior mesenteric artery dissection. The therapeutic strategies depend on the clinical symptoms and imaging examinations.
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Affiliation(s)
- Yue-Xin Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China
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48
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Hotoleanu C, Andercou O, Andercou A. Mesenteric venous thrombosis: clinical and therapeutical approach. INT ANGIOL 2008; 27:462-465. [PMID: 19078907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Mesenteric venous thrombosis (MVT), an unusual location of deep venous thrombosis, occurs especially on a predisposing terrain. Recently, hyperhomocysteinemia has been shown to be associated with venous thrombosis, often recurrent and located in an uncommon site. Hyperhomocysteinemia is mainly due to genetic causes (mutations 677C>T and 1298A>C of methylenetetrahydrofolate reductase) and vitamins B deficiencies. MVT may present as acute, subacute or chronic form. The clinical supposition of mesenteric thrombosis is based on the discrepancy between the abdominal pain and the physical examination. The nonspecific character of the pain, mimicking peptic ulceration in some cases, and the possibility of an initial normal clinical examination may delay the diagnosis. The occurrence of the fever, rebound tenderness and guarding suggests progression to bowel infarction. MVT leads to peritonitis in 1/3 to 2/3 of cases. Laboratory blood tests are not helpful in confirming the diagnosis of venous thrombosis. Leukocytosis and metabolic acidosis are considered to be the most specific laboratory findings in patients with mesenteric ischemia. Abdominal computed tomography is the test of choice for the diagnosis. However, most of the cases are diagnosed during laparotomy or autopsy. Anticoagulant therapy administrated early increases the survival rate. Surgery is indicated in cases with bowel infarction or peritonitis.
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Affiliation(s)
- C Hotoleanu
- Medical Clinic 2, UMF Iuliu Hatieganu, Cluj-Napoca, Romania.
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49
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Fischerová B. [Notes on the issues of acute embolization into the veins in the splanchnic bed--editorial]. Vnitr Lek 2008; 54:1029-1030. [PMID: 19069674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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50
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Miklík R, Kala P, Manousek J, Poloczek M, Parenica J, Lokaj P, Spinar J. [Acute embolization into the veins in the splanchnic bed--an overview of current methods of diagnosis and therapies]. Vnitr Lek 2008; 54:1081-1086. [PMID: 19069681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Acute mesentery artery embolization is a rare diagnosis. In case of late recognition the mortality may reach up to 93%. Acute abdominal pain, vomitus, rapid and sudden bowel evacuation with or without blood are the typical symptoms of the disease. Unfortunately, the symptoms do not often correlate with clinical findings. Plain X-ray of abdomen or CT tomography may show no signs of intestinal ischaemia. The diagnostic method to choose is either spiral CT angiography or contrast angiography, respectively. The most common therapeutical approach is surgical revascularization but in selected cases it is feasible to perform local thrombolysis with a microcatheter placed directly into the occluded artery. Papaverin vasodilatation and intravenous anticoagulation are also justifiable, catheter aspiration and stent implantation have also been challenged. Our review is to provide a detailed up-to-date information about the issue and is an extensive follow-up of our recently published case report [Superior mesentery artery embolization as a complication of the primary angioplasty solved by local thrombolysis. Vnitr Lék 2008; 54(9): 871-875].
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Affiliation(s)
- R Miklík
- Interní kardiologická klinika Lékarské fakulty MU a FN Brno, pracoviste Bohunice.
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