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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 -
Interventional Cardiology Clinics Apr 2020Atherosclerotic renal artery stenosis is the most common cause of secondary hypertension and may cause progressive renal disease and cardiac destabilization syndromes.... (Review)
Review
Atherosclerotic renal artery stenosis is the most common cause of secondary hypertension and may cause progressive renal disease and cardiac destabilization syndromes. Guideline-directed medical therapy is advised in all patients. Patients with refractory symptoms and hemodynamically significant stenoses are more likely to benefit from renal artery stent placement. Chronic mesenteric ischemia (CMI) is an infrequent and difficult to diagnose illness. Due to robust collateralization, clinical symptoms from mesenteric artery stenosis or occlusion is uncommon. Atherosclerosis is the most common etiology of CMI. Current evidence suggests that, compared with open surgical repair, endovascular therapy is the most cost-effective choice for CMI.
Topics: Computed Tomography Angiography; Humans; Mesenteric Arteries; Mesenteric Ischemia; Renal Artery; Renal Artery Obstruction; Stents; Vascular Surgical Procedures
PubMed: 32147118
DOI: 10.1016/j.iccl.2019.11.002 -
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 -
Vascular Medicine (London, England) Feb 2021
Topics: Celiac Artery; Chronic Disease; Constriction, Pathologic; Humans; Ischemia; Mesenteric Arteries; Mesenteric Artery, Superior; Mesenteric Ischemia; Mesenteric Vascular Occlusion; Stents
PubMed: 33357138
DOI: 10.1177/1358863X20979734 -
Angiology Jan 2023Mesenteric artery dissection (D) and wall-thickening (WT) are rare vasculopathies that can lead to serious complications. This is a single center analysis of all... (Review)
Review
Mesenteric artery dissection (D) and wall-thickening (WT) are rare vasculopathies that can lead to serious complications. This is a single center analysis of all patients evaluated for mesenteric arterial (celiac, superior (SMA) and/or inferior mesenteric (IMA)) D and/or WT from January 1, 2000, to January 31, 2020 at our hospital. Among the 101 included patients, the average age was 55.6 ± 13.6 years, mostly affecting men (62%). There were 20 celiac artery D, 8 WT, 15 D with WT, 15 SMA D, 7 WT, 8 D with WT, one IMA D, two WT, and 25 with multiple arterial involvement. Primary etiologies included segmental arterial mediolysis (SAM) (n = 17), isolated D (n = 17), localized vasculitis of the gastrointestinal tract (LVGT) (n = 16), fibromuscular dysplasia (FMD) (n = 13), extension of thoracoabdominal aortic D (n = 12), and trauma (n = 12). Most (71%) patients presented with abdominal pain. Hypertension (55%), hyperlipidemia (33%) and tobacco use (31%) were prevalent. Management included conservative (22%), medical (47%), endovascular (19%), and/or open repair (12%) with high in-hospital survival (98%) and symptom relief (73%). Our paper complements the scarce literature addressing the diagnosis and management of rare mesenteric vasculopathies. Most patients improved with conservative management, reserving endovascular or surgical interventions for symptomatic patients with more complicated presentations.
Topics: Adult; Aged; Humans; Male; Middle Aged; Celiac Artery; Hypertension; Mesenteric Arteries; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 35921630
DOI: 10.1177/00033197221100601 -
Progress in Cardiovascular Diseases 2021Chronic mesenteric ischemia (CMI) is an uncommon, potentially underdiagnosed clinical condition. Although there is a high prevalence of mesenteric artery stenoses (MAS),... (Review)
Review
Chronic mesenteric ischemia (CMI) is an uncommon, potentially underdiagnosed clinical condition. Although there is a high prevalence of mesenteric artery stenoses (MAS), an abundant collateral network in the mesenteric circulation mitigates occurrence of ischemia. The most common etiology of CMI is atherosclerosis. CMI is a clinical diagnosis, based upon typical and atypical symptoms and consistent anatomic findings. Typical symptoms of CMI are postprandial abdominal pain, unintended weight loss and food avoidance. The main modalities to diagnose MAS are duplex ultrasound, CT angiography or MR angiography, although high resolution CTA is preferred. Endovascular therapy with balloon expandable stents has become the preferred treatment for MAS.
Topics: Angioplasty, Balloon; Chronic Disease; Constriction, Pathologic; Endarterectomy; Humans; Incidence; Mesenteric Arteries; Mesenteric Ischemia; Mesenteric Vascular Occlusion; Prevalence; Stents; Treatment Outcome; Vascular Grafting; Vascular Patency
PubMed: 33901516
DOI: 10.1016/j.pcad.2021.03.002 -
Morphologie : Bulletin de L'Association... Jun 2022The celiaco-mesenteric anastomoses occur either directly between the celiac trunk and the superior mesenteric artery (SMA), or between different branches of them. A...
The celiaco-mesenteric anastomoses occur either directly between the celiac trunk and the superior mesenteric artery (SMA), or between different branches of them. A rarely occurring such anastomosis is the arc of Bühler. A new variant of arc of Bühler was found incidentally during a retrospective study of the computed tomography angiograms of a 62 y.o. male patient. In that case, the arc of Bühler left from the splenic artery and inserted into the inferior pancreaticoduodenal artery (IPDA), proximally to the IPDA division into its anterior and posterior branches. Moreover, that arc of Bühler was giving off a mesenterico-jejunal branch, which descended applied on the anterior side of the SMA. Such anatomic variants could impede on the surgical or interventional procedures in the duodenopancreatic region, or could be physiologically useful to divert the celiac flow towards the mesenteric territory, or vice versa.
Topics: Anastomosis, Surgical; Anatomic Variation; Celiac Artery; Humans; Male; Mesenteric Artery, Superior; Pancreas; Retrospective Studies
PubMed: 33962860
DOI: 10.1016/j.morpho.2021.04.002 -
Journal of the College of Physicians... Dec 2022We report a unique case of obstruction of the upper gastrointestinal tract diagnosed in a 15-year boy presenting with a 6-month history of persistent abdominal pain,...
We report a unique case of obstruction of the upper gastrointestinal tract diagnosed in a 15-year boy presenting with a 6-month history of persistent abdominal pain, epigastric fullness, repeated episodes of vomiting, and significant weight loss. The computed tomography (CT) scan of the abdomen with intravenous and oral contrast demonstrated the angle between the aorta and superior mesenteric artery (SMA) to be 15° and revealed the stomach and duodenum to be massively dilated, leading up to a diagnosis of SMA syndrome, which was successfully operated. SMA syndrome is a challenging diagnosis and must always be included in the list of probable diagnoses causing obstruction of the upper gastrointestinal tract. Key Words: Upper gastrointestinal obstruction, Superior mesenteric artery syndrome, Small bowel obstruction, Duodenojejunostomy.
Topics: Male; Humans; Superior Mesenteric Artery Syndrome; Duodenum; Intestinal Obstruction; Mesenteric Artery, Superior; Tomography, X-Ray Computed
PubMed: 36597304
DOI: 10.29271/jcpsp.2022.Supp0.SS100 -
Clinical Anatomy (New York, N.Y.) May 2022The aim of this study was to characterize the branching pattern and morphology of the superior mesenteric artery (SMA), and also to create a new SMA classification,...
The aim of this study was to characterize the branching pattern and morphology of the superior mesenteric artery (SMA), and also to create a new SMA classification, which seems necessary for clinicians performing surgery in this anatomical area. The anatomical variations in the branching patterns of the SMA were examined in 30 cadavers fixed in 10% formalin. Morphometric measurements were then obtained twice by two researchers. In the proposed classification system, Type I, characterized by all normal branches-inferior pancreatoduodenal artery, ileocolic artery, right colic artery, middle colic artery and intestinal arteries-occurred in 53.33% of the specimens. Type II, characterized by absence of the inferior pancreatoduodenal artery, was present in 26.67%. Type III, characterized by absence of the right colic artery, was present in 3.33%. Type IV, characterized by a common trunk for the inferior pancreatoduodenal artery and middle colic arteries, was observed in 3.33%. Type V, characterized by an aberrant hepatic artery and absence of the inferior pancreatoduodenal artery, was observed in 13.33%. The origin of the SMA was at the Th12/L1 level in 10% of cases, at L1 in 43.33%, at L1/L2 in 36.67%, and at L2 in 10%. The SMA is characterized by high morphological variability, the variants being associated with distinct clinical aspects. The introduction of a new, structured, anatomical classification seems necessary for all clinicians.
Topics: Cadaver; Humans; Mesenteric Artery, Superior
PubMed: 35088464
DOI: 10.1002/ca.23841 -
Journal of Vascular Surgery Jul 2023
Topics: Humans; Mesenteric Artery, Superior; Aneurysm, False; Abdomen; Stents
PubMed: 37349010
DOI: 10.1016/j.jvs.2022.10.004