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American Journal of Physiology. Heart... Nov 2019Hydrogen sulfide (HS) dilates isolated arteries, and knockout of the HS-synthesizing enzyme cystathionine γ-lyase (CSE) increases blood pressure. However, the... (Comparative Study)
Comparative Study
Hydrogen sulfide (HS) dilates isolated arteries, and knockout of the HS-synthesizing enzyme cystathionine γ-lyase (CSE) increases blood pressure. However, the contributions of endogenously produced HS to blood flow regulation in specific vascular beds are unknown. Published studies in isolated arteries show that CSE production of HS influences vascular tone more in small mesenteric arteries than in renal arteries or the aorta. Therefore, the goal of this study was to evaluate HS regulation of blood pressure, vascular resistance, and regional blood flows using chronically instrumented rats. We hypothesized that during whole animal CSE inhibition, vascular resistance would increase more in the mesenteric than the renal circulation. Under anesthesia, CSE inhibition [β-cyanoalanine (BCA), 30 mg/kg bolus + 5 mg·kg·min for 20 min iv) rapidly increased mean arterial pressure (MAP) more than saline administration (%Δ: saline -1.4 ± 0.75 vs. BCA 7.1 ± 1.69, < 0.05) but did not change resistance (MAP/flow) in either the mesenteric or renal circulation. In conscious rats, BCA infusion similarly increased MAP (%Δ: saline -0.8 ± 1.18 vs. BCA 8.2 ± 2.6, < 0.05, = 7) and significantly increased mesenteric resistance (saline 0.9 ± 3.1 vs. BCA 15.6 ± 6.5, < 0.05, = 12). The HS donor NaS (50 mg/kg) decreased blood pressure and mesenteric resistance ,but the fall in resistance was not significant. Inhibiting CSE for multiple days with dl-proparglycine (PAG, 50 mg·kg·min iv bolus for 5 days) significantly increased vascular resistance in both mesenteric (ratio of : saline 0.86 ± 0.033 vs. PAG 1.79 ± 0.38) and renal circulations (ratio of : saline 1.26 ± 0.22 vs. 1.98 ± 0.14 PAG). These results support our hypothesis that CSE-derived HS is an important regulator of blood pressure and vascular resistance in both mesenteric and renal circulations. Furthermore, inhalation anesthesia diminishes the effect of CSE inhibition on vascular tone. These results suggest that CSE-derived HS has a prominent role in regulating blood pressure and blood flow under physiological conditions, which may have been underestimated in prior studies in anesthetized subjects. Therefore, enhancing substrate availability or enzyme activity or dosing with HS donors could be a novel therapeutic approach to treat cardiovascular diseases.
Topics: Alanine; Animals; Arterial Pressure; Blood Flow Velocity; Cystathionine gamma-Lyase; Enzyme Inhibitors; Hydrogen Sulfide; Male; Mesenteric Arteries; Rats, Sprague-Dawley; Renal Artery; Renal Circulation; Splanchnic Circulation; Sulfides; Vascular Resistance
PubMed: 31625777
DOI: 10.1152/ajpheart.00303.2019 -
Evaluation of characteristics of left-sided colorectal perfusion in elderly patients by angiography.World Journal of Gastroenterology Jun 2020Handling of the inferior mesenteric artery (IMA) and maintaining anastomotic perfusion are important in radical resection of left-sided colorectal cancer. However, the...
BACKGROUND
Handling of the inferior mesenteric artery (IMA) and maintaining anastomotic perfusion are important in radical resection of left-sided colorectal cancer. However, the branching of this artery and the drainage patterns of this vein vary among individuals, and the characteristics and perfusion region of this artery in elderly patients remain unclear.
AIM
To evaluate the characteristics and perfusion region of the IMA in elderly patients using angiography.
METHODS
We enrolled 154 patients (> 65 years old) who underwent digital subtraction angiography of the IMA. The characteristics, bifurcation, and distribution of the IMA and termination of the anastomotic perfusion of the left colon and rectum were examined using digital subtraction angiography. Collateral arterial arches and the IMA hemoperfusion region were also recorded. Perfusion regions were cross-referenced with clinical and anatomical features by the univariate analysis.
RESULTS
Of 154 patients, 25 (16.2%) had IMA lesions. The left colic artery arose independently from the IMA in 44.2% of patients, shared a trunk with the sigmoid artery in 35.1%, shared an opening with the sigmoid and superior rectal arteries in 16.9%, and was absent in 5.1%. The IMA perfusion region stopped at the splenic flexure in 50 (32.5%) patients. The collateral circulation existed in the colonic perfusion region, including the marginal artery (Drummond's artery), the ascending branch of the left colonic artery to supply the transverse colon, and the arc of Riolan with a frequency of 100%, 22.7%, and 1.9%, respectively. The IMA perfusion region was independently associated with the comorbidity of atherosclerosis, IMA atherosclerotic lesion, branching pattern, collateral circulation, and marginal artery integrity.
CONCLUSION
The IMA and its branches are prone to arteriosclerosis, and IMA perfusion may be interrupted at the splenic flexure in elderly patients. The applicability and precision of preoperative angiography for evaluating the IMA branching and perfusion patterns could facilitate geriatric laparoscopic left-sided colorectal cancer surgery with suspicion of poor IMA perfusion.
Topics: Aged; Angiography; Colorectal Neoplasms; Humans; Laparoscopy; Mesenteric Artery, Inferior; Perfusion
PubMed: 32655271
DOI: 10.3748/wjg.v26.i24.3484 -
VASA. Zeitschrift Fur Gefasskrankheiten Mar 2023Spontaneous peripheral dissections are rare, and in a substantial number of cases, the underlying aetiology remains unclear. We report the case of a 63-year-old male... (Review)
Review
Spontaneous peripheral dissections are rare, and in a substantial number of cases, the underlying aetiology remains unclear. We report the case of a 63-year-old male patient with a recent asymptomatic SARS-CoV-2 infection who presented with sudden-onset intermittent abdominal pain. Imaging studies revealed a dissection of the superior mesenteric artery (SMA) and large-vessel vasculitis involving the SMA as well as the carotid, subclavian, axillary and femoropopliteal arteries. In the absence of other predisposing factors, we supposed an association with prior COVID-19 and performed a systematic review of the literature to search for similar cases with arterial dissection related to acute or recent SARS-CoV-2 infection. We identified 25 cases, including ours: 13 males and 12 females, with a median age of 48 years. In 22/25 patients, arterial dissection occurred within 4 weeks after the diagnosis of COVID-19 and involved the cerebral (11/25; 44%), coronary (10/25; 40%), splanchnic (3/25; 12%) and renal (2/25; 8%) arteries. Although initially known for its respiratory manifestations, it has become evident that SARS-CoV-2 not only infects pneumocytes but also enters the vascular endothelium, leading to endothelial dysfunction and hypercoagulability and - as shown in our case - large-vessel vasculitis, which may predispose patients to intramural haemorrhage and arterial dissection.
Topics: Male; Female; Humans; Middle Aged; Mesenteric Artery, Superior; COVID-19; SARS-CoV-2; Abdominal Pain; Vasculitis
PubMed: 36636830
DOI: 10.1024/0301-1526/a001051 -
BMJ Case Reports Mar 2021Isolated dissection of one of the mesenteric arteries without concurrent involvement of the aorta is a rare clinical entity and an unusual cause of abdominal pain. It...
Isolated dissection of one of the mesenteric arteries without concurrent involvement of the aorta is a rare clinical entity and an unusual cause of abdominal pain. It usually involves one artery, most commonly the superior mesenteric artery (SMA) followed by the coeliac artery. We are reporting a rare case where both coeliac and SMA were showing dissection. We are reporting a case of 60-year-old hypertensive male who came with worsening abdominal pain for 5 days; CT scan showed coeliac and SMA dissection without any imaging evidence of intestinal ischaemia. He was successfully managed medically with bowel rest and anticoagulation. Two weeks of follow-up CT scan showed no progression or thrombus formation. For complicated cases, percutaneous transluminal angioplasty of a visceral artery or open surgical exploration or hybrid approach is required. However, for stable uncomplicated cases, medical therapy alone is sufficient.
Topics: Aortic Dissection; Celiac Artery; Dissection; Humans; Male; Mesenteric Artery, Superior; Mesenteric Ischemia; Middle Aged
PubMed: 33722914
DOI: 10.1136/bcr-2020-240047 -
Anatomical Science International Jun 2021A plate-like structure is located posterior to the portal vein system, between the pancreatic head and roots and/or branches of two major arteries of the aorta: the...
What comprises the plate-like structure between the pancreatic head and the celiac trunk and superior mesenteric artery? A proposal for the term "P-A ligament" based on anatomical findings.
A plate-like structure is located posterior to the portal vein system, between the pancreatic head and roots and/or branches of two major arteries of the aorta: the celiac trunk and superior mesenteric artery. We aimed to clarify the distribution and components of this plate-like structure. Macroscopic examination of the upper abdomen and histological examination of the plate-like structure were performed on 26 cadavers. The plate-like structure is connected to major arteries (aorta, celiac trunk, superior mesenteric artery) and the pancreatic head; it contains abundant fibrous bundles comprising nerves, vessels, collagen fibers, and adipose tissue. Furthermore, it consists of three partly overlapping fibrous components: rich fibrous bundles (superior mesenteric artery plexus) fused to the uncinate process of the pancreas; fibrous bundles arising from the right celiac ganglion and celiac trunk that spread radially to the dorsal side of the pancreatic head and superior mesenteric artery plexus; and fibrous bundles, accompanied by the inferior pancreaticoduodenal artery, entering the pancreatic head. The plate-like structure is the pancreas-major arteries (aorta, celiac trunk, superior mesenteric artery) ligament (P-A ligament). The term "P-A ligament" may be clinically useful and can facilitate comprehensive understanding of the anatomy surrounding the pancreatic head and provide an anatomical basis for further pancreatic surgery studies.
Topics: Aged; Aged, 80 and over; Celiac Artery; Female; Hepatic Artery; Humans; Ligaments; Male; Mesenteric Artery, Superior; Pancreas
PubMed: 33417190
DOI: 10.1007/s12565-020-00597-1 -
International Journal of Surgery... May 2017To demonstrate the clinical applicability of 3-dimensional CT angiography (3D-CTA) in evaluating the anatomic variations of inferior mesenteric artery (IMA) and left... (Observational Study)
Observational Study
Anatomic variations of inferior mesenteric artery and left colic artery evaluated by 3-dimensional CT angiography: Insights into rectal cancer surgery - A retrospective observational study.
OBJECTIVE
To demonstrate the clinical applicability of 3-dimensional CT angiography (3D-CTA) in evaluating the anatomic variations of inferior mesenteric artery (IMA) and left colic artery (LCA), to help make pre-operative strategies of rectal cancer surgery.
METHODS
188 patients with abdominal and pelvic contrast-enhanced CT scan were retrospectively enrolled and 3D-CTA was reconstructed. The origin and branching patterns of IMA, tracking patterns of LCA, intersectional patterns among IMA, LCA and inferior mesenteric vein (IMV) were examined, and their associations with clinical features were analyzed.
RESULTS
The origin of IMA was located 42.1 ± 7.7 mm above iliac artery bifurcation, 64.4% within the area of the 3rd lumbar vertebra. 47.3% of LCA arose independently from IMA, 27.1% arose at the root of sigmoid artery (SA), 20.7% shared a common trunk with SA while 4.8% of LCA was absent. As for track of LCA before anastomosis with marginal artery, 53.2% went straight upward while medial to the inner border of left kidney (Type A), 27.1% traveled diagonally across left kidney (Type B) and14.9% went infero-laterally to the lower border of left kidney (Type C). Short IMA trunk was independently associated with type A LCA and lower site of IMA origin. At the horizontal level of IMA origin, 29% of the LCA went distant from IMV, while 71% (21% medial, 50% lateral) were mutually close, and the close type was independently associated with type A LCA.
CONCLUSION
Preoperative understanding of the vascular variations and the mutual relationship among LCA, IMA and IMV could be obtained by 3D-CTA, which would further help surgeons to set detailed plans for laparoscopic rectal cancer surgery.
Topics: Anatomic Variation; Arteries; Colon, Transverse; Computed Tomography Angiography; Female; Humans; Laparoscopy; Male; Mesenteric Artery, Inferior; Middle Aged; Rectal Neoplasms; Retrospective Studies
PubMed: 28323157
DOI: 10.1016/j.ijsu.2017.03.012 -
Journal of the American Heart... Oct 2020Background is a major susceptibility gene for moyamoya disease (MMD), characterized by chronic progressive steno-occlusion of the intracranial arteries. However,...
Background is a major susceptibility gene for moyamoya disease (MMD), characterized by chronic progressive steno-occlusion of the intracranial arteries. However, coincidental extracranial arteriopathy is sporadically described in a few cases and in children with MMD. Methods and Results This study prospectively enrolled 63 young adults (aged 20-49 years) without a known history of systemic vascular diseases who were confirmed to have definite (bilateral, n=54) or probable (unilateral, n=9) MMD, as per typical angiographic findings. Coronary and aorta computed tomography angiography was performed to characterize extracranial arteriopathy and investigate its correlation with clinical characteristics and MMD status, including the p.Arg4810Lys variation (c.14429G>A, rs112735431). Altogether, 11 of 63 patients (17%) had significant (>50%) stenosis in the coronary (n=6), superior mesenteric (n=2), celiac (n=2), renal (n=1), and/or internal iliac artery (n=1). One patient showed both mesenteric and iliac artery stenosis. Patients with extracranial arteriopathy were more likely to have diabetes mellitus and posterior cerebral artery involvement. Moreover, a higher prevalence of extracranial arteriopathy was observed in the presence of the p.Arg4810Lys variant (67% in homozygotes). After controlling for diabetes mellitus and posterior cerebral artery involvement, the p.Arg4810Lys variant was independently associated with extracranial arteriopathy (additive model; =0.035; adjusted odds ratio, 4.57; 95% CI, 1.11-27.20). Conclusions Young adults with MMD may have concomitant extracranial arteriopathy in various locations. Patients with variants, especially the p.Arg4810Lys homozygous variant, should be screened for systemic arteriopathy.
Topics: Adenosine Triphosphatases; Adult; Arterial Occlusive Diseases; Computed Tomography Angiography; Coronary Vessels; Female; Genetic Testing; Genetic Variation; Homozygote; Humans; Male; Mesenteric Arteries; Middle Aged; Moyamoya Disease; Polymorphism, Single Nucleotide; Renal Artery; Republic of Korea; Ubiquitin-Protein Ligases
PubMed: 32954918
DOI: 10.1161/JAHA.120.016670 -
Journal of Vascular Surgery Jul 2021To evaluate the outcomes of various surgical approaches in the treatment of renovascular hypertension and midaortic syndrome (MAS) in children. (Comparative Study)
Comparative Study
OBJECTIVE
To evaluate the outcomes of various surgical approaches in the treatment of renovascular hypertension and midaortic syndrome (MAS) in children.
METHODS
We performed a retrospective medical record review of patients who had undergone surgery for renovascular hypertension from 2010 to 2018 at our center under the care of a multidisciplinary team. The operative interventions included mesenteric artery growth improves circulation (MAGIC), tissue expander-stimulated lengthening of arteries (TESLA), aortic bypass using polytetrafluorethylene, renal artery reimplantation, and autotransplantation. The MAGIC procedure uses the meandering mesenteric artery as a free conduit for aortic bypass. The TESLA procedure is based on lengthening the normal distal aorta and iliac arteries by gradual filling of a retroaortic tissue expander for several weeks, followed by resection of the stenotic aorta and subsequent primary reconstruction.
RESULTS
A total of 39 patients were identified, 10 with isolated renal artery stenosis, 26 with MAS, and 3 with systemic inflammatory vasculitis. The median age at presentation and surgery was 6.4 years (range, 0-16.3 years) and 9.3 years (range, 0-9.2 years), respectively. The MAS-associated syndromes included neurofibromatosis type 1 (15.4%) and Williams syndrome (5.1%), although most cases were idiopathic. At surgery, 33.3% had had stage 1 hypertension (HTN), 53.8% stage 2 HTN, and 12.8% normal blood pressure with a median of three antihypertensive medications. Follow-up of 37 patients at a median of 2.5 years demonstrated normal blood pressure in 86.1%, stage 1 HTN in 8.3%, and stage 2 HTN in 5.6%, with a median of one antihypertensive medication for the entire cohort.
CONCLUSIONS
The patterns of vascular involvement leading to renovascular hypertension in children are variable and complex, requiring thoughtful multidisciplinary planning and surgical decision-making. The MAGIC and TESLA procedures provide feasible approaches for aortic bypass and reconstruction using autologous tissues and will result in normalization of blood pressure in 85% of children 2.5 years after surgery.
Topics: Adolescent; Age Factors; Aorta; Aortic Diseases; Arterial Occlusive Diseases; Blood Pressure; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Child; Child, Preschool; Female; Humans; Hypertension, Renovascular; Iliac Artery; Infant; Male; Mesenteric Arteries; Renal Artery; Renal Artery Obstruction; Replantation; Retrospective Studies; Syndrome; Time Factors; Tissue Expansion; Tissue Expansion Devices; Transplantation, Autologous; Treatment Outcome; Vascular Surgical Procedures
PubMed: 33340698
DOI: 10.1016/j.jvs.2020.12.053 -
Journal of Vascular Surgery Jan 2018
Topics: Abdominal Pain; Axillary Artery; Computed Tomography Angiography; Humans; Ischemia; Male; Mesenteric Arteries; Mesenteric Vascular Occlusion; Middle Aged; Postprandial Period; Vascular Grafting
PubMed: 29268920
DOI: 10.1016/j.jvs.2016.08.088 -
International Journal of Molecular... Nov 2021(1) Background: Chronic increases in blood flow, as in cardiovascular diseases, induce outward arterial remodeling. Thrombospondin-1 (TSP-1) is known to interact with...
(1) Background: Chronic increases in blood flow, as in cardiovascular diseases, induce outward arterial remodeling. Thrombospondin-1 (TSP-1) is known to interact with matrix proteins and immune cell-surface receptors, but its contribution to flow-mediated remodeling in the microcirculation remains unknown. (2) Methods: Mesenteric arteries were ligated in vivo to generate high- (HF) and normal-flow (NF) arteries in wild-type (WT) and TSP-1-deleted mice (TSP-1). After 7 days, arteries were isolated and studied ex vivo. (3) Results: Chronic increases in blood flow induced outward remodeling in WT mice (increasing diameter from 221 ± 10 to 280 ± 10 µm with 75 mmHg intraluminal pressure) without significant effect in TSP-1 (296 ± 18 to 303 ± 14 µm), neutropenic or adoptive bone marrow transfer mice. Four days after ligature, pro inflammatory gene expression levels (CD68, Cox2, Gp91phox, p47phox and p22phox) increased in WT HF arteries but not in TSP-1 mice. Perivascular neutrophil accumulation at day 4 was significantly lower in TSP-1 than in WT mice. (4) Conclusions: TSP-1 origin is important; indeed, circulating TSP-1 participates in vasodilation, whereas both circulating and tissue TSP-1 are involved in arterial wall thickness and diameter expansion.
Topics: Animals; Endothelium, Vascular; Mesenteric Arteries; Mice; Mice, Knockout; Microcirculation; Models, Animal; Regional Blood Flow; Thrombospondin 1; Vasodilation
PubMed: 34769516
DOI: 10.3390/ijms222112086