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Mihatsch PW, Schmidt AM, Augustin AM, Thurner A, Peter D, Kickuth R. Pancreatic Ischemia-Reperfusion Injury Following Endovascular Treatment of Symptomatic Celiac and Superior Mesenteric Artery Stenosis. J Endovasc Ther 2023:15266028231209247. [PMID: 37933445 DOI: 10.1177/15266028231209247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
CLINICAL IMPACT With endovascular therapy becoming the first-line treatment for symptomatic chronic mesenteric ischemia, acute pancreatitis within the context of abdominal ischemia-reperfusion injury may be seen more often in cross-sectional imaging following this kind of interventions and should therefore be kept in mind by the reading physician.
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Affiliation(s)
- Patrick W Mihatsch
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Alexander M Schmidt
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Anne Marie Augustin
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Annette Thurner
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Dominik Peter
- Department of General, Visceral, Vascular and Pediatric Surgery (Surgery I), University Hospital Würzburg, Würzburg, Germany
| | - Ralph Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
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2
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Charfeddine S, Gueldiche M, Feki W, Bahloul A. An unusual complication following stenting in a patient with chronic mesenteric ischaemia due to radiation therapy. Interact Cardiovasc Thorac Surg 2020; 32:664-665. [PMID: 33347582 DOI: 10.1093/icvts/ivaa318] [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: 09/13/2020] [Revised: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 11/14/2022] Open
Abstract
The endovascular treatment is the first-line revascularization technique in chronic mesenteric ischaemia. We report a case of reperfusion haemorrhage complicating endovascular repair of severe stenosis of the superior mesenteric and coeliac arteries' anatomic variant following abdominal radiation therapy. The haemorrhage resolved spontaneously after medical management, with successful outcome.
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Affiliation(s)
- Salma Charfeddine
- Department of Cardiology, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Tunisia
| | - Majdi Gueldiche
- Department of Cardiovascular Surgery, Habib Bourguiba University Hospital, Faculty of Medicine of Sfax, University of Sfax, Tunisia
| | - Wiem Feki
- Department of Radiology, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Tunisia
| | - Amine Bahloul
- Department of Cardiology, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Tunisia
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Robles-Martín ML, Reyes-Ortega JP, Rodríguez-Morata A. A Rare Case of Ischemia–Reperfusion Injury After Mesenteric Revascularization. Vasc Endovascular Surg 2019; 53:424-428. [DOI: 10.1177/1538574419839547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- María L. Robles-Martín
- Department of Angiology and Vascular Surgery, Quirónsalud Málaga Hospital, Málaga, Spain
| | - Juan P. Reyes-Ortega
- Department of Angiology and Vascular Surgery, Quirónsalud Málaga Hospital, Málaga, Spain
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Zhang H, Jia B, Zeng L, Xiao Z, Shen J, Qian H, Zhang E, Hu J. Unexpected renal hemorrhage after endovascular repair of complicated type B aortic dissection: two cases report. BMC Surg 2018; 18:100. [PMID: 30445948 PMCID: PMC6240213 DOI: 10.1186/s12893-018-0440-1] [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: 11/14/2017] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
Background Thoracic endovascular aortic repair (TEVAR) is the therapeutic choice for type B aortic dissection. One of the most unfavored complications of this procedure is hemorrhage, which has a low incidence but high mortality. Renal hemorrhage (RH) after endovascular aortic repair has been rarely reported. We presented two cases of unexpected RH after TEVAR for complicated type B aortic dissection, and the potential causes, diagnosis and therapeutic management were discussed. Case presentation A 67-year-old female developed hypotension and progressively decrease of hemoglobin within 5 h after TEVAR for acute complicated type B dissection. Bedside ultrasonography and abdominal computed tomography angiography revealed a massive right perinephric hematoma. The right renal angiography detected multiple tortuous vascular branches with diffuse perinephric bleeding. The main trunk of right renal artery was embolized. The patient recovered uneventfully and presented with normal renal function 6 months later. Another patient was a 69-year-old male who was admitted for endovascular repair of a chronic complicated type B aortic dissection. The patient presented with hemodynamic instability early after TEVAR. Bedside ultrasonography showed a giant left retroperitoneal hematoma. The abdominal angiography revealed two active bleeding sits located in the distal branches of left renal artery. A super-selective embolization of the two arteries was performed, however the patient developed abdominal compartment syndrome and died of multiple organ failure. Conclusions Unexpected RH after endovascular repair of aortic dissection might be associated with iatrogenic and idiopathic factors. Close surveillance and clinician’s awareness of this rare complication is crucial for accurate and prompt diagnosis. Renal angiography and subsequent selective embolization of bleeding vessels are effective interventions for treating this fatal condition. Electronic supplementary material The online version of this article (10.1186/s12893-018-0440-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hongwei Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Bangsheng Jia
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ling Zeng
- Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Zhenghua Xiao
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jiayu Shen
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hong Qian
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Eryong Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jia Hu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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Lima FV, Kolte D, Kennedy KF, Louis DW, Abbott JD, Soukas PA, Hyder ON, Mamdani ST, Aronow HD. Endovascular Versus Surgical Revascularization for Chronic Mesenteric Ischemia. JACC Cardiovasc Interv 2017; 10:2440-2447. [DOI: 10.1016/j.jcin.2017.09.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/20/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
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Moghadamyeghaneh Z, Carmichael JC, Mills SD, Dolich MO, Pigazzi A, Fujitani RM, Stamos MJ. Early Outcome of Treatment of Chronic Mesenteric Ischemia. Am Surg 2015. [DOI: 10.1177/000313481508101128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
There are limited data regarding long-term outcomes of chronic mesenteric ischemia (CMI) of the intestine. We sought to identify treatment outcomes of CMI. The NIS database was used to identify patients admitted for the diagnosis of CMI between 2002 and 2012. Multivariate analysis using logistic regression was performed to quantify outcomes of CMI. A total of 160,889 patients were admitted for chronic vascular insufficiency of intestine; of which 7,906 patients underwent surgical/endovascular treatment for CMI. Among patients who underwent surgery 62 per cent had endovascular treatment and 38 per cent had open vascular treatment. Need of open surgery (adjusted odds ratio (AOR): 5.13, P < 0.01) and age ≥70 years (AOR: 3.41, P < 0.01) had strong associations with mortality of patients. Open vascular treatment has higher mortality (AOR: 5.07, P < 0.01) and morbidity (AOR: 2.14, P < 0.01). However, endovascular treatment had higher risk of postoperative wound hematoma (AOR: 2.81, P < 0.01). Most patients admitted for CMI are treated with endovascular treatment. Endovascular treatment has the advantage of lower mortality and morbidity. Need to open surgery and age ≥70 years have strong associations with mortality of patients.
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Affiliation(s)
- Zhobin Moghadamyeghaneh
- Divisions of Colorectal Surgery, Department of Surgery, University of California, Irvine, School of Medicine, Orange, California
| | - Joseph C. Carmichael
- Divisions of Colorectal Surgery, Department of Surgery, University of California, Irvine, School of Medicine, Orange, California
| | - Steven D. Mills
- Divisions of Colorectal Surgery, Department of Surgery, University of California, Irvine, School of Medicine, Orange, California
| | - Matthew O. Dolich
- Divisions of Trauma and Critical Care Surgery, Department of Surgery, University of California, Irvine, School of Medicine, Orange, California
| | - Alessio Pigazzi
- Divisions of Colorectal Surgery, Department of Surgery, University of California, Irvine, School of Medicine, Orange, California
| | - Roy M. Fujitani
- Vascular and Endovascular Surgery, Department of Surgery, University of California, Irvine, School of Medicine, Orange, California
| | - Michael J. Stamos
- Divisions of Colorectal Surgery, Department of Surgery, University of California, Irvine, School of Medicine, Orange, California
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Isquemia mesentérica crónica. ANGIOLOGIA 2015. [DOI: 10.1016/j.angio.2014.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Shah AS, Schwartz LB, Moawad J, Gewertz BL. Technique profile: mesenteric reconstructions for occlusive disease. Expert Rev Cardiovasc Ther 2015; 13:1445-58. [DOI: 10.1586/14779072.2015.1094376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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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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Abstract
Ischemic changes of the abdominal organs are crucial since they develop slowly and are therefore often diagnosed at a late stage. Due to this general aspect, mortality from this disease could not be significantly reduced over the last decade. One of the main causes of these high mortality rates is the insufficient integration of the overall clinical picture into the diagnostic work-up. Acute mesenteric ischemia should be differentiated from chronic visceral ischemia. Acute intestinal ischemia is a vascular emergency with a mortality rate of 60-80%. The incidence of chronic visceral vascular disorders accounts for approximately 1-2% of all abdominal conditions and has to be differentiated from the acute form, since intestinal ischemia has a progressive nature and usually is related to general atherosclerotic disease. Therefore, this condition is associated with an increase of arteriosclerotic-related multimorbidity in an increasingly elderly population. Due to excellent collateralization, extensive chronic occlusion processes affecting the visceral arteries can be asymptomatically treated on a long-term basis.
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11
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Debus E, Larena-Avellaneda A, Carpenter W, Diener H, Kölbel T. Operative Therapie der chronischen mesenterialen Ischämie. Chirurg 2011; 82:871-4, 876-9. [DOI: 10.1007/s00104-011-2099-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Heiss P, Loewenhardt B, Manke C, Hellinger A, Dietl KH, Schlitt HJ, Scheibl K, Feuerbach S, Paetzel C. Primary percutaneous aspiration and thrombolysis for the treatment of acute embolic superior mesenteric artery occlusion. Eur Radiol 2010; 20:2948-58. [PMID: 20563813 DOI: 10.1007/s00330-010-1859-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 05/10/2010] [Accepted: 05/19/2010] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To evaluate technical success rate and clinical outcome of patients with acute embolic superior mesenteric artery (SMA) occlusion who were treated with primary percutaneous revascularization. METHODS At three medical centers the radiological information system databases were used to identify all patients in whom primary percutaneous revascularization for the treatment of acute embolic SMA occlusion was attempted between 2001 and 2010. Percutaneous treatment was performed in 15 patients (median age 80 years, range 49-88 years). These patients represent the study population. Eleven patients reported abdominal pain. Five patients exhibited peritoneal signs. Revascularization was defined as complete technical success if (1) patency of the SMA with residual stenosis of not more than 30% in diameter and (2) sufficient perfusion of the entire bowel were obtained. RESULTS Complete technical success was achieved in eleven patients. After percutaneous revascularization laparotomy was performed in six patients and in three of them bowel resection was carried out (length of resected segments 20-80 cm). The 30-day mortality was 33% (five of 15 patients). None of the surviving patients exhibited short-bowel syndrome. CONCLUSIONS Primary percutaneous aspiration and thrombolysis constitutes a promising alternative to surgical revascularization in selected patients with acute embolic SMA occlusion.
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Affiliation(s)
- Peter Heiss
- Department of Radiology, University Medical Center Regensburg, 93042, Regensburg, Germany.
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Gibbons CP, Roberts DE. Endovascular treatment of chronic arterial mesenteric ischemia: a changing perspective? Semin Vasc Surg 2010; 23:47-53. [PMID: 20298949 DOI: 10.1053/j.semvascsurg.2009.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endovascular treatment for chronic mesenteric ischemia is growing in popularity because of its lower periprocedural morbidity and mortality than open surgery. It is especially suitable for the high-risk surgical candidate and for those who have a poor nutritional state, although endovascular surgery may not be possible in patients with ostial occlusions or heavily calcified vessels. A positive response to angioplasty is helpful to secure a diagnosis in patients with slightly atypical symptoms. There are little data at present to suggest that primary stenting is better than angioplasty alone, but insertion of a stent may be valuable as a rescue procedure following dissection, vascular recoil, or thrombosis during angioplasty. The superior mesenteric artery is probably the most important vessel to treat but, where this is impossible, celiac or inferior mesenteric artery dilatation may have therapeutic benefit. However, there is some evidence at present favoring multiple, as opposed to single-vessel, angioplasty or stenting. Long-term patency is better after mesenteric bypass, which may be preferred in the younger and fitter patient. Treatment of the celiac artery compression syndrome is primarily surgical, but stent insertion may have a role as a secondary procedure where there is a residual stenosis after median arcuate ligament division.
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Affiliation(s)
- C P Gibbons
- Department of Vascular Surgery, Morriston Hospital, Swansea, UK.
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Aytekin C, Yıldırım UM, Ozyer U, Harman A, Boyvat F. Emergency Renal Ablation for Life-Threatening Hemorrhage from Multiple Capsular Branches During Renal Artery Stenting. Cardiovasc Intervent Radiol 2009; 33:663-6. [DOI: 10.1007/s00270-009-9760-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Ischemic lesions of the splanchnic organs are characterized by an insidious course and therefore are often underestimated. They can result in dramatic courses of disease which even in the last decade still results in a mortality of up to 90%. The reasons for this depressing situation are various but mainly due to insufficient consideration of the symptoms and late therapy due to delayed diagnosis.The incidence of chronic splanchnic ischemia is approximately 1-2% of all abdominal diseases. In contrast to acute intestinal ischemia the course is progressive, caused by progression of the underlying atherosclerosis and polymorbidity in this aging society. On the one hand occlusions of splanchnic arteries are diagnosed more often and on the other hand the incidence has increased due to the rising number of therapy-linked vascular catheter maneuvers. Due to excellent collateralization, diffuse stenotic processes can maintain asymptomatic for a long time. Duplex sonography should be performed as this technique reveals relevant insights into the hemodynamic severity of lesions.
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Affiliation(s)
- E S Debus
- Abt. Allgemein-, Gefäss- und Visceralchirurgie, Asklepios Klinik Harburg, Eissendorfer Pferdeweg 52, 21075 Hamburg, Deutschland.
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