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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 -
Clinical Physiology and Functional... Jan 2022Chronic mesenteric ischaemia (CMI) is a vastly underdiagnosed condition that typically leads to postprandial abdominal pain and weight loss. The aim of the study was to... (Clinical Trial)
Clinical Trial
BACKGROUND
Chronic mesenteric ischaemia (CMI) is a vastly underdiagnosed condition that typically leads to postprandial abdominal pain and weight loss. The aim of the study was to explore the involvement of various mesenteric vessels in total splanchnic blood flow (SBF) and hepatic vein oxygenation.
METHODS
Single-blinded comparative trial of 476 patients clinically suspected of CMI. Routine investigation included measurement of hepatic vein oxygen saturation, indirect measurement of the total splanchnic blood flow (SBF), using Fick's principle and the tracer [ Tc]Mebrofenin, before and after a meal, and digital subtraction angiography.
RESULTS
A total of 176 of the 476 patients (36%) had at least one angiographically significant stenosis (lumen reduction ≥70%). In patients with a significant one-vessel disease, the percentage having CMI according to SBF was 10% for a celiac trunk stenosis (n = 60), 50% for a superior mesenteric stenosis (n = 24) and 6% for an inferior mesenteric artery stenosis (n = 34). In patients with a significant two-vessel disease, the percentage with CMI according to SBF response was 92%, 18% and 79%, for no significant stenosis of the celiac trunk (n = 13), superior mesenteric artery (n = 17) and inferior mesenteric artery (n = 19), respectively.
CONCLUSION
Patients with significant one- or two-vessel stenosis involving the superior mesenteric artery have a higher likelihood of CMI according to flow criteria and a greater postprandial decrease in hepatic vein saturation on average than patients with no involvement of the superior mesenteric artery.
Topics: Aniline Compounds; Chronic Disease; Glycine; Humans; Mesenteric Arteries; Mesenteric Ischemia; Oxygen Saturation
PubMed: 34608740
DOI: 10.1111/cpf.12730 -
Surgery Today May 2022Surgical treatment of the transverse colon is difficult because of the many variations of blood vessels. We reviewed the patterns of vascular anatomy and the definition... (Review)
Review
Surgical treatment of the transverse colon is difficult because of the many variations of blood vessels. We reviewed the patterns of vascular anatomy and the definition of the vessels around the splenic flexure. We searched the PubMed database for studies on the vascular anatomy of the splenic flexure that were published from January 1990 to October 2020. After screening of full texts, 33 studies were selected. The middle colic arteries were reported to arise independently without forming a common trunk in 8.9-33.3% of cases. The left colic artery was absent in 0-7.5% of cases. The accessory middle colic artery was present in 6.7-48.9% of cases and was present in > 80% of cases without a left colic artery. The reported frequency of Riolan's arch was 7.5-27.8%. The frequency was found to vary widely across studies, partially due to the ambiguous definition of Riolan's arch. A comprehensive preoperative knowledge of the branching patterns of the middle colic artery and left colic artery and the presence of collateral arteries would be helpful in surgery for colon cancer in the splenic flexure.
Topics: Colon; Colon, Transverse; Colonic Neoplasms; Databases, Factual; Humans; Mesenteric Artery, Inferior; Mesenteric Artery, Superior
PubMed: 34350464
DOI: 10.1007/s00595-021-02328-z -
European Radiology Jun 2021A practical screening tool for chronic mesenteric ischemia (CMI) could facilitate early recognition and reduce undertreatment and diagnostic delay. This study explored...
OBJECTIVE
A practical screening tool for chronic mesenteric ischemia (CMI) could facilitate early recognition and reduce undertreatment and diagnostic delay. This study explored the ability to discriminate CMI from non-CMI patients with a mesenteric artery calcium score (MACS).
METHODS
This retrospective study included CTAs of consecutive patients with suspected CMI in a tertiary referral center between April 2016 and October 2019. A custom-built software module, using the Agatston definition, was developed and used to calculate the MACS for the celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery. Scoring was performed by two blinded observers. Interobserver agreement was determined using 39 CTAs scored independently by both observers. CMI was defined as sustained symptom improvement after treatment. Non-CMI patients were patients not diagnosed with CMI after a diagnostic workup and patients not responding to treatment.
RESULTS
The MACS was obtained in 184 patients, 49 CMI and 135 non-CMI. Interobserver agreement was excellent (intraclass correlation coefficient 0.910). The MACS of all mesenteric arteries was significantly higher in CMI patients than in non-CMI patients. ROC analysis of the combined MACS of CA + SMA showed an acceptable AUC (0.767), high sensitivity (87.8%), and high NPV (92.1%), when using a ≥ 29.7 CA + SMA MACS cutoff. Comparison of two CTAs, obtained in the same patient at different points in time with different scan and reconstruction parameters, was performed in 29 patients and revealed significant differences in MACSs.
CONCLUSION
MACS seems a promising screening method for CMI, but correction for scan and reconstruction parameters is warranted.
KEY POINTS
• A mesenteric artery calcium score obtained in celiac artery and superior mesenteric artery has a high negative predictive value for chronic mesenteric ischemia and could serve as a screening tool. • Interobserver agreement of the mesenteric artery calcium score is excellent. • Scan and reconstruction parameters influence the mesenteric artery calcium score and warrant the development of a method to correct for these parameters.
Topics: Calcium; Celiac Artery; Chronic Disease; Delayed Diagnosis; Humans; Ischemia; Mesenteric Arteries; Mesenteric Artery, Superior; Mesenteric Ischemia; Mesenteric Vascular Occlusion; Retrospective Studies; Stents; Treatment Outcome
PubMed: 33263162
DOI: 10.1007/s00330-020-07530-0 -
Pancreatology : Official Journal of the... Sep 2023The dorsal pancreatic artery (DPA) is a pancreatic branch with various anatomical variations. Previous studies mostly focused on the origin of the DPA, and its pathways...
OBJECTIVES
The dorsal pancreatic artery (DPA) is a pancreatic branch with various anatomical variations. Previous studies mostly focused on the origin of the DPA, and its pathways and branching patterns have rarely been examined. The purpose of this study was to investigate the branching patterns and pathways of the DPA.
METHODS
This study included 110 patients who underwent computed tomography scans. We examined the pathways and branching patterns of the DPA.
RESULTS
The DPA was identified in 101 patients (92%), and originated from the splenic artery in 30 patients (31%), the common hepatic artery in 17 patients (17%), the celiac trunk in 10 patients (10%), the superior mesenteric artery in 27 patients (27%), the replaced right hepatic artery in 7 patients (7%), the inferior pancreaticoduodenal artery in 5 patients (5%), and other arteries in 3 patients (3%). Four distinct types of branches were identified as follows: the superior branch (32%), the inferior branch (86%), the right branch (80%), and the accessory middle colic artery (12%). Additionally, the arcs of Buhler and Riolan were observed in two patients each and their anastomotic vessels followed almost the same pathway as the DPA.
CONCLUSION
A number of variations of the DPA were observed with regard to its origin and branching pattern; however, the DPA and its branches always ran along the same pathway, as summarized in Fig. 4. The anatomical information gained from this study may contribute to performing safe pancreatic resections.
Topics: Humans; Splenic Artery; Pancreas; Mesenteric Artery, Superior; Celiac Artery; Embryonic Development
PubMed: 37574438
DOI: 10.1016/j.pan.2023.07.009 -
Reproductive Sciences (Thousand Oaks,... Apr 2021Epidemiological evidence suggests that normal pregnancy in women is associated with decreased cardiovascular risk in later life. Clinical studies have provided evidence...
Epidemiological evidence suggests that normal pregnancy in women is associated with decreased cardiovascular risk in later life. Clinical studies have provided evidence that alterations in vascular function and structure are detectable long after delivery. To understand these findings, we examined mesenteric artery reactivity at both early (3 days and 2-4 weeks) and late (12 weeks) postpartum (PP) time points in relation to late pregnancy (LP) and lactation. Vessels from virgin controls, LP, PP, and nursing and non-nursing mothers were tested for responses to phenylephrine (PE), high potassium solutions (high K), and acetylcholine (ACh). Passive arterial distensibility, vessel dimensions, and collagen and elastin content were evaluated for the studied groups. We observed that (1) there was a significant inhibition of vascular reactivity to PE in LP, 3 days and 2 weeks PP vessels that returned to pre-pregnancy levels at 4 and 12 weeks PP; (2) inhibition of NO production in PP vessels restored PE-induced constriction to pre-pregnancy levels; (3) vasodilator responses to ACh were similar at all PP periods; (4) LP and early PP was associated with a persistent increase in arterial distensibility that correlates with a PP-induced reduction in wall collagen, and regressed to pre-conception levels at 12 weeks PP; (5) vessels from non-nursing PP mice demonstrated an increased PE reactivity, diminished responses to ACh, and reduced distensibility compared to breastfeeding mice. These studies provide a timeframe for mesenteric artery adaptations that occur during pregnancy and extend to the PP period, but which may be modified by PP events.
Topics: Acetylcholine; Animals; Collagen; Elastin; Female; Lactation; Mesenteric Arteries; Mice; Phenylephrine; Postpartum Period; Potassium; Pregnancy; Vasoconstrictor Agents; Vasodilator Agents
PubMed: 33415648
DOI: 10.1007/s43032-020-00402-4 -
Journal of Vascular and Interventional... Feb 2022
Topics: Digestive System Abnormalities; Humans; Intestinal Volvulus; Mesenteric Arteries
PubMed: 35101225
DOI: 10.1016/j.jvir.2021.10.024 -
The Journal of Invasive Cardiology Jul 2022Three-dimensional (3D) printing of mesenteric artery (MA) anatomy preprocedurally for endovascular interventions can allow strategic preprocedure planning and improve...
BACKGROUND
Three-dimensional (3D) printing of mesenteric artery (MA) anatomy preprocedurally for endovascular interventions can allow strategic preprocedure planning and improve procedure-related clinical outcomes.
METHODS
Three patients with computed tomography angiography (CTA) of the abdomen and pelvis who subsequently underwent MA interventions were 3D printed retrospectively, and 2 patients with symptoms and severe MA stenosis on CTA, who had not undergone intervention, were 3D printed for procedure-related planning and anatomy-specific implications. The 3D-printed models (3D-PMs) were painted with acrylic paint to highlight anatomy. Reference vessel size, lesion length (LL), and renal artery (RA) to MA distance were determined using a digital millimeter caliper.
RESULTS
Each of the 5 patients with variable anatomy, including an MA chronic total occlusion (CTO), were successfully 3D printed. A digital caliper allowed determination of vessel size, LL, and RA to MA distance, which were then compared with intraprocedural MA angiograms and intravascular imaging when available. Further complex anatomies, such as intraprocedural navigation in the setting of prior abdominal aortic endograft and CTO assessment with relevance to cap morphology, small branch arteries, and collateral flow, were also successfully 3D printed.
CONCLUSION
Preprocedural 3D printing of MA anatomy for interventions can theoretically lead to decreases in contrast use, radiation dose, and fluoroscopic and procedural times, as well as enhance comprehension of complex patient-specific anatomy.
Topics: Abdomen; Angiography; Feasibility Studies; Humans; Mesenteric Arteries; Printing, Three-Dimensional; Retrospective Studies
PubMed: 35551104
DOI: No ID Found -
Anatomical Science International Jun 2021Awareness of the anatomical variations in abdominal surface anatomy with emphasis on relation to the abdominal planes may facilitate anatomical education and physical...
Awareness of the anatomical variations in abdominal surface anatomy with emphasis on relation to the abdominal planes may facilitate anatomical education and physical examination and inconvenience surgical intervention by giving surgeons more insight in surgical planning and training. This study was designed to verify whether the anatomical planes promote to the comprehension of surface anatomy and how the lumbar lordosis angle affects the vertebral level of the bifurcation of great vessels. This retrospective study was performed using computed tomography angiography images of 155 patients ranging from 18 up to 82 years. The vertebral levels of the celiac truncus, superior mesenteric artery, portal vein confluence, right and left renal arteries were within the transpyloric plane in 60%, 70%, 56.1% and 48.3-36.2% of patients, respectively. The inferior mesenteric artery was below the subcostal plane in 58% of patients. The aortic bifurcation (AB) was mostly corresponded to the level of L4 and was located within the umbilical plane in 73.1% of patients. The level of the inferior vena cava (IVC) confluence was within the supracristal plane in 54% of patients. We measured the mean value of the AB, IVC and lumbar lordosis angles as 39.54°, 58.05° and 54.26°, respectively. The AB and IVC levels showed a downward shift with decreasing lumbar lordosis angle. Precise knowledge of these relationships is crucial in clinical practice and surgical approaches to the anterior lumbosacral spine for safer and effective surgery.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Computed Tomography Angiography; Female; Humans; Lordosis; Lumbar Vertebrae; Male; Mesenteric Arteries; Middle Aged; Retrospective Studies; Young Adult
PubMed: 33453038
DOI: 10.1007/s12565-021-00602-1 -
The Israel Medical Association Journal... Sep 2021Among dialysis patients, occlusive mesenteric vascular disease has rarely been reported.
BACKGROUND
Among dialysis patients, occlusive mesenteric vascular disease has rarely been reported.
OBJECTIVES
To report on the experience of one center with regard to diagnosing and treating this complication.
METHODS
The retrospective case-series involved six patients (3 females, 3 males; age 52-88 years; 5/6 were smokers) on chronic hemodialysis at a single center. All patients with symptoms suggestive of occlusive mesenteric disease and a subsequent angiographic intervention were included. Demographic, clinical, and laboratory data were collected from patient charts for the period before and after angioplasty and stenting of the mesenteric vessels. A Wilcoxon signed-rank test was used to compare the relevant data before and after the intervention.
RESULTS
All participants had variable co-morbidities and postprandial abdominal pain, food aversion, and weight loss. CT angiography was limited due to heavy vascular calcifications. All underwent angioplasty with stenting of the superior mesenteric artery (4 patients) or the celiac artery (2 patients). All procedures were successful in resolving abdominal pain, malnutrition, and inflammation. Weight loss before was 15 ± 2 kg and weight gain after was 6 ± 2 kg. C-reactive protein decreased from 13.4 ± 5.2 mg/dl to 2.2 ± 0.4 mg/dl (P < 0.05). Serum albumin increased from 3.0 ± 0.2 g/dl to 3.9 ± 0.1 g/dl (P < 0.05). Two patients underwent a repeat procedure (4 years, 5 months, respectively). Follow-up ranged from 0.5-7 years.
CONCLUSIONS
Occlusive mesenteric ischemia occurs among dialysis patients. The diagnosis requires a high degree of suspicion, and it is manageable by angiography and stenting of the most involved mesenteric artery.
Topics: Abdominal Pain; Aged; Aged, 80 and over; Angioplasty; Celiac Artery; Female; Follow-Up Studies; Humans; Male; Mesenteric Arteries; Mesenteric Ischemia; Mesenteric Vascular Occlusion; Middle Aged; Renal Dialysis; Retrospective Studies; Stents
PubMed: 34472237
DOI: No ID Found