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Frontiers in Cardiovascular Medicine 2023Early/follow-up durability of superior mesenteric artery (SMA) stent-grafts is crucial after fenestrated/branched endografting (FB-EVAR) in complex abdominal aortic...
AIM
Early/follow-up durability of superior mesenteric artery (SMA) stent-grafts is crucial after fenestrated/branched endografting (FB-EVAR) in complex abdominal aortic aneurysms (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs). The study aimed to report early/midterm outcomes of SMA incorporated during FB-EVAR procedures.
METHODS
FB-EVAR procedures performed between 2016 and 2021 in a single institution were reviewed. Anatomical SMA characteristics were analyzed. The SMA configuration was classified into three types according to the angle between the SMA main trunk and the aorta: (A) perpendicular, (B) downward, and (C) upward. SMA-related technical success (SMA-TS: cannulation and stenting, patency at completion angiography without endoleak, stenosis/kinking, dissection, bleeding, and 24-h mortality) and SMA-adverse events (SMA-AEs: one among bowel ischemia, stenosis, occlusion, endoleak, reinterventions, or SMA-related mortality) were assessed.
RESULTS
Two hundred FB-EVAR procedures with SMA as the target artery were performed. The indication for FB-EVAR was CAAAs and TAAAs in 99 (49%) and 101 (51%) cases, respectively. The SMA configuration was A, B, and C in 132 (66%), 63 (31%), and 5 (3%) cases, respectively. SMA was incorporated with fenestrations and branches in 131 (66%) and 69 (34%) cases, respectively. Directional branch ( < .001), aortic diameter ≥35 mm at the SMA level ( < .001), and ≥2 SMA bridging stent-grafts ( = .001) were more frequent in TAAAs. Relining of the SMA stent-graft with a bare metal stent was necessary in 41 (21%) cases to correct an acute angle between the stent-graft and native artery (39), stent-graft stenosis (1), or SMA dissection (1). Relining was associated with type A or C SMA configuration (OR: 17; 95% CI: 1.8-157.3; = .01). SMA-TS was achieved in all cases. Overall, 15 (7.5%) patients had SMA-AEs [early: 9 (60%), follow-up: 6 (40%)] due to stenosis (2), endoleak (8), and bowel ischemia (5). Aortic diameter ≥35 mm at the SMA level was an independent risk factor for SMA-AEs (OR: 4; 95% CI: 1.4-13.8; = .01). Fourteen (7%) patients died during hospitalization with 10 (5%) events within the 30-postoperative day. Emergency cases (OR: 33; 95% CI: 5.7-191.3; = .001), peripheral arterial occlusive disease (OR: 14; 95% CI: 2.3-88.8; = .004), and bowel ischemia (OR: 41; 95% CI: 1.9-87.9; = .01) were risk factors for 30-day/in-hospital mortality. The mean follow-up was 32 ± 24 months; estimated 3-year survival was 81%, with no case of late SMA-related mortality or occlusion. The estimated 3-year freedom from overall and SMA-related reinterventions was 74% and 95%, respectively.
CONCLUSION
SMA orientation determines the necessity of stent-graft relining. Aortic diameter ≥35 mm at the SMA level is a predictor of SMA-AEs. Nevertheless, SMA-related outcomes of FB-EVAR are satisfactory, with excellent technical success and promising clinical outcomes during the follow-up.
PubMed: 37771670
DOI: 10.3389/fcvm.2023.1252533 -
Vascular Apr 2024Vascular aberrancy of superior mesenteric artery (SMA) may contribute to the occurrence of SMA dissection. However, there is no direct evidence to support this... (Review)
Review
OBJECTIVE
Vascular aberrancy of superior mesenteric artery (SMA) may contribute to the occurrence of SMA dissection. However, there is no direct evidence to support this hypothesis. Etiology, natural history, classification, and treatment options of ISMAD are still in controversial at some degree. We also review the current understanding of ISMAD based on our results.
METHODS
Out of 57 patients, 2 cases of isolated superior mesenteric artery dissection (ISMAD) which concomitant with replaced common hepatic artery with SMA origin, are first reported.
RESULTS
Two patients have no any typical etiological factors, such as atherosclerosis, hypertension, long-term smoking, and connective tissue disease. The contrast-enhanced computed tomography and (or) angiography showed concomitant SMA aberrancy. They have 81.2°, 132.7° SMA angle, respectively. After conservative treatment of 4, 6 days, respectively, these 2 patients were discharged smoothly.
CONCLUSION
Vascular aberrancy may be a new identified risk factor for ISMAD. Even in ISMAD cases with vascular aberrancy, conservative treatment still can be used as first line therapy.
PubMed: 38664953
DOI: 10.1177/17085381241251426 -
The Journal of General Physiology Jul 2024The TMEM16A calcium-activated chloride channel is a promising therapeutic target for various diseases. Niclosamide, an anthelmintic medication, has been considered a...
The TMEM16A calcium-activated chloride channel is a promising therapeutic target for various diseases. Niclosamide, an anthelmintic medication, has been considered a TMEM16A inhibitor for treating asthma and chronic obstructive pulmonary disease (COPD) but was recently found to possess broad-spectrum off-target effects. Here, we show that, under physiological Ca2+ (200-500 nM) and voltages, niclosamide acutely potentiates TMEM16A. Our computational and functional characterizations pinpoint a putative niclosamide binding site on the extracellular side of TMEM16A. Mutations in this site attenuate the potentiation. Moreover, niclosamide potentiates endogenous TMEM16A in vascular smooth muscle cells, triggers intracellular calcium increase, and constricts the murine mesenteric artery. Our findings advise caution when considering clinical applications of niclosamide as a TMEM16A inhibitor. The identification of the putative niclosamide binding site provides insights into the mechanism of TMEM16A pharmacological modulation and provides insights into developing specific TMEM16A modulators to treat human diseases.
Topics: Niclosamide; Anoctamin-1; Animals; Mice; Humans; Vasoconstriction; HEK293 Cells; Binding Sites; Calcium; Mesenteric Arteries; Muscle, Smooth, Vascular; Myocytes, Smooth Muscle; Male
PubMed: 38814250
DOI: 10.1085/jgp.202313460 -
Folia Morphologica Dec 2023The arterial supply of the large colon is provided by the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). A particularly important area,...
BACKGROUND
The arterial supply of the large colon is provided by the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). A particularly important area, especially in the field of colorectal surgery is the splenic flexure of the colon. There is a noticeable misunderstanding in the correct nomenclature of the major arterial anastomoses between SMA and IMA - Drummond's Marginal Artery (DMA), Arc of Riolan (AOR), and Moskovitz Artery (MA). The aim of this study is to organize the nomenclature and propose a new simplified one to facilitate communication between physicians of various specialties.
MATERIALS AND METHODS
Fourteen formalin-fixed cadavers (9 male, 5 female) accessible from the Chair of Anatomy of the Jagiellonian University Collegium Medicum were dissected to examine and describe the anatomical variations of anastomoses between SMA and IMA.
RESULTS
The artery of Drummond was present in all 14 specimens maintaining the continuity of the vessel along its entire course. The Arc of Riolan was found in 7 out of 14 cadavers (50%). The artery of Moskovitz was not found. The average length measured between IMA and aortic bifurcation and between IMA and SMA was 51,00 mm and 84,68mm respectively. CONCLUSIONS: SMA and IMA anastomoses form an arterial network that is characterized by high variability and trail in surgically strategic areas. For this reason, simplifying the terminology and using unambiguous names of these vessels based on their trail and anatomical relationship with IMV are crucial for the proper planning and execution of surgical procedures performed on the colon.
PubMed: 38152920
DOI: 10.5603/fm.98013 -
Journal of Hypertension Nov 2023Extracellular ATP is elevated in hypertensive mice and humans and may trigger immune activation through the purinergic receptor P2X7 (P2RX7) causing interleukin-1β...
OBJECTIVE
Extracellular ATP is elevated in hypertensive mice and humans and may trigger immune activation through the purinergic receptor P2X7 (P2RX7) causing interleukin-1β production and T-cell activation and memory T-cell development. Furthermore, P2RX7 single nucleotide polymorphisms (SNP) are associated with hypertension. We hypothesized that P2RX7 activation contributes to hypertension and cardiovascular injury by promoting immune activation.
METHODS
Male wild-type and P2rx7-/- mice were infused or not with angiotensin II (AngII) for 14 days. A second group of AngII-infused wild-type mice were co-infused with the P2RX7 antagonist AZ10606120 or vehicle. BP was monitored by telemetry. Cardiac and mesenteric artery function and remodeling were assessed using ultrasound and pressure myography, respectively. T cells were profiled in thoracic aorta/perivascular adipose tissue by flow cytometry. Associations between SNPs within 50 kb of P2RX7 transcription, and BP or hypertension were modeled in 384 653 UK Biobank participants.
RESULTS
P2rx7 inactivation attenuated AngII-induced SBP elevation, and mesenteric artery dysfunction and remodeling. This was associated with decreased perivascular infiltration of activated and effector memory T-cell subsets. Surprisingly, P2rx7 knockout exaggerated AngII-induced cardiac dysfunction and remodeling. Treatment with a P2RX7 antagonist reduced BP elevation, preserved mesenteric artery function and reduced activated and effector memory T cell perivascular infiltration without adversely affecting cardiac function and remodeling in AngII-infused mice. Three P2RX7 SNPs were associated with increased odds of DBP elevation.
CONCLUSION
P2RX7 may represent a target for attenuating BP elevation and associated vascular damage by decreasing immune activation.
Topics: Humans; Mice; Male; Animals; Angiotensin II; Gene Knockout Techniques; Vascular System Injuries; Hypertension; T-Lymphocytes; Mice, Knockout; Mice, Inbred C57BL; Receptors, Purinergic P2X7
PubMed: 37796207
DOI: 10.1097/HJH.0000000000003520 -
Journal of Medical Case Reports Nov 2023Superior mesenteric artery (SMA) syndrome is an underdiagnosed complication in anorexia nervosa (AN) patients, which results from weight loss-induced atrophy of the...
BACKGROUND
Superior mesenteric artery (SMA) syndrome is an underdiagnosed complication in anorexia nervosa (AN) patients, which results from weight loss-induced atrophy of the mesenteric fat pad, causing compression of the third part of the duodenum. SMA syndrome can be life-threatening as its nonspecific symptomatology often results in a delayed diagnosis. It is a rare condition, but its true prevalence may be higher than the reported numbers. A history of persistent nausea and vomiting after oral intake and weight loss in AN should raise suspicion about this diagnosis, as weight loss is the most significant factor in this diagnosis. Other high-risk factors include rapid, extreme weight loss, anatomical abnormalities, or a history of prior abdominal or spinal surgeries.
CASE PRESENTATION
The patient presented in this report was a 26-year-old Caucasian female with a history of severe enduring anorexia nervosa. This patient suffered from an insidious case of SMA syndrome secondary to AN. This patient presented with vague symptoms of nausea and vomiting, persistent abdominal pain, and rapid weight loss. The patient was successfully treated but could have had a much different outcome if the diagnosis had been further delayed.
CONCLUSIONS
An awareness of SMA syndrome and its clinical presentation within similar populations can prevent complications and even fatalities that come with it.
Topics: Humans; Female; Adult; Superior Mesenteric Artery Syndrome; Anorexia Nervosa; Nausea; Vomiting; Weight Loss
PubMed: 37924161
DOI: 10.1186/s13256-023-04168-6 -
Vascular Pharmacology Dec 2023Göttingen Minipigs (GM) are used as an important preclinical model for cardiovascular safety pharmacology and for evaluation of cardiovascular drug targets. To improve...
Göttingen Minipigs (GM) are used as an important preclinical model for cardiovascular safety pharmacology and for evaluation of cardiovascular drug targets. To improve the translational value of the GM model, the current study represents a basic characterization of vascular responses to endothelial regulators and sympathetic, parasympathetic, and sensory neurotransmitters in different anatomical origins. The aim of the current comparative and descriptive study is to use myography to characterize the vasomotor responses of coronary artery isolated from GM and compare the responses to those obtained from parallel studies using cerebral and mesenteric arteries. The selected agonists for sympathetic (norepinephrine), parasympathetic (carbachol), sensory (calcitonin gene-related peptide, CGRP), and endothelial pathways (endothelin-1, ET-1, and bradykinin) were used for comparison. Further, the robust nature of the vasomotor responses was evaluated after 24 h of cold storage of vascular tissue mimicking the situation under which human biopsies are often kept before experiments or grafting is feasible. Results show that bradykinin and CGRP consistently dilated, and endothelin consistently contracted artery segments from coronary, cerebral, and mesenteric origin. By comparison, norepinephrine and carbachol, had responses that varied with the anatomical source of the tissues. To support the basic characterization of GM vasomotor responses, we demonstrated the presence of mRNA encoding selected vascular receptors (CGRP- and ET-receptors) in fresh artery segments. In conclusion, the vasomotor responses of isolated coronary, cerebral, and mesenteric arteries to selected agonists of endothelial, sympathetic, parasympathetic, and sensory pathways are different and the phenotypes are similar to sporadic human findings.
Topics: Swine; Animals; Humans; Calcitonin Gene-Related Peptide; Swine, Miniature; Bradykinin; Carbachol; Muscle, Smooth, Vascular; Norepinephrine; Mesenteric Arteries; Vasodilation
PubMed: 37730143
DOI: 10.1016/j.vph.2023.107231 -
Clinical and Experimental Hypertension... Dec 2023Endothelial dysfunction is a critical initiating factor in the development of hypertension and related complications. Follistatin-like 1 (FSTL1) can promote endothelial...
OBJECTIVE
Endothelial dysfunction is a critical initiating factor in the development of hypertension and related complications. Follistatin-like 1 (FSTL1) can promote endothelial cell function and stimulates revascularization in response to ischemic insult. However, it is unclear whether FSTL1 has an effect on ameliorating endothelial dysfunction in spontaneously hypertensive rats (SHRs).
METHODS
Wistar Kyoto (WKY) and SHRs were treated with a tail vein injection of vehicle (1 mL/day) or recombinant FSTL1 (100 μg/kg body weight/day) for 4 weeks. Blood pressure was measured by tail-cuff plethysmograph, and vascular reactivity in mesenteric arteries was measured using wire myography.
RESULTS
We found that treatment with FSTL1 reversed impaired endothelium-dependent relaxation (EDR) in mesenteric arteries and lowered blood pressure of SHRs. Decreased AMP-activated protein kinase (AMPK) phosphorylation, elevated endoplasmic reticulum (ER) stress markers, increased reactive oxygen species (ROS), and reduction of nitric oxide (NO) production in mesenteric arteries of SHRs were also reversed by FSTL1 treatment. treatment with FSTL1 improved the impaired EDR in mesenteric arteries from SHRs and reversed tunicamycin (ER stress inducer)-induced ER stress and the impairment of EDR in mesenteric arteries from WKY rats. The effects of FSTL1 were abolished by cotreatment of compound C (AMPK inhibitor).
CONCLUSIONS
These results suggest that FSTL1 prevents endothelial dysfunction in mesenteric arteries of SHRs through inhibiting ER stress and ROS and increasing NO production via activation of AMPK signaling.
Topics: Rats; Animals; Rats, Inbred SHR; AMP-Activated Protein Kinases; Follistatin; Rats, Inbred WKY; Reactive Oxygen Species; Follistatin-Related Proteins; Endothelium, Vascular; Hypertension; Mesenteric Arteries; Endoplasmic Reticulum Stress
PubMed: 37963199
DOI: 10.1080/10641963.2023.2277654 -
Frontiers in Pediatrics 2023The gut is a relatively silent organ but takes on a major role after birth for the absorption and digestion of feed for adequate nutrition and growth. The neonatal... (Review)
Review
The gut is a relatively silent organ but takes on a major role after birth for the absorption and digestion of feed for adequate nutrition and growth. The neonatal circulation undergoes a transition period after birth, and gut perfusion increases rapidly to satisfy the oxygen demand and consumption. If this process is compromised at any stage, preterm and fetal growth restricted infants are at particular risk of gut tissue injury secondary to hypoxia, leading to necrotizing enterocolitis. Feeding can also be a challenge in these high-risk groups due to gut dysmotility. Superior mesenteric artery (SMA) Doppler is a safe, bedside investigation that could rapidly aid clinicians with feeding strategies and in monitoring high-risk infants. This article aims to establish normal patterns of gut blood flow velocity in neonates using SMA Doppler and reviews how it might be used clinically in pathologic states.
PubMed: 37601136
DOI: 10.3389/fped.2023.1154611 -
The British Journal of Surgery Jul 2023
Topics: Humans; Pancreatectomy; Mesenteric Artery, Superior; Pancreatic Neoplasms; Abdomen; Portal Vein; Hepatic Artery
PubMed: 36378526
DOI: 10.1093/bjs/znac363