1
|
Dreksler H, Nagpal SK, Hajjar G, Roberts DJ. Successful surgical management of a suspected high-flow inferior mesenteric artery aneurysm in a patient with chronic celiac and superior mesenteric artery occlusions. J Vasc Surg Cases Innov Tech 2024; 10:101438. [PMID: 38445064 PMCID: PMC10912906 DOI: 10.1016/j.jvscit.2024.101438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/11/2024] [Indexed: 03/07/2024] Open
Abstract
Inferior mesenteric artery (IMA) aneurysms account for approximately 1% of visceral artery aneurysms and can occur secondary to high flow because of occlusive disease in other mesenteric arteries. We describe the case of a 79-year-old man who presented with a 3.3-cm IMA aneurysm and chronic total occlusions of the celiac artery and superior mesenteric artery (SMA). After an unsuccessful attempt at endovascular SMA recanalization, he underwent an uncomplicated retrograde aorta to SMA bypass and antegrade aorta to IMA bypass. We propose that an aorta to IMA bypass after SMA revascularization is safe and effective to treat suspected high-flow IMA aneurysms.
Collapse
Affiliation(s)
- Hannah Dreksler
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Sudhir K. Nagpal
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - George Hajjar
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Derek J. Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
2
|
Chen YA, Tai FC, Chen JH, Chen WL, Chung JY. Warfarin Overdose Associated Inferior Mesentery Artery Aneurysm Rupture Mimicking Spontaneous Bowel Hematoma. J Acute Med 2018; 8:186-189. [PMID: 32995222 PMCID: PMC7517977 DOI: 10.6705/j.jacme.201812_8(4).0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/14/2018] [Accepted: 03/27/2018] [Indexed: 11/14/2022]
Abstract
Inferior mesentery artery (IMA) aneurysm rupture is easily overlooked in patients with abdominal pain due to its uncommon occurrence. It may result in catastrophic consequence once misdiagnosed as spontaneous bowel hematoma in patients with anticoagulant overdose and intra-abdominal hematoma, as treatment strategy for both diseases varies differently. We present a case of a 70-year-old male who came to our emergency department with the chief complaint of abdominal pain over periumbilical area, eventually diagnosed as anticoagulant overdose associated IMA aneurysm rupture without occlusion of superior mesentery artery (SMA) and celiac artery (CA). This case report alerts us to consider the rare other source of bleeding, for instance ruptured inferior mesentery aneurysm, while encountering such an extraordinary large intra-abdominal hematoma in patients on anticoagulant.
Collapse
Affiliation(s)
- Yen-An Chen
- Cathay General Hospital Department of Emergency Medicine Taipei Taiwan
| | - Feng-Chuan Tai
- Cathay General Hospital Department of Surgery Taipei Taiwan
| | - Jiann-Hwa Chen
- Cathay General Hospital Department of Emergency Medicine Taipei Taiwan
| | - Wei-Lung Chen
- Cathay General Hospital Department of Emergency Medicine Taipei Taiwan
| | - Jui-Yuan Chung
- Cathay General Hospital Department of Emergency Medicine Taipei Taiwan
| |
Collapse
|
3
|
Inferior Mesenteric Artery Aneurysm Complicated With Occluded Celiac and Superior Mesenteric Artery After Replacement of Thoracoabdominal Aorta for Chronic Dissected Thoracoabdominal Aortic Aneurysm. Ann Vasc Surg 2017; 44:420.e7-420.e10. [PMID: 28479427 DOI: 10.1016/j.avsg.2017.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 02/12/2017] [Accepted: 04/25/2017] [Indexed: 11/24/2022]
Abstract
We report a case of inferior mesenteric artery aneurysm (IMAA) after the replacement of the thoracoabdominal aorta for a chronic dissected thoracoabdominal aortic aneurysm in which the celiac artery and superior mesenteric artery were occluded. We performed the resection of the IMAA and the revascularization of the superior mesenteric artery, inferior mesenteric artery, and meandering artery. The patient's postoperative course was uneventful, without bowel ischemia. From the findings of intraoperative flow measurement of the visceral arteries, revascularization of the superior mesenteric artery was judged to be appropriate in this situation.
Collapse
|
4
|
Hansraj N, Hamdi A, Wise ES, DiChiacchio L, Sarkar R, Toursavadkohi S. Open and Endovascular Management of Inferior Mesenteric Artery Aneurysms: A Report of Two Cases. Ann Vasc Surg 2017; 43:316.e9-316.e14. [PMID: 28479424 DOI: 10.1016/j.avsg.2017.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 04/12/2017] [Accepted: 04/12/2017] [Indexed: 11/28/2022]
Abstract
Inferior mesenteric artery (IMA) aneurysms are a rare entity, attributing to 1% of Splanchnic aneurysms (Edogawa S, Shibuya T, Kurose K et al. Inferior mesenteric artery aneurysm: case report and literature review. Ann Vasc Dis 2013;6:98-101), often found incidentally on evaluation for other intra-abdominal pathologies. Similar to other visceral arterial aneurysms, there is an estimated 20-50% risk of potentially fatal rupture and repair is generally recommended. We report 2 patients with IMA aneurysms, using them as cases to illustrate feasibility of both open and endovascular management options. Patient 1 is a 69-year-old male with bilateral claudication found to have an asymptomatic 20-mm IMA aneurysm. This patient underwent aortobifemoral bypass with branch polytetrafluoroethylene graft to distal IMA after excision of IMA aneurysm. Patient 2 is a 32-year-old male who underwent an ex vivo renal artery aneurysm repair and was noted on routine follow-up to have an incidental saccular 1.5-cm IMA aneurysm for which he underwent endovascular coil embolization. Both patients had an unremarkable postoperative course with a notable absence of stigmata of bowel ischemia.
Collapse
Affiliation(s)
- Natasha Hansraj
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
| | - Abdulrahman Hamdi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Eric S Wise
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Laura DiChiacchio
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Rajabrata Sarkar
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Shahab Toursavadkohi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
5
|
Radak D, Sevkovic M, Kecmanovic V, Tanaskovic S. Rare case of inferior mesenteric artery aneurysm with associated pelvic arteriovenous malformation. ANZ J Surg 2016; 88:1202-1203. [PMID: 27723256 DOI: 10.1111/ans.13788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/09/2016] [Accepted: 08/19/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Djordje Radak
- Vascular Surgery Clinic, 'Dedinje' Cardiovascular Institute, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milorad Sevkovic
- Vascular Surgery Clinic, 'Dedinje' Cardiovascular Institute, Belgrade, Serbia
| | | | - Slobodan Tanaskovic
- Vascular Surgery Clinic, 'Dedinje' Cardiovascular Institute, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
6
|
Edogawa S, Shibuya T, Kurose K, Sasaki K, Tomita H. Inferior mesenteric artery aneurysm: case report and literature review. Ann Vasc Dis 2013; 6:98-101. [PMID: 23641294 DOI: 10.3400/avd.cr.12.00086] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 01/11/2013] [Indexed: 11/13/2022] Open
Abstract
An inferior mesenteric artery (IMA) aneurysm is the rarest among visceral artery aneurysms. A 69-year-old man was referred to our hospital with an asymptomatic IMA aneurysm associated with occlusion of the superior mesenteric artery (SMA) and celiac artery (CA). After revascularization of the SMA with an 8-mm expanded polytetrafluoroethylene (ePTFE) graft, the aneurysm was resected, and the IMA was reconstructed. The "jet disorder" phenomenon has been thought to cause an IMA aneurysm in the case of CA and SMA obstruction. We consider it better to revascularize not only an IMA but also an SMA or CA for preventing that phenomenon.
Collapse
Affiliation(s)
- Seiji Edogawa
- Division of Vascular Surgery, Department of Cardiovascular Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | | | | | | | | |
Collapse
|
7
|
Edogawa S, Shibuya T, Kurose K, Sasaki K, Tomita H. Inferior Mesenteric Artery Aneurysm: Case Report and Literature Review. Ann Vasc Dis 2013. [DOI: 10.3400/avd.oa.12.00086] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
8
|
Troisi N, Esposito G, Cefalì P, Setti M. A case of atherosclerotic inferior mesenteric artery aneurysm secondary to high flow state. J Vasc Surg 2011; 54:205-7. [DOI: 10.1016/j.jvs.2010.11.114] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 11/17/2010] [Accepted: 11/22/2010] [Indexed: 11/15/2022]
|
9
|
Acute retroperitoneal bleeding due to inferior mesenteric artery aneurysm: case report. BMC Gastroenterol 2010; 10:59. [PMID: 20534123 PMCID: PMC2889853 DOI: 10.1186/1471-230x-10-59] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2009] [Accepted: 06/09/2010] [Indexed: 11/29/2022] Open
Abstract
Background Visceral artery aneurysms (VAA), although uncommon, are increasingly being detected. We describe a case of spontaneous retroperitoneal hemorrhage from a ruptured IMA aneurysm associated with stenosis of the superior mesenteric artery (SMA) and celiac trunk, successfully treated with surgery. Methods A 65-year-old man presented with abdominal pain and hypovolemic shock. Abdominal CT scan showed an aneurysm of the inferior mesenteric artery with retroperitoneal hematoma. In addition, an obstructive disease of the superior mesenteric artery and celiac axis was observed. Results Upon emergency laparotomy a ruptured inferior mesenteric artery aneurysm was detected. The aneurysm was excised and the artery reconstructed by end-to-end anastomosis. Conclusions This report discusses the etiology, presentation, diagnosis and case management of inferior mesenteric artery aneurysms.
Collapse
|
10
|
Momin AA, Chaubal NG, Saifi SGA, Kazi ZN. Sonographic diagnosis of inferior mesenteric artery aneurysm and marginal artery of Drummond. JOURNAL OF CLINICAL ULTRASOUND : JCU 2008; 36:42-4. [PMID: 17583563 DOI: 10.1002/jcu.20397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
We report the case of a patient in whom sonographic examination revealed an aneurysm of the inferior mesenteric artery with severe proximal stenosis and poststenotic dilatation--the enlargement of the proximal portion of the artery of Drummond. This collateral pathway should be kept in mind when studying bowel ischemia, especially when stenosis is present or when there is occlusion of the superior mesenteric artery.
Collapse
Affiliation(s)
- Asif A Momin
- Department of Ultrasound, Prince Aly Khan Hospital, Nesbit Road, Mazagaon, Mumbai 400 010, India
| | | | | | | |
Collapse
|