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United European Gastroenterology Journal May 2020Chronic mesenteric ischaemia is a severe and incapacitating disease, causing complaints of post-prandial pain, fear of eating and weight loss. Even though chronic...
European guidelines on chronic mesenteric ischaemia - joint United European Gastroenterology, European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Gastrointestinal and Abdominal Radiology, Netherlands Association of Hepatogastroenterologists, Hellenic Society of...
Chronic mesenteric ischaemia is a severe and incapacitating disease, causing complaints of post-prandial pain, fear of eating and weight loss. Even though chronic mesenteric ischaemia may progress to acute mesenteric ischaemia, chronic mesenteric ischaemia remains an underappreciated and undertreated disease entity. Probable explanations are the lack of knowledge and awareness among physicians and the lack of a gold standard diagnostic test. The underappreciation of this disease results in diagnostic delays, underdiagnosis and undertreating of patients with chronic mesenteric ischaemia, potentially resulting in fatal acute mesenteric ischaemia. This guideline provides a comprehensive overview and repository of the current evidence and multidisciplinary expert agreement on pertinent issues regarding diagnosis and treatment, and provides guidance in the multidisciplinary field of chronic mesenteric ischaemia.
Topics: Chronic Disease; Computed Tomography Angiography; Contrast Media; Europe; Evidence-Based Medicine; Gastroenterology; Interdisciplinary Communication; Magnetic Resonance Angiography; Mesenteric Arteries; Mesenteric Ischemia; Patient Care Team; Radiology; Risk Assessment; Severity of Illness Index; Societies, Medical; Treatment Outcome
PubMed: 32297566
DOI: 10.1177/2050640620916681 -
Journal of Vascular Surgery Jan 2021Endovascular aortic aneurysm repair of complex aortic aneurysms requires incorporation of side branches using specially designed aortic stent grafts with fenestrations,...
Endovascular aortic aneurysm repair of complex aortic aneurysms requires incorporation of side branches using specially designed aortic stent grafts with fenestrations, directional branches, or parallel stent grafts. These techniques have been increasingly used and reported in the literature. The purpose of this document is to clarify and to update terminology, classification systems, measurement techniques, and end point definitions that are recommended for reports dealing with endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms involving the renal and mesenteric arteries.
Topics: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Endovascular Procedures; Female; Guidelines as Topic; Humans; Male; Mesenteric Arteries; Middle Aged; Publishing; Renal Artery; Societies, Medical; Specialties, Surgical; Terminology as Topic
PubMed: 32615285
DOI: 10.1016/j.jvs.2020.06.011 -
European Journal of Vascular and... Apr 2017
Review
Topics: Endovascular Procedures; Humans; Mesenteric Arteries; Mesenteric Veins; Predictive Value of Tests; Risk Factors; Splanchnic Circulation; Treatment Outcome; Vascular Diseases; Vascular Surgical Procedures
PubMed: 28359440
DOI: 10.1016/j.ejvs.2017.01.010 -
Revue Medicale de Liege May 2018Acute mesenteric ischemia is a real life-threatening emergency. Mode of presentation is severe abdominal pain with sudden onset. The etiology is most of the time embolus... (Review)
Review
Acute mesenteric ischemia is a real life-threatening emergency. Mode of presentation is severe abdominal pain with sudden onset. The etiology is most of the time embolus coming from the heart or thrombosis of atherosclerotic vessel wall concerning the superior mesenteric artery. The best investigation is computed tomography with intravenous contrast media injection. Treatment consists of revascularization by open surgery or endovascular approach. Bowel resection may be necessary, as well as delayed second look surgery. This paper aims to review etiologies and therapeutics options for acute mesenteric ischemia.
Topics: Acute Disease; Endovascular Procedures; Humans; Mesenteric Artery, Superior; Mesenteric Ischemia; Tomography, X-Ray Computed
PubMed: 29926570
DOI: No ID Found -
Pancreatology : Official Journal of the... Mar 2022The dorsal pancreatic artery is the main artery of the body and tail of the pancreas. Its origin and branching is highly variable. The aim of this study was to perform a... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/OBJECTIVES
The dorsal pancreatic artery is the main artery of the body and tail of the pancreas. Its origin and branching is highly variable. The aim of this study was to perform a meta-analysis to generate pooled prevalence data on the presence and origin of the dorsal pancreatic artery. Clinically important aspects of the dorsal pancreatic artery were summarised during the literature review.
METHODS
Major medical databases were searched. Data on the presence and point of origin of the dorsal pancreatic artery were extracted and quantitatively synthesised. The obtained data of anatomical based studies and computed tomography based studies were statistically analysed.
RESULTS
In total, 30 studies, comprising 2322 anatomical and computed tomography based cases were included. The dorsal pancreatic artery was present in 95.8% of cases. It originated from the splenic artery in 37.6% of cases, common hepatic artery in 18.3% of cases, coeliac trunk in 11.9% of cases and the superior mesenteric artery in 23.9% of cases. Other rare origins were present in 2.77% of cases. Multiple dorsal pancreatic arteries were found in 1,7% of cases. There was no significant difference in the presence or origin of the dorsal pancreatic artery between anatomical and computed tomography based studies.
CONCLUSION
The dorsal pancreatic artery is present in the vast majority of cases. Its origin and branching are highly variable. Multiplicity of the dorsal pancreatic artery is infrequent.
Topics: Celiac Artery; Humans; Mesenteric Artery, Superior; Pancreas; Splenic Artery; Tomography, X-Ray Computed
PubMed: 35177332
DOI: 10.1016/j.pan.2022.02.002 -
Journal of Vascular Surgery Jun 2016Visceral artery aneurysms as a result of arterial degenerative disease are rare (0.1%-2%), and the superior mesenteric artery (SMA) accounts for 3.2% of all reported... (Review)
Review
OBJECTIVE
Visceral artery aneurysms as a result of arterial degenerative disease are rare (0.1%-2%), and the superior mesenteric artery (SMA) accounts for 3.2% of all reported series. The current incidence of inferior mesenteric artery (IMA) aneurysm is unknown. However, infective causes (mycotic) of SMA and IMA aneurysm as a result of primary, secondary, and cryptogenic etiology remain a separate entity and attain fewer cases in the literature. Currently, there is no consensus on their presentation, diagnosis, and overall management.
METHODS
A systematic review and meta-aggregation of literature from 1944 to March 2015 in the English language and of adult subjects in MEDLINE, Ovid, CINAHL, and the Cochrane database was conducted.
RESULTS
The median age of patients with SMA aneurysm was 36 (range, 14-92) years, with a significant male predominance (73% vs 27%). In order of prevalence, abdominal pain (n = 25; 65%), low-grade fever (n = 23; 60%), malaise (n = 10; 26%), weight loss (n = 9; 23%), and nausea and vomiting (n = 8; 20%) were the most common presenting signs and symptoms. The most common microorganism was Streptococcus (n = 18; 47%), followed by Staphylococcus (n = 11; 28%). The investigative modality of choice was computed tomography (n = 22; 57.8%), followed by ultrasonography of the abdomen (n = 9; 23%). Primary etiology was noted in 5.4%, secondary in 71%, and cryptogenic in 13% of all cases. Aneurysmectomy alone was associated with bowel resection in four cases (10.5%), whereas aneurysmectomy with interposition vein grafting required no further intervention. The inpatient mortality after surgery was 7.8%, and the overall mortality was 15%. The median follow-up was 12 months (range, 2-120 months). The median age of patients with IMA aneurysm was 48 (range, 22-64) years, with a male predominance of 2:1 and abdominal pain in all cases (n = 3; 100%). The most common microorganism was Streptococcus (n = 2; 66.6%), and the operation of choice was aneurysmectomy (n = 2; 66.6%) after computed tomography scan (n = 3; 100%) as an investigative modality of choice.
CONCLUSIONS
The pentad of abdominal pain, pyrexia of unknown origin, malaise, weight loss, and nausea remains the most convincing presentation of mycotic aneurysms of the SMA and IMA. Computed tomography is the investigative modality of choice, and such patients are best served with aneurysmectomy alone in IMA aneurysms and interposition vein grafting in SMA aneurysms after initiation of antimicrobial therapy on suspicion of the diagnosis.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aneurysm, Infected; Anti-Bacterial Agents; Computed Tomography Angiography; Female; Humans; Male; Mesenteric Artery, Inferior; Mesenteric Artery, Superior; Middle Aged; Predictive Value of Tests; Risk Factors; Treatment Outcome; Vascular Surgical Procedures; Young Adult
PubMed: 26951998
DOI: 10.1016/j.jvs.2016.01.031 -
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 -
Experimental Physiology Aug 2016What is the topic of this review? This report looks at the role of endothelial nitric oxide signalling in the time-of-day variation in vasoconstriction of resistance... (Review)
Review
What is the topic of this review? This report looks at the role of endothelial nitric oxide signalling in the time-of-day variation in vasoconstriction of resistance vessels. What advances does it highlight? It highlights a time-of-day variation in contraction of mesenteric arteries, characterized by a reduced contractile response to either phenylephrine or high K(+) and increased relaxation in response to acetylcholine during the active period. This time-of-day variation in contraction results from a difference in endothelial nitric oxide synthase (eNOS) signalling that correlates with levels of eNOS expression, which peak during the active period and may have far reaching physiological consequences beyond regulation of blood pressure. There is a strong time-of-day variation in the vasoconstriction in response to sympathetic stimulation that may contribute to the time-of-day variation in blood pressure, which is characterized by a dip in blood pressure during the individual's rest period when sympathetic activity is low. Vasoconstriction is known to be regulated tightly by nitric oxide signalling from the endothelial cells, so we have looked at the effect of time-of-day on levels of endothelial nitric oxide synthase (eNOS) and vascular contractility. Mesenteric arteries isolated from the nocturnal rat exhibit a time-of-day variation in their contractile response to α1 -adrenoreceptor and muscarinic activation, which is characterized by a reduced vasoconstriction in response to phenylephrine and enhanced vasodilatation in response to acetylcholine during the rat's active period at night. An increase in eNOS signalling during the active period is responsible for this time-of-day difference in response to phenylephrine and acetylcholine and correlates with the large increase in eNOS expression (mRNA and protein) during the active period, possibly driven by the presence of a functioning peripheral circadian clock. This increase in eNOS signalling may function to limit the increase in peripheral resistance and therefore blood pressure during the increased sympathetic activity.
Topics: Animals; Blood Pressure; Endothelium, Vascular; Humans; Mesenteric Arteries; Nitric Oxide Synthase Type III; Signal Transduction; Vasoconstriction
PubMed: 27474265
DOI: 10.1113/EP085780 -
Canadian Association of Radiologists... Aug 2014The recent introduction of multidetector computed tomography scanners has significantly improved computed tomography angiographic (CTA) applications, especially for the... (Review)
Review
The recent introduction of multidetector computed tomography scanners has significantly improved computed tomography angiographic (CTA) applications, especially for the evaluation of medium- and small-arterial structures. CTA of the superior mesenteric artery has been reported previously. However, there have been few systematic and detailed reviews of the superior mesenteric artery pathologies that use CTA. The purpose of this pictorial essay is mainly to review the various superior mesenteric artery pathologies at CTA with our own experiences.
Topics: Contrast Media; Humans; Intestinal Diseases; Mesenteric Artery, Superior; Multidetector Computed Tomography; Vascular Diseases
PubMed: 24874500
DOI: 10.1016/j.carj.2013.10.001 -
The Journal of Thoracic and... Nov 2022We aimed to examine the incidence, etiologies, and consequences of acute mesenteric ischemia as well as the impact of preprocedural subclinical mesenteric artery...
OBJECTIVES
We aimed to examine the incidence, etiologies, and consequences of acute mesenteric ischemia as well as the impact of preprocedural subclinical mesenteric artery stenosis in patients undergoing transcatheter aortic valve replacement.
METHODS
Among prospective follow-up of 269 consecutive patients undergoing transcatheter aortic valve replacement, diagnosis of acute mesenteric ischemia was confirmed by abdominal computed tomography. Cumulative hazard of 1-year all-cause and cardiovascular mortality according to the absence or presence of mesenteric artery stenosis 70% or greater from preprocedural computed tomography angiography was analyzed.
RESULTS
Acute mesenteric ischemia was confirmed in 7 patients (2.6%) during mid-term (median, 33.3 months, interquartile range, 15.0-61.0 months) follow-up. Thrombotic occlusions of previously stenotic mesenteric arteries account for 4 cases (57.1%), and embolic acute mesenteric ischemia constitute the rest (42.9%) of the cases. The mortality rate of acute mesenteric ischemia was 100%. At 30 days, death from acute mesenteric ischemia accounts for 40% of all-cause mortality and 67% of cardiovascular death. By multivariable analysis, higher Society of Thoracic Surgeons score and mesenteric artery stenosis 70% or greater were independently associated with acute mesenteric ischemia. Thirty-two patients (11.9%) with preprocedural mesenteric artery stenosis 70% or greater had an increased risk of all-cause mortality (adjusted hazard ratio, 3.78; 95% confidence interval, 1.74-8.19; P = .001) at 1 year after transcatheter aortic valve replacement.
CONCLUSIONS
Acute mesenteric ischemia, an important cause of 30-day mortality, should be considered in patients who become clinically unstable after transcatheter aortic valve replacement, particularly but not exclusively in those with preexisting mesenteric artery stenosis. Mesenteric artery stenosis should be routinely assessed in all patients who are indicated for transcatheter aortic valve replacement considering the dismal prognosis of acute mesenteric ischemia.
Topics: Aortic Valve; Aortic Valve Stenosis; Constriction, Pathologic; Humans; Mesenteric Arteries; Mesenteric Ischemia; Peripheral Arterial Disease; Prospective Studies; Risk Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 35469598
DOI: 10.1016/j.jtcvs.2022.03.015