Clinical presentation, management, follow-up, and outcomes of isolated celiac and superior mesenteric artery dissections

We herein report a rare case of mycotic aneurysm of the superior mesenteric artery caused by <i>Klebsiella pneumoniae</i>. A 66-year-old man, a known case of hypertension and aorto-oesophageal fistula with stented aorta in 2010 and 2018, presented to the emergency department multiple times over 2 months with severe postprandial abdominal pain associated with vomiting and fever. On his last presentation, the obtained blood cultures grew ESBL positive <i>K. pneumoniae</i> and a repeated computed tomography (CT) showed a growing aneurysm at the origin of the ileocecal branch of the superior mesenteric artery measuring 17 × 10 mm (the aneurysm was 8 × 7.5 mm in the CT angiography on the previous admission). Extensive workup did not reveal the underlying cause of the mycotic aneurysm, thus we believe the cause to be the infected aortic stent, leading to bacteraemia and vegetations to the mesenteric artery causing the aneurysm. The management plan was placed by a multidisciplinary team consisting of vascular surgeons and infectious disease specialists along with review from a dietician to evaluate the patient’s nutritional status. The patient was started on total parenteral nutrition due to his postprandial pain and on antibiotic therapy according to the infectious disease team’s recommendation. He underwent surgical resection of the mycotic aneurysm, which showed a thrombosed aneurysm in the jejunoileal mesenteric area. The histopathology of the resected tissue demonstrated inflammatory aneurysm of the mesenteric artery. Following the surgery, the patient continued his antibiotic therapy and was discharged on the 13th post-operative day with follow-up appointments in the vascular surgery and infectious disease clinic.

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Endovascular Treatment of an Acute Superior Mesenteric Artery Occlusion following Failed Surgical Embolectomy

Journal of Endovascular Therapy ◽

10.1177/152660280301000236 ◽

2003 ◽

Vol 10 (2) ◽

pp. 386-391 ◽

Cited By ~ 2

Author(s):

Saim Yilmaz ◽

Alihan Gürkan ◽

Okan Erdoğan ◽

Timur Sindel ◽

Kağan Çeken ◽

...

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Artery Occlusion ◽

Distal Embolization ◽

Primary Stenting ◽

History Of ◽

Surgical Embolectomy ◽

Failed Surgery ◽

Symptom Recurrence

Purpose: To present the successful primary stenting of a superior mesenteric artery (SMA) occlusion following failed surgical embolectomy. Case Report: A 65-year-old woman with a history of atrial fibrillation underwent surgical embolectomy of an acute embolic occlusion of the superior mesenteric artery (SMA). The following day, symptom recurrence suggested reocclusion, which was confirmed with emergent arteriography. Two balloon-expandable stents were deployed primarily, which ameliorated the patient's symptoms. Follow-up angiography at 3 months showed continued SMA patency, with no evidence of distal embolization or restenosis. The patient remains asymptomatic at 9 months after the stent procedure. Conclusions: Although more experience is required, primary stenting may be a valuable alternative in the treatment of acute SMA occlusions, in particular, for reocclusions after failed surgery.

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A Novel Approach for Repairing Superior Mesenteric Artery Injury During Left Nephrectomy—6-year Follow-up

Urology ◽

10.1016/j.urology.2020.07.017 ◽

2020 ◽

Vol 144 ◽

pp. 241-244

Author(s):

Liyuan Zhang ◽

Xiaokang Zhang ◽

Pengcheng Chang ◽

Jie Yang ◽

Duo Zheng ◽

...

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Artery Injury ◽

Novel Approach

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Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome: intermediate follow-up results and a review of the literature

Surgical Endoscopy ◽

10.1007/s00464-016-5088-2 ◽

2016 ◽

Vol 31 (3) ◽

pp. 1180-1185 ◽

Cited By ~ 10

Author(s):

Julietta Chang ◽

Mena Boules ◽

John Rodriguez ◽

Matthew Walsh ◽

Raul Rosenthal ◽

...

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Superior Mesenteric Artery Syndrome ◽

Review Of The Literature

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Comments regarding ‘Treatment Guidelines for Isolated Dissection of the Superior Mesenteric Artery Based on Follow-up CT Findings’

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2011.02.018 ◽

2011 ◽

Vol 41 (6) ◽

pp. 786 ◽

Cited By ~ 1

Author(s):

W. Wisselink

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Treatment Guidelines ◽

Ct Findings

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Hybrid Repair of Thoracic and Thoracoabdominal Aortic Aneurysms (Mega Aortic Syndrome) with Lupiae Technique

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e318247fb71 ◽

2011 ◽

Vol 6 (6) ◽

pp. 366-372 ◽

Cited By ~ 4

Author(s):

Giampiero Esposito ◽

Giangiuseppe Cappabianca ◽

Gaetano Contegiacomo ◽

Giuseppe Labriola ◽

Nunzio Gallo ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

False Lumen ◽

Celiac Trunk ◽

Aortic Aneurysms ◽

Cord Injury ◽

Hybrid Repair

Objective Several techniques have been described for the treatment of thoracic and thoracoabdominal aneurysms in patients with mega aortic syndrome (MAS), but the incidence of stroke, spinal cord injury, and endoleaks remains high. We present the midterm results of a new hybrid, multistep technique to treat patients with MAS. Methods From November 2005 to January 2011, 80 patients with MAS underwent hybrid repair of thoracic and thoracoabdominal aneurysms with the Lupiae technique. Forty-six patients presented with chronic aortic aneurysms, and 34 patients who had undergone aortic arch debranching with the Lupiae graft for acute aortic dissection presented with an expanding false lumen into the residual aorta. Sixty patients underwent ascending aorta and arch replacement with a Gelweave Lupiae prosthesis plus epiaortic vessel debranching (thoracic Lupiae procedure). Fourteen patients underwent a thoracic Lupiae procedure plus partial visceral debranching (celiac trunk and superior mesenteric artery) through a mini-laparotomy. Six patients underwent a thoracic Lupiae procedure plus a complete visceral debranching (celiac trunk, superior mesenteric artery, and renal arteries) with the implant of a second Lupiae prosthesis to replace the abdominal aorta. After the surgical steps, all the surviving patients underwent an endovascular procedure to implant multiple stent grafts to exclude the residual segment of diseased aorta. Results In-hospital mortality was 8.4%, and the incidence of temporary renal failure was 5.2%. None of the patients had a stroke or a spinal cord injury, and none of the patients presented endoleaks immediately following the procedure or during the follow-up computed tomography scans. No deaths occurred during the 6-year follow-up after the hybrid procedure. Conclusions These preliminary results showed that the Lupiae technique is a safe and effective option for the treatment of patients with MAS. Indeed, the Lupiae technique achieves complete exclusion of thoracic and thoracoabdominal aneurysms with a low risk of paraplegia and endoleaks.

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Endovascular management of chronic mesenteric ischemia: a single centre experience in Western Rajasthan, India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172449 ◽

2017 ◽

Vol 5 (6) ◽

pp. 2572

Author(s):

Pawan Sarda ◽

Goutam Kumar ◽

Deepak Gupta ◽

Sanjeev Sanghvi ◽

Anil Baroopal

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Percutaneous Transluminal Angioplasty ◽

Inferior Mesenteric Artery ◽

Mesenteric Ischemia ◽

Celiac Trunk ◽

Transluminal Angioplasty ◽

Chronic Mesenteric Ischemia ◽

Percutaneous Transluminal

Background: Chronic mesenteric ischemia (CMI) or mesenteric angina is a condition characterised by inadequate blood supply to bowel as a result of stenosis affecting one or more of the three mesenteric arteries: the celiac artery (CA), the superior mesenteric artery (SMA) and the inferior mesenteric artery (IMA).Methods: Ten patients with significant lesion, treated with PTA and stenting were selected for study and were followed at 2 weeks, at 2 months then at 6 months after index procedure to see composite of symptomatic improvement, weight gain and revascularization.Results: On mesenteric angiography, significant ostial stenosis of celiac trunk and superior mesenteric artery in 5 patients, 3 patients had significant ostial stenosis of celiac trunk and ostial stenosis of inferior mesenteric artery and 2 patients had significant stenosis of superior mesenteric artery. Percutaneous transluminal angioplasty (PTA) and stenting was done, final result was good and there was no residual stenosis and dissection. After stenting patients were stable and pain free. There were no post-operative complications. Follow up was done after 2 weeks and 2 months and then at six months. There was no postprandial abdominal pain on follow up and almost all patient had gained weight in 2 months and on 6 months of follow up, no case of repeat revascularization was recorded.Conclusions: Percutaneous transluminal angioplasty (PTA) and stenting to mesenteric artery is good alternative management of CMI. In present series, all cases were susses fully revascularized without residual stenosis and dissection.

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Long-term Outcomes of Conservative Treatment and Endovascular Treatment in Patients with Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection: A Single-center Experience

10.21203/rs.2.17427/v2 ◽

2020 ◽

Author(s):

Leyin Xu ◽

Jiang Shao ◽

Daming Zhang ◽

Chenyang Qiu ◽

Jingjing Wang ◽

...

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Artery Dissection ◽

Single Center ◽

Long Term Outcomes ◽

Conservative Group ◽

Superior Mesenteric Artery Dissection ◽

Symptom Recurrence

Abstract Background: Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare vascular disorder, and the treatment strategies remain controversial. This study aimed to compare outcomes of conservative and endovascular treatments in symptomatic patients with SISMAD. Methods: Forty-two consecutive SISMAD patients who were admitted to a single center between October 2009 and May 2018 were enrolled in this study. Based on their symptoms, 15 had conservative treatment, and 27 had endovascular treatment. The baseline characteristics, treatments, and follow-up results of the conservative group and endovascular group were analysed. Results: The rates of symptom relief were 93.3% in the conservative group and 96.3% in the endovascular group. The procedure-related complications in the endovascular group included one case of pseudoaneurysm formation in the left brachial artery. During the follow-up period (median 28.5 months), a higher proportion of patients in the conservative group had symptom recurrence (42.9% in the conservative group versus 4.8% in the endovascular group, p < 0.001). Four patients in the conservative group and one patient in the endovascular group had additional endovascular intervention during follow-up. Compared with the conservative group, patients in the endovascular group had statistically significantly longer symptom-free survival ( p = 0.014) and a higher rate of superior mesenteric artery (SMA) remodeling ( p < 0.001). Conclusions: For symptomatic SISMAD, endovascularly treated patients had a lower rate of symptom recurrence and a higher rate of SMA remodeling in the long term. Prospective, multi-center studies are needed to confirm the long-term outcomes of both treatments.

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Long-term Outcomes of Conservative Treatment and Endovascular Treatment in Patients with Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection: A Single-center Experience

10.21203/rs.2.17427/v1 ◽

2019 ◽

Author(s):

Leyin Xu ◽

Daming Zhang ◽

Chenyang Qiu ◽

Jingjing Wang ◽

Kang Li ◽

...

Keyword(s):

Endovascular Treatment ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Artery Dissection ◽

Single Center ◽

Conservative Group ◽

Superior Mesenteric Artery Dissection ◽

Symptom Recurrence

Abstract Background: Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare vascular disorder and the treatment strategies remain controversial. This study aimed to compare outcomes of conservative and endovascular treatments in symptomatic patients with SISMAD. Methods: Forty-two consecutive SISMAD patients between October 2009 and May 2018 in a single center were enrolled in the study. Based on their symptoms, 15 had conservative treatment and 27 had endovascular treatment. The baseline characteristics, treatments, and follow-up results of the conservative group and endovascular group were analyzed. Results: The rate of symptom relief was 93.3% in the conservative group and 96.3% in the endovascular group, respectively. The procedure-related complications in the endovascular group included one case of pseudoaneurysm formation in the left brachial artery. During the follow-up period (median 28.5 months), a higher proportion of patients in the conservative group had symptom recurrence (42.9% in the conservative group versus 4.8% in the endovascular group, p < 0.001). Four patients in the conservative group and one patient in the endovascular group had additional endovascular intervention during follow-up. Compared with the conservative group, patients in the endovascular group had statistically significantly longer symptom-free survival ( p = 0.014) and a higher rate of superior mesenteric artery (SMA) remodeling ( p < 0.001). Conclusions: For symptomatic SISMAD, endovascularly treated patients had a lower rate of symptom recurrence and a higher rate of SMA remodeling in the long term. Endovascular treatment should be considered as the first-line treatment of SISMAD.

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