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Chirurgie (Heidelberg, Germany) May 2024
Topics: Humans; Mesenteric Ischemia; Ischemia; Mesenteric Arteries
PubMed: 38639773
DOI: 10.1007/s00104-024-02048-3 -
Folia Morphologica Dec 2023The superior mesenteric artery is one of the most important arteries in the abdominal cavity, which is of great clinical importance, especially in surgical procedures...
BACKGROUND
The superior mesenteric artery is one of the most important arteries in the abdominal cavity, which is of great clinical importance, especially in surgical procedures and fatal ischemic complications. The aim of this study was to develop a clinical classification of the superior mesenteric artery.
MATERIALS AND METHODS
Postmortem contrast-enhanced computed tomography of 104 (29.8% female, age 50.7±18.7) human bodies were analyzed. Based on anatomic predisposition to ischemic and iatrogenic complications, a three-tiered clinical classification of the superior mesenteric artery was developed. Type 0 was defined as standard risk for ischemic and iatrogenic complications. Type 1 was defined as increased thromboembolic risk with decreased risk of iatrogenic bleeding, and type 2 was defined as decreased ischemic risk with increased risk of iatrogenic bleeding. The supply area of the superior mesenteric artery was divided into 4 regions: pancreas, caecum, ascending colon, and transverse colon.
RESULTS
Type 0 (standard risk) was found in 62.5% of cases. Type 1 was most frequently observed in the ascending colon region (15.4%). Type 2 was most frequently observed in the pancreatic region (17.3%). Regarding type, most abnormalities were found in the region of the ascending colon (18.3%), pancreas region (17.3%), and transverse colon (16.3%).
CONCLUSIONS
The proposed clinical classification of SMA links anatomic variations in morphology with their clinical significance. A simple, three-level classification can be easily applied in daily practice and serve as a great support for preoperative evaluation and recognition of patients at risk of iatrogenic or thromboembolic complications.
PubMed: 38152922
DOI: 10.5603/fm.98167 -
Frontiers in Cardiovascular Medicine 2023Abdominal vascular compression syndrome (AVCS) is caused by the compression of abdominal blood vessels by adjacent structures or the compression of abdominal organs by... (Review)
Review
Abdominal vascular compression syndrome (AVCS) is caused by the compression of abdominal blood vessels by adjacent structures or the compression of abdominal organs by neighboring blood vessels. Such compressions can result in a variety of clinical symptoms. They are not commonly seen in ultrasound practices, and their presence may have been underrecognized and underdiagnosed. This article reviews the clinical features, ultrasound characteristics, and diagnostic criteria of four types of AVCS, namely, celiac artery compression syndrome, renal vein compression syndrome, iliac vein compression syndrome, and superior mesenteric artery syndrome to increase awareness of these conditions among ultrasound practitioners. The ultrasound criteria for AVCS are primarily based on studies with small sample sizes, and therefore, it is important to exercise caution if these criteria are used.
PubMed: 38173818
DOI: 10.3389/fcvm.2023.1282597 -
Cellular and Molecular Life Sciences :... Jul 2023Dysregulated autophagy is associated with cardiovascular and metabolic diseases, where impaired flow-mediated endothelial cell responses promote cardiovascular risk. The...
Dysregulated autophagy is associated with cardiovascular and metabolic diseases, where impaired flow-mediated endothelial cell responses promote cardiovascular risk. The mechanism by which the autophagy machinery regulates endothelial functions is complex. We applied multi-omics approaches and in vitro and in vivo functional assays to decipher the diverse roles of autophagy in endothelial cells. We demonstrate that autophagy regulates VEGF-dependent VEGFR signaling and VEGFR-mediated and flow-mediated eNOS activation. Endothelial ATG5 deficiency in vivo results in selective loss of flow-induced vasodilation in mesenteric arteries and kidneys and increased cerebral and renal vascular resistance in vivo. We found a crucial pathophysiological role for autophagy in endothelial cells in flow-mediated outward arterial remodeling, prevention of neointima formation following wire injury, and recovery after myocardial infarction. Together, these findings unravel a fundamental role of autophagy in endothelial function, linking cell proteostasis to mechanosensing.
Topics: Humans; Autophagy; Autophagy-Related Protein 5; Endothelial Cells; Endothelium, Vascular; Mesenteric Arteries; Myocardial Infarction; Nitric Oxide Synthase Type III; Signal Transduction; Vasodilation; Animals; Mice
PubMed: 37460898
DOI: 10.1007/s00018-023-04859-9 -
FASEB Journal : Official Publication of... Sep 2023The evergreen plant rosemary (Salvia rosmarinus) has been employed medicinally for centuries as a memory aid, analgesic, spasmolytic, vasorelaxant and antihypertensive,...
The evergreen plant rosemary (Salvia rosmarinus) has been employed medicinally for centuries as a memory aid, analgesic, spasmolytic, vasorelaxant and antihypertensive, with recent preclinical and clinical evidence rationalizing some applications. Voltage-gated potassium (Kv) channels in the KCNQ (Kv7) subfamily are highly influential in the nervous system, muscle and epithelia. KCNQ4 and KCNQ5 regulate vascular smooth muscle excitability and contractility and are implicated as antihypertensive drug targets. Here, we found that rosemary extract potentiates homomeric and heteromeric KCNQ4 and KCNQ5 activity, resulting in membrane hyperpolarization. Two rosemary diterpenes, carnosol and carnosic acid, underlie the effects and, like rosemary, are efficacious KCNQ-dependent vasorelaxants, quantified by myography in rat mesenteric arteries. Sex- and estrous cycle stage-dependence of the vasorelaxation matches sex- and estrous cycle stage-dependent KCNQ expression. The results uncover a molecular mechanism underlying rosemary vasorelaxant effects and identify new chemical spaces for KCNQ-dependent vasorelaxants.
Topics: Rats; Animals; Muscle, Smooth, Vascular; Rosmarinus; Plants, Medicinal; KCNQ Potassium Channels; Vasodilator Agents
PubMed: 37535015
DOI: 10.1096/fj.202301132R -
Radiology Case Reports Sep 2023This case report describes the clinical presentation, diagnostic approach, and treatment strategies for a 58-year-old male patient diagnosed with spontaneous isolated...
This case report describes the clinical presentation, diagnostic approach, and treatment strategies for a 58-year-old male patient diagnosed with spontaneous isolated superior mesenteric artery dissection (SISMAD). The patient presented with suddenonset abdominal pain and was diagnosed with SISMAD using computed tomography angiography (CTA). SISMAD is a rare but potentially serious condition that can lead to bowel ischemia and other complications. Management options include surgery, endovascular therapy and conservative management with anticoagulation and close observation. The patient was managed conservatively with antiplatelet therapy and close follow-up. During hospitalization, he received antiplatelet therapy and was closely monitored for signs of bowel ischemia or other complications. The patients' symptoms gradually improved over time, and he was eventually discharged on oral mono- antiagreggation therapy. Clinical follow-up showed a significant symptimatic improvement. Conservative management with antiplatelet therapy was chosen due to the absence of bowel ischemia signs and overall stable clinical condition of patient. This report emphasizes the importance of prompt recognition and management of SISMAD to prevent potentially life-threatening complications. Conservative management with antiplatelet therapy can be a safe and effective treatment option for SISMAD, especially in cases without evidence of bowel ischemia or other complications.
PubMed: 37434612
DOI: 10.1016/j.radcr.2023.06.027 -
Journal of Vascular Surgery Cases and... Dec 2023Anatomic compression of the left renal vein in the angle between the aorta and superior mesenteric artery may be asymptomatic or may result in symptoms, including flank...
Anatomic compression of the left renal vein in the angle between the aorta and superior mesenteric artery may be asymptomatic or may result in symptoms, including flank pain, hematuria, or pelvic pain and/or congestion. Patients can be referred to a vascular surgeon due to symptoms and/or radiologic findings. Because symptoms of nutcracker syndrome can be vague and/or nondiagnostic, careful evaluation, assessment, and counseling with patients are required before undertaking intervention, which is often an open surgical procedure. The definitive diagnosis is ideally confirmed with diagnostic venography, including pressure measurements from the left renal vein and inferior vena cava. The optimal treatment includes open decompression of the left renal vein with renal vein transposition or gonadal vein transposition, with or without concomitant management of pelvic varicosities if symptomatic. Because most patients with nutcracker syndrome are young, long-term follow-up with scheduled ultrasound examinations should be maintained.
PubMed: 38054082
DOI: 10.1016/j.jvscit.2023.101344