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Bastian MB, Wessendorf J, Scheschenja M, König AM, Nadjiri J, Mahnken AH. Retrospective evaluation of interventional radiological treatments for chronic mesenteric ischemia in Germany based on a four-year period of the DeGIR Registry: comparison of outcomes with international quality standards. ROFO-FORTSCHR RONTG 2024. [PMID: 38408473 DOI: 10.1055/a-2258-3437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
PURPOSE Endovascular treatment has emerged as the gold standard for managing chronic mesenteric ischemia (CMI) resulting from arterial stenosis or occlusion. This study aimed to assess the efficacy and complication rates of continuous interventional radiology treatment for CMI in Germany between 2018 and 2021, comparing these findings with international quality standards. MATERIALS AND METHODS Data for CMI therapy with stenting and percutaneous transluminal angioplasty (PTA) was obtained from the quality management system of the German Interventional Radiological Society (DeGIR). A total of 3752 endovascular procedures for CMI performed from 2018 to 2021 were documented (PTA: n = 675; stenting: n = 3077). Data was analyzed for technical and clinical success rates, as well as major complication rates. RESULTS Overall technical and clinical success rates for PTA and stenting procedures were 92.03 %/85.9 % and 98.76 %/96.62 %, respectively. The most common major complications were: arterial occlusion (PTA: 0.73 %; stenting: 0.63), major bleeding (PTA: 1.05 %; stenting: 0.68 %), aneurysm formation (PTA: 0.29 %; stenting: 0.72 %), stent dislodgment (PTA: 0 %; stenting: 0.06 %), and organ failure (PTA: 0.43 %; stenting: 0.96 %). Technical and clinical success rates were higher, while complication rates were lower than the corresponding threshold recommended by the Society of Interventional Radiology for the percutaneous management of chronic mesenteric ischemia. CONCLUSION Treatment of CMI performed by interventional radiologists in Germany is safe and effective during daily and on-call shifts with results exceeding internationally accepted standards. KEY POINTS · Treatment of CMI by interventional radiologists in Germany is effective and safe.. · The interventions are safe and effective regardless of whether they are performed during on-call shifts or the daily routine.. · The clinical and technical success rates favorably surpass the thresholds presented by SIR.. · Different major complications occurred in under 1.1 % of CMI interventions..
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Affiliation(s)
- Moritz B Bastian
- Department of Diagnostic and Interventional Radiology, University Hospital of Gießen and Marburg Campus Marburg, Germany
| | - Joel Wessendorf
- Department of Diagnostic and Interventional Radiology, University Hospital of Gießen and Marburg Campus Marburg, Germany
| | - Michael Scheschenja
- Department of Diagnostic and Interventional Radiology, University Hospital of Gießen and Marburg Campus Marburg, Germany
| | - Alexander Marc König
- Department of Diagnostic and Interventional Radiology, University Hospital of Gießen and Marburg Campus Marburg, Germany
| | - Jonathan Nadjiri
- Department of Interventional Radiology, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, University Hospital of Gießen and Marburg Campus Marburg, Germany
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Thurner A, Augustin AM, Bley TA, Kickuth R. 2D-perfusion angiography for intra-procedural endovascular treatment response assessment in chronic mesenteric ischemia: a feasibility study. BMC Med Imaging 2022; 22:90. [PMID: 35578260 PMCID: PMC9109376 DOI: 10.1186/s12880-022-00820-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endovascular revascularization has become the first-line treatment of chronic mesenteric ischemia (CMI). The qualitative visual analysis of digital subtraction angiography (DSA) is dependent on observer experience and prone to interpretation errors. We evaluate the feasibility of 2D-Perfusion Angiography (2D-PA) for objective, quantitative treatment response assessment in CMI. METHODS 49 revascularizations in 39 patients with imaging based evidence of mesenteric vascular occlusive disease and clinical signs of CMI were included in this retrospective study. To assess perfusion changes by 2D-PA, DSA-series were post-processed using a dedicated, commercially available software. Regions of interest (ROI) were placed in the pre- and post-stenotic artery segment. In aorto-ostial disease, the inflow ROI was positioned at the mesenteric artery orifice. The ratios outflow to inflow ROI for peak density (PD), time to peak and area-under-the-curve (AUC) were computed and compared pre- and post-interventionally. We graded motion artifacts by means of a four-point scale. Feasibility of 2D-PA and changes of flow parameters were evaluated. RESULTS Motion artifacts due to a mobile vessel location beneath the diaphragm or within the mesenteric root, branch vessel superimposition and inadequate contrast enhancement at the inflow ROI during manually conducted DSA-series via selective catheters owing to steep vessel angulation, necessitated exclusion of 26 measurements from quantitative flow evaluation. The feasibility rate was 47%. In 23 technically feasible assessments, PDoutflow/PDinflow increased by 65% (p < 0.001) and AUCoutflow/AUCinflow increased by 85% (p < 0.001). The time to peak density values in the outflow ROI accelerated only minimally without reaching statistical significance. Age, BMI, target vessel (celiac trunk, SMA or IMA), stenosis location (ostial or truncal), calcification severity, plaque composition or the presence of a complex stenosis did not reach statistical significance in their distribution among the feasible and non-feasible group (p > 0.05). CONCLUSIONS Compared to other vascular territories and indications, the feasibility of 2D-PA in mesenteric revascularization for CMI was limited. Unfavorable anatomic conditions contributed to a high rate of inconclusive 2D-PA results.
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Affiliation(s)
- Annette Thurner
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Anne Marie Augustin
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Ralph Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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Awouters J, Jardinet T, Hiele M, Laenen A, Dymarkowski S, Fourneau I, Maleux G. Factors predicting long-term outcomes of percutaneous angioplasty and stenting of the superior mesenteric artery for chronic mesenteric ischemia. VASA 2021; 50:431-438. [PMID: 34231372 DOI: 10.1024/0301-1526/a000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: To analyse the long-term outcomes of percutaneous angioplasty and stenting of the superior mesenteric artery (SMA) in the treatment of chronic mesenteric ischemia (CMI), and to assess predictive factors for a better clinical outcome. Patients and methods: Retrospective analysis of 76 consecutive patients, treated percutaneously for CMI between January 1999 and January 2018 and followed up until the end of 2018. Patients' pre-, peri- and post-interventional clinical and radiological data were gathered from the institutional electronic medical records. The Kaplan Meier method with log rank test or the Cox model were used to analyse overall survival; the cumulative incidence function with Pepe and Mori test or the Fine and Grey model were used to analyse relapse-free survival, considering death as a competing event. Results: Seventy-six consecutive patients with a mean age of 72 years were included in the study. Catheter-angiography revealed an ostial or non-ostial >90% stenosis in n=23 (29.7%) and n=53 (69.7%) of included patients, respectively. Immediate clinical success was achieved in n=68 (89.5%), and procedural complications were observed in n=13 (17.1%) patients. Long-term follow-up revealed relapse of symptoms in n=21 (28.8%) patients, and overall survival estimates are 81.8%, 57.0% and 28.2% after two, five and ten years of follow-up, respectively. A trend towards longer relapse-free survival was found in the circumferential stenosis group (78.2% at five years) compared with the non-circumferential stenosis group (55.5%) (P=0.063). Conclusions: Angioplasty and stenting of the SMA for CMI is relatively safe and effective despite a substantial number of patients experiencing clinical relapse over time. Patients with focal, circumferential stenosis might have longer relapse-free survival than patients with non-circumferential stenosis.
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Affiliation(s)
- Joris Awouters
- Department of Radiology, University Hospitals Leuven, Belgium
| | - Thomas Jardinet
- Department of Radiology, University Hospitals Leuven, Belgium
| | - Martin Hiele
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (L-BioStat), Leuven, Belgium
| | | | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Belgium
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Sardar P, White CJ. Chronic mesenteric ischemia: Diagnosis and management. Prog Cardiovasc Dis 2021; 65:71-75. [PMID: 33901516 DOI: 10.1016/j.pcad.2021.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 03/13/2021] [Indexed: 01/13/2023]
Abstract
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.
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Affiliation(s)
- Partha Sardar
- Department of Cardiovascular Diseases, The John Ochsner Heart and Vascular Institute, The Ochsner Clinical School, University of Queensland, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, United States of America
| | - Christopher J White
- Department of Cardiovascular Diseases, The John Ochsner Heart and Vascular Institute, The Ochsner Clinical School, University of Queensland, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, United States of America.
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Wang G, Zhou X, Shu X, Wang E, Wang L, Fu W. Transcollateral Recanalization of an Occluded Superior Mesenteric Artery. Ann Vasc Surg 2021; 74:525.e7-525.e12. [PMID: 33838238 DOI: 10.1016/j.avsg.2021.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/26/2020] [Accepted: 02/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To report the technique of transcollateral retrograde recanalization of a superior mesenteric artery flush occlusion. METHODS The technique of a patient undergoing transcollateral retrograde recanalization for acute symptomatic superior mesenteric artery flush occlusion was reviewed and presented. Other adjunctive methods to facilitate the endovascular treatment of the superior mesenteric artery total occlusion lesion were also compared and discussed. RESULTS The patient was a 47-year-old woman, acute onset of symptomatic chronic mesenteric ischemia with flush occlusion of the superior mesenteric artery which was unable to be revascularized in a routine operation. A collateral was found to connect celiac artery and superior mesenteric artery (gastroduodenal arch). The guidewire was retrograde crossed the occluded lesion via this collateral and recaptured by the catheter from the same single brachial sheath followed by balloon angioplasty and stent implantation. The patient recovered well and the symptoms completely disappeared after the procedure. CONCLUSION The technique of retrograde recanalization through collateral pathway is an applicable alternative option for patients with superior mesenteric artery flush occlusion who have failed attempts by conventional antegrade approaches.
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Affiliation(s)
- Guili Wang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China; Department of Vascular Surgery, Affiliated Ji'nan Central Hospital of Shandong First Medical University, Jinan, China
| | - Xiushi Zhou
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Xiaolong Shu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Enci Wang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Lixin Wang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China; Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China.
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China; Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
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Brasoveanu V, Romanescu D, Diaconu C, Iliescu L, Bratu O, Savu C, Savu C, Neacsu A, Socea B, Balescu I, Bacalbasa N. Reconstruction of superior mesenteric artery by prostheses placement in a case of chronic mesenteric ischemia: A case report and literature review. Exp Ther Med 2020; 20:3504-3507. [PMID: 32905147 PMCID: PMC7464867 DOI: 10.3892/etm.2020.9119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/03/2020] [Indexed: 11/06/2022] Open
Abstract
Although superior mesenteric artery stenosis is a relatively common situation, it is rarely symptomatic due to the fact that in a significant number of cases an adequate collateral circulation exists. The aim of this study is to report a case in which arterial reconstruction was needed due to the absence of such a patent collateral circulation. The 47-year-old patient was investigated for chronic postprandial pain and was diagnosed with superior mesenteric artery stenosis. Percutaneous treatment was the initial option of choice but the patient rapidly became symptomatic again. Therefore surgery was performed, the segment of arterial stenosis was resected and the arterial continuity was re-established by using a synthetic prosthesis. The postoperative outcome was uneventful, the patient was discharged in the seventh postoperative day under anticoagulant therapy. In conclusion, superior mesenteric artery reconstruction by using a synthetic prosthesis can be useful in cases presenting chronic mesenteric ischemia and failure of percutaneous treatment.
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Affiliation(s)
- Vladislav Brasoveanu
- Department of Surgery, ‘Dan Setlacec’ Center of Gastrointestinal Diseases and Liver Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Department of Surgery, ‘Titu Maiorescu’ University of Medicine and Pharmacy, 040441 Bucharest, Romania
| | - Dragos Romanescu
- Department of Surgery, Sanador Medical Center, 011038 Bucharest, Romania
| | - Camelia Diaconu
- Department of Internal Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Internal Medicine, Clinical Emergency Hospital Bucharest, 105402 Bucharest, Romania
| | - Laura Iliescu
- Department of Internal Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Internal Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Ovidiu Bratu
- Department of Urology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Urology, ‘Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Cornel Savu
- Department of Thoracic Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Thoracic Surgery, ‘Marius Nasta’ Institute of Pneumonology, 050159 Bucharest, Romania
| | - Carmen Savu
- Department of Anesthesiology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Adrian Neacsu
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Obstetrics and Gynecology, ‘Sf. Ioan’ Clinical Emergency Hospital, 042122 Bucharest, Romania
| | - Bogdan Socea
- Department of Surgery, ‘Sf. Pantelimon’ Clinical Hospital, 021659 Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, ‘Ponderas’ Academic Hospital, 021188 Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Visceral Surgery, Center of Excellence in Translational Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Department of Obstetrics and Gynecology, ‘I. Cantacuzino’ Clinical Hospital, 030167 Bucharest, Romania
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Yoshida R, Yoshizako T, Maruyama M, Ando S, Nakamura M, Fukushi K, Takinami Y, Kawabata Y, Nakamura T, Tamaki Y, Kitagaki H. Hemosuccus pancreaticus successful treatment by double balloon-assisted coil embolization for active bleeding from the main trunk of the superior mesenteric artery. Radiol Case Rep 2018; 13:644-647. [PMID: 30038696 PMCID: PMC6053772 DOI: 10.1016/j.radcr.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/08/2018] [Indexed: 11/17/2022] Open
Abstract
We report a case of a 63-year-old man with hemosuccus pancreaticus due to large pseudoaneurysm originating from the main trunk of the superior mesenteric artery (SMA). The patient was treated successfully with the double balloon-assisted coil embolization technique combined with proximal and distal balloon inflation in the short segment of the SMA. This technique preserved the pancreaticoduodenal arterial arcade and the supply to the distal part of the SMA by embolizing SMA in a short segment.
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Affiliation(s)
- Rika Yoshida
- Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Takeshi Yoshizako
- Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Mitsunari Maruyama
- Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Shinji Ando
- Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Megumi Nakamura
- Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Keiko Fukushi
- Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Yoshikazu Takinami
- Department of Emergency, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Yasunari Kawabata
- Department of Digestive and General Surgery, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Tomonori Nakamura
- Department of Radiology, Matsue Seikyo Hospital, Matsue, Shimane, Japan
| | - Yukihisa Tamaki
- Department of Radiation Oncology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Hajime Kitagaki
- Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
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Saadi EK, Oderich G, Medronha E, Saadi RP, Saadi MP, Jaegger C. Endovascular recanalization of occluded superior mesenteric artery using retrograde access through the inferior mesenteric artery. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2017; 3:155-158. [PMID: 29349407 PMCID: PMC5764864 DOI: 10.1016/j.jvscit.2017.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/23/2017] [Indexed: 01/25/2023]
Abstract
Symptomatic occlusion of the superior mesenteric artery can be treated by open repair, hybrid procedure, or endovascular revascularization. In most cases, endovascular procedures are done by the antegrade approach. We report a case of a 67-year-old woman who presented with acute-on-chronic mesenteric ischemia successfully treated by retrograde endovascular recanalization of an occluded common hepatomesenteric trunk through the inferior mesenteric artery and arc of Riolan.
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Affiliation(s)
| | - Gustavo Oderich
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
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Jaster A, Choudhery S, Ahn R, Sutphin P, Kalva S, Anderson M, Pillai AK. Anatomic and radiologic review of chronic mesenteric ischemia and its treatment. Clin Imaging 2016; 40:961-9. [PMID: 27232932 DOI: 10.1016/j.clinimag.2016.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 04/06/2016] [Accepted: 04/12/2016] [Indexed: 01/01/2023]
Abstract
Chronic mesenteric ischemia (CMI) is a vascular occlusive disease process that generally affects the elderly population. Clinical presentation occurs when two of the three mesenteric arteries are affected and includes non-specific abdominal pain and weight loss. The most common cause of CMI is atherosclerotic arterial occlusion. The aim of this review is to present the vascular anatomy of the mesenteric arterial circulation including the different collateral pathways. The imaging findings and the different treatment options with a brief review of the literature is presented.
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Affiliation(s)
- Adam Jaster
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX.
| | - Sadia Choudhery
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Richard Ahn
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Patrick Sutphin
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Sanjeeva Kalva
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Matthew Anderson
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Anil K Pillai
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
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Patel S, Devgarha S, Mathur RM, Sharma S. Successful surgical bypass of superior mesenteric and inferior mesenteric artery. Indian J Thorac Cardiovasc Surg 2015. [DOI: 10.1007/s12055-015-0389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Madden NJ, Piccolo C, Kunasani R, Mohan C, Khoobehi A, Sohn R. Celiac artery stent placement for coronary ischemia. Ann Vasc Surg 2015; 29:1319.e11-4. [PMID: 26072719 DOI: 10.1016/j.avsg.2015.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 02/24/2015] [Accepted: 02/27/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The use of endovascular technology for mesenteric interventions has become an increasingly accepted treatment modality. We present an unusual case of celiac artery stent placement for coronary ischemia. CASE DESCRIPTION A 66-year-old male with a history most notable for coronary artery disease and coronary artery bypass grafting (CABG) x 3 utilizing left internal mammary artery to left anterior descending, radial artery to first diagonal and his right gastroepiploic artery (GEA) to posterior descending artery presented with chest pain. His work-up included a cardiac catheterization that revealed a 90% stenosis at the origin of the celiac axis. A subsequent computerized tomography angiogram confirmed this and noted moderate stenosis of his superior mesenteric artery (SMA) as well as severe inferior mesenteric artery (IMA) stenosis. The patient was taken for mesenteric angiography by vascular surgery at which time he underwent balloon-expandable stent placement in the celiac axis. The patient tolerated this procedure well and was noted to have an improvement in his symptoms postoperatively. DISCUSSION Use of arterial conduits for CABG have proven to be superior to vein. Long-term viability of the GEA as a conduit is dependent in part on the patency of mesenteric circulation. Our findings demonstrate a viable endovascular treatment option for angina pectoris secondary to mesenteric stenosis in this unique patient population.
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Affiliation(s)
- Nicholas J Madden
- Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA.
| | - Carmen Piccolo
- Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | - Ratna Kunasani
- Division of Vascular Surgery, Aria Health System, Philadelphia, PA
| | - Chittur Mohan
- Division of Vascular Surgery, Aria Health System, Philadelphia, PA
| | - Ali Khoobehi
- Division of Vascular Surgery, Aria Health System, Philadelphia, PA
| | - Richard Sohn
- Division of Vascular Surgery, Aria Health System, Philadelphia, PA
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White RD, Weir-McCall JR, Sullivan CM, Mustafa SAR, Yeap PM, Budak MJ, Sudarshan TA, Zealley IA. The Celiac Axis Revisited: Anatomic Variants, Pathologic Features, and Implications for Modern Endovascular Management. Radiographics 2015; 35:879-98. [DOI: 10.1148/rg.2015140243] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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13
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Grilli CJ, Fedele CR, Tahir OM, Wrigley CW, Garcia MJ, Kimbiris G, Agriantonis DJ, Leung DA. Recanalization of Chronic Total Occlusions of the Superior Mesenteric Artery in Patients with Chronic Mesenteric Ischemia: Technical and Clinical Outcomes. J Vasc Interv Radiol 2014; 25:1515-22. [DOI: 10.1016/j.jvir.2014.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/21/2014] [Accepted: 07/03/2014] [Indexed: 12/30/2022] Open
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Sundermeyer A, Zapenko A, Moysidis T, Luther B, Kröger K. Endovascular treatment of chronic mesenteric ischemia. Interv Med Appl Sci 2014; 6:118-24. [PMID: 25243077 DOI: 10.1556/imas.6.2014.3.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/15/2014] [Accepted: 05/20/2014] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Data regarding endovascular treatment of chronic mesenteric ischemia (CMI) are sparse. Angioplasty is often accompanied by early restenosis and the need of further interventions. Thus we present our own patients' data and review the recent literature. METHODS We retrospectively reviewed all endovascular CMI treatments performed from 2008 to 2012 (27 patients, 14 females, mean age 70 ± 9 years). Patients' data were retrieved from electronic health records. Patients' follow-up included routinely performed color-coded ultrasonography, and, if performed for other clinical reasons, computed tomography or angiography. In addition, data extracted from 11 studies focusing on endovascular CMI treatment were analyzed. RESULTS Procedures were performed without clinical complications in all patients. Seven patients received pure angioplasty and 20 patients stent-assisted angioplasties using bare metal stents, respectively. Three patients died 3, 5 and 32 months after the intervention. Five patients underwent re-intervention (one early restenosis at day 4 after pure angioplasty with stent placement and four because of in-stent restenosis, 5 to 23 months after placement). Another patient was treated surgically because of stent occlusion and reoccurring abdominal angina 15 months after the intervention. The 11 studies found in the literature included 429 cases with 196 treatments of the coeliac trunk (truncus coeliacus = TC), 319 of the superior mesenteric artery (SMA) and 42 of the inferior mesenteric artery (IMA). Patency rates in the more recent studies were high with up to 80% within 1 year. Data of earlier studies report longer follow-up periods and indicate low patency rates after three years. Our 2-year patency rate of 50% is within the range of reported patency data. CONCLUSIONS The presented data show that endovascular SMA treatment is a suitable and safe procedure in patients suffering from CMI, but long-term results are limited.
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Ferro C, Rossi UG, Seitun S, Bovio G, Fornaro R. Endovascular Treatment of Totally Occluded Superior Mesenteric Artery by Retrograde Crossing via the Villemin Arcade. Cardiovasc Intervent Radiol 2012; 36:848-52. [DOI: 10.1007/s00270-012-0469-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 07/30/2012] [Indexed: 10/28/2022]
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Staniloae CS. Commentary: the new state of the art in endovascular treatment of chronic mesenteric ischemia. J Endovasc Ther 2012; 19:495-6. [PMID: 22891828 DOI: 10.1583/19-4_12-3900c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Idiopathic infantile arterial calcification in a 12-year-old girl presenting as chronic mesenteric ischemia: imaging findings and angioplasty results. Pediatr Radiol 2011; 41:1476-80. [PMID: 21394437 DOI: 10.1007/s00247-011-2030-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 01/18/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
Abstract
We report an unusual case of chronic mesenteric ischemia presenting in a 12-year-old girl with idiopathic infantile arterial calcinosis (IIAC). This is the first reported case in the literature of chronic mesenteric ischemia in the setting of IIAC. The girl presented with a classical history of postprandial abdominal pain. Imaging demonstrated significant stenoses of the celiac axis, superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). Angioplasty of the celiac axis and SMA was attempted, with successful dilation of the SMA only. At 3-, 6- and 12-month follow-ups, the child's symptoms had almost resolved. This case report has three important ramifications: chronic mesenteric ischemia is a possible clinical presentation in children with IACC, pre-angioplasty imaging is important in guiding treatment approach, and angioplasty was effective in this case of chronic mesenteric ischemia and offers hope for other similarly affected children.
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Ferro C, Rossi UG, Petrocelli F, Seitun S, Robaldo A, Mazzei R. Penetrating atherosclerotic ulcer of the abdominal aorta involving the celiac trunk origin and superior mesenteric artery occlusion: endovascular treatment. Cardiovasc Intervent Radiol 2010; 34 Suppl 2:S40-3. [PMID: 21103874 DOI: 10.1007/s00270-010-0041-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 10/28/2010] [Indexed: 11/30/2022]
Abstract
We describe a case of endovascular treatment in a 64-year-old woman affected by a penetrating atherosclerotic ulcer (PAU) of the abdominal aorta with a 26-mm pseudoaneurysm involving the celiac trunk (CT) origin and with superior mesenteric artery (SMA) occlusion in the first 30 mm. The patient underwent stenting to treat the SMA occlusion and subsequent deployment of a custom-designed fenestrated endovascular stent-graft to treat the PAU involving the CT origin. Follow-up at 6 months after device placement demonstrated no complications, and there was complete thrombosis of the PAU and patency of the two branch vessels.
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Affiliation(s)
- Carlo Ferro
- Department of Diagnostic and Interventional Radiology, San Martino University Hospital, 16132 Genoa, Italy
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Renner P, Kienle K, Dahlke MH, Heiss P, Pfister K, Stroszczynski C, Piso P, Schlitt HJ. Intestinal ischemia: current treatment concepts. Langenbecks Arch Surg 2010; 396:3-11. [PMID: 21072535 DOI: 10.1007/s00423-010-0726-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Accepted: 11/03/2010] [Indexed: 02/06/2023]
Abstract
PURPOSE Mesenteric ischemia is a condition well-known among physicians treating patients with abdominal symptoms. Even so, mortality rates have not decreased significantly over the last decades. The purpose of this article is to review current treatment concepts of acute and chronic mesenteric ischemia. RESULTS Early diagnosis is one of the most important features that determine a patient's prognosis. Conventional angiography and multidetector computed tomography are therefore appropriate to quickly diagnose mesenteric ischemia, the latter being commonly more available. Once a patient presents with signs of peritonitis, instant laparotomy is indicated, and infarcted bowel segments need to be resected, followed by a second-look operation if necessary. If bowel necrosis is clinically not suspected, different approaches should be applied according to source and nature of mesenteric ischemia. Besides established surgical treatment concepts, more and more interventional procedures are developed and evaluated. However, superiority of these new techniques could only be shown for selected patient groups so far. In chronic mesenteric ischemia, interventional approaches seem to be an attractive alternative in patients who are in a condition too bad to undergo surgery. Patients with colonic ischemia are treated best in a conservative manner and by resolving the underlying cause, if identified. CONCLUSION Patients with acute mesenteric ischemia are still at highest risk for a fatal course of disease. New diagnostic and therapeutic developments have not been tested in larger studies yet, neither has any of these methods led to an increased survival in studies published so far. Taken together, mesenteric ischemia requires high awareness, earliest possible diagnosis, and treatment by an experienced interdisciplinary team of gastroenterologists, radiologists, and surgeons.
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Affiliation(s)
- Philipp Renner
- Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
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