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Interventional Cardiology Clinics Apr 2020Atherosclerotic renal artery stenosis is the most common cause of secondary hypertension and may cause progressive renal disease and cardiac destabilization syndromes.... (Review)
Review
Atherosclerotic renal artery stenosis is the most common cause of secondary hypertension and may cause progressive renal disease and cardiac destabilization syndromes. Guideline-directed medical therapy is advised in all patients. Patients with refractory symptoms and hemodynamically significant stenoses are more likely to benefit from renal artery stent placement. Chronic mesenteric ischemia (CMI) is an infrequent and difficult to diagnose illness. Due to robust collateralization, clinical symptoms from mesenteric artery stenosis or occlusion is uncommon. Atherosclerosis is the most common etiology of CMI. Current evidence suggests that, compared with open surgical repair, endovascular therapy is the most cost-effective choice for CMI.
Topics: Computed Tomography Angiography; Humans; Mesenteric Arteries; Mesenteric Ischemia; Renal Artery; Renal Artery Obstruction; Stents; Vascular Surgical Procedures
PubMed: 32147118
DOI: 10.1016/j.iccl.2019.11.002 -
Vascular Medicine (London, England) Feb 2021
Topics: Celiac Artery; Chronic Disease; Constriction, Pathologic; Humans; Ischemia; Mesenteric Arteries; Mesenteric Artery, Superior; Mesenteric Ischemia; Mesenteric Vascular Occlusion; Stents
PubMed: 33357138
DOI: 10.1177/1358863X20979734 -
Progress in Cardiovascular Diseases 2021Chronic mesenteric ischemia (CMI) is an uncommon, potentially underdiagnosed clinical condition. Although there is a high prevalence of mesenteric artery stenoses (MAS),... (Review)
Review
Chronic mesenteric ischemia (CMI) is an uncommon, potentially underdiagnosed clinical condition. Although there is a high prevalence of mesenteric artery stenoses (MAS), an abundant collateral network in the mesenteric circulation mitigates occurrence of ischemia. The most common etiology of CMI is atherosclerosis. CMI is a clinical diagnosis, based upon typical and atypical symptoms and consistent anatomic findings. Typical symptoms of CMI are postprandial abdominal pain, unintended weight loss and food avoidance. The main modalities to diagnose MAS are duplex ultrasound, CT angiography or MR angiography, although high resolution CTA is preferred. Endovascular therapy with balloon expandable stents has become the preferred treatment for MAS.
Topics: Angioplasty, Balloon; Chronic Disease; Constriction, Pathologic; Endarterectomy; Humans; Incidence; Mesenteric Arteries; Mesenteric Ischemia; Mesenteric Vascular Occlusion; Prevalence; Stents; Treatment Outcome; Vascular Grafting; Vascular Patency
PubMed: 33901516
DOI: 10.1016/j.pcad.2021.03.002 -
Clinical Anatomy (New York, N.Y.) May 2022The aim of this study was to characterize the branching pattern and morphology of the superior mesenteric artery (SMA), and also to create a new SMA classification,...
The aim of this study was to characterize the branching pattern and morphology of the superior mesenteric artery (SMA), and also to create a new SMA classification, which seems necessary for clinicians performing surgery in this anatomical area. The anatomical variations in the branching patterns of the SMA were examined in 30 cadavers fixed in 10% formalin. Morphometric measurements were then obtained twice by two researchers. In the proposed classification system, Type I, characterized by all normal branches-inferior pancreatoduodenal artery, ileocolic artery, right colic artery, middle colic artery and intestinal arteries-occurred in 53.33% of the specimens. Type II, characterized by absence of the inferior pancreatoduodenal artery, was present in 26.67%. Type III, characterized by absence of the right colic artery, was present in 3.33%. Type IV, characterized by a common trunk for the inferior pancreatoduodenal artery and middle colic arteries, was observed in 3.33%. Type V, characterized by an aberrant hepatic artery and absence of the inferior pancreatoduodenal artery, was observed in 13.33%. The origin of the SMA was at the Th12/L1 level in 10% of cases, at L1 in 43.33%, at L1/L2 in 36.67%, and at L2 in 10%. The SMA is characterized by high morphological variability, the variants being associated with distinct clinical aspects. The introduction of a new, structured, anatomical classification seems necessary for all clinicians.
Topics: Cadaver; Humans; Mesenteric Artery, Superior
PubMed: 35088464
DOI: 10.1002/ca.23841 -
Khirurgiia 2022We report surgical treatment of 4 patients with superior mesenteric artery aneurysm. A comprehensive examination including Doppler ultrasound and CT angiography of...
We report surgical treatment of 4 patients with superior mesenteric artery aneurysm. A comprehensive examination including Doppler ultrasound and CT angiography of visceral arteries made it possible to assess the features of vascular anatomy. In accordance with the peculiarities of upper mesenteric artery angioarchitectonics, open and endovascular methods were used. A differentiated approach made it possible to treat patients without any complications.
Topics: Aneurysm; Computed Tomography Angiography; Endovascular Procedures; Gastrointestinal Diseases; Humans; Mesenteric Artery, Superior
PubMed: 36073591
DOI: 10.17116/hirurgia2022091105 -
Surgical and Radiologic Anatomy : SRA May 2022The literature reports the presence of the intermesenteric artery (IA), an anastomosis connecting the superior mesenteric artery (SMA) to the inferior mesenteric artery...
PURPOSE
The literature reports the presence of the intermesenteric artery (IA), an anastomosis connecting the superior mesenteric artery (SMA) to the inferior mesenteric artery (IMA) in 9-18% of human cadaver dissections. This is the first study describing the morphological and demographic characteristics of the IA based on in vivo imaging.
METHODS
A total of 150 consecutive abdominal computed tomography (CT) angiographies of adult patients identified by sex and age were analyzed. The IA was assessed for its presence, point of origin, pathway, point of insertion, and diameter at its origin. The diameters of the SMA, IMA, and other arteries from which the IA originated and into which it inserted were measured by CT angiography using Radiant™ and Osirix MD™ software.
RESULTS
The IA was found in 17 (51.5%) of the females and 60 (51.3%) of the males. The diameters of the SMA and IMA were larger in the males than in the females, but there was no sex difference in the diameter of the IA. The diameter of the SMA was larger than that of the IMA, and the diameter of the IA was smaller than that of the other arteries evaluated. An IA connecting the SMA and IMA trunks was found in 25.9% of the cases, while other connections between the branches of those trunks through an IA occurred less frequently.
CONCLUSIONS
The intermesenteric artery is more frequently found than the literature refers and in most of cases directly connects the upper and lower arterial mesenteric circulations.
Topics: Abdomen; Adult; Angiography; Female; Humans; Male; Mesenteric Artery, Inferior; Mesenteric Artery, Superior; Tomography, X-Ray Computed
PubMed: 35543749
DOI: 10.1007/s00276-022-02956-1 -
Anatomia, Histologia, Embryologia Sep 2021Rats are often used as animal models in studies such as on intestinal transplantation and anastomosis healing, which require colectomy. Although detailed information...
Rats are often used as animal models in studies such as on intestinal transplantation and anastomosis healing, which require colectomy. Although detailed information regarding arterial supply is important to establish accurate and reproducible experimental procedures, this has not been studied in the rat colon. Therefore, we analysed the detailed arterial distribution pattern and its individual variations in the colon of 34 rats. The rat colon received colic branches of the ileocolic artery, and the right, middle and left colic arteries. The single left colic artery constantly arose from the caudal mesenteric artery and was distributed to the descending colon, whereas the others showed variations in number and distribution. The ileocolic artery gave rise to one (12%) or two (88%) colic branches supplying the proximal ascending colon, and these branches formed rich, mesh-like anastomoses along the initial portion of the ascending colon. One (74%) or two (26%) right colic arteries originated from the cranial mesenteric artery and supplied the ascending colon and right colic flexure. Moreover, one (38%), two (56%) or three (6%) middle colic arteries emerged from the cranial mesenteric artery and were distributed to the transverse colon, left colic flexure and proximal descending colon. In total, we categorized the individual variations in arterial branching and anastomosis into 11 patterns. Arterial supply to the rat colon showed a specific pattern and frequent individual variations. These findings thus provide essential information for establishing reproducible models of rat colic surgery.
Topics: Animals; Colon; Intestines; Mesenteric Arteries; Rats
PubMed: 34414598
DOI: 10.1111/ahe.12730 -
Rheumatology (Oxford, England) Apr 2018
Topics: Diagnosis, Differential; Female; Humans; Magnetic Resonance Angiography; Mesenteric Arteries; Polyarteritis Nodosa; Radial Artery; Renal Artery; Ultrasonography; Young Adult
PubMed: 28968697
DOI: 10.1093/rheumatology/kex327 -
Surgery Today May 2016Mesenteric ischemia complicated by acute aortic dissection (AAD) is uncommon, but serious, as there is no established treatment strategy and it can progress rapidly to... (Review)
Review
Mesenteric ischemia complicated by acute aortic dissection (AAD) is uncommon, but serious, as there is no established treatment strategy and it can progress rapidly to multi-organ failure. Diagnosing mesenteric ischemia before necrotic change is difficult, not only for primary care physicians, but even for gastrointestinal or cardiovascular surgeons as it can occur at any time during surgery. Thus, measures need to be in place at the bedside to enable us to obtain information on visceral perfusion. It is often difficult to decide which of laparotomy or aortic repair should be performed first, especially when there is associated shock or malperfusion of other vital organs. The standard surgical procedures for mesenteric ischemia are prompt revascularization of the mesenteric artery and, if needed, resection of necrotic intestine. However, the development of endovascular treatment and the introduction of hybrid ORs have improved the treatment strategies for mesenteric ischemia. This article reviews the issues of "diagnosis" in relation to the mechanism of mesenteric ischemia, and discusses the current "treatment strategies".
Topics: Acute Disease; Aortic Dissection; Aortic Aneurysm; Endovascular Procedures; Humans; Laparoscopy; Mesenteric Arteries; Mesenteric Ischemia; Vascular Surgical Procedures
PubMed: 26024781
DOI: 10.1007/s00595-015-1193-4 -
Asian Cardiovascular & Thoracic Annals May 2023Spontaneous isolated mesenteric arterial dissection (SIMAD) is an uncommon subset of non-traumatic dissection of the mesenteric arteries without concurrent aortic... (Review)
Review
Spontaneous isolated mesenteric arterial dissection (SIMAD) is an uncommon subset of non-traumatic dissection of the mesenteric arteries without concurrent aortic dissection. Due to the widespread use of computer tomography angiography, SIMAD cases have been increasingly reported in the past 20 years. Common risk factors associated with SIMAD include male gender, age 50-60 years, hypertension and smoking. This review summarises the diagnostic pathway and management of SIMAD based on contemporary literature and proposes a treatment algorithm for SIMAD. The presentation of SIMAD can be divided into symptomatic and asymptomatic cases. Symptomatic patients should be carefully assessed to detect the development of complications, particularly bowel ischemia or vessel rupture. Although these complications are rare, they necessitate urgent surgical management. The vast majority of symptomatic SIMAD cases are uncomplicated and can be managed safely with conservative treatment that includes antihypertensive therapy, bowel rest, with or without antithrombotic therapy. For asymptomatic SIMAD cases, expectant management with outpatient surveillance imaging appears to be a safe strategy.
Topics: Humans; Male; Middle Aged; Mesenteric Artery, Superior; Mesenteric Arteries; Mesenteric Ischemia; Computed Tomography Angiography; Aortic Dissection; Treatment Outcome; Retrospective Studies
PubMed: 37005792
DOI: 10.1177/02184923231166338