Stenting of stenotic mesenteric arteries for symptomatic chronic mesenteric ischemia

VASA ◽  
2012 ◽  
Vol 41 (6) ◽  
pp. 425-431 ◽  
Author(s):  
Aschenbach ◽  
Bergert ◽  
Kerl ◽  
Zangos ◽  
Neumeister ◽  
...  
Keyword(s):  
Weight Loss ◽  
Abdominal Pain ◽  
Gastrointestinal Bleeding ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Celiac Artery ◽  
Lower Gastrointestinal Bleeding ◽  
Mesenteric Arteries ◽  
Chronic Mesenteric Ischemia ◽  
Technical Failure

Background: We report the results of our single center series of patients with chronic mesenteric ischemia (CMI) to determine the role of stenting in the management of patients. Patients and methods: We retrospectively reviewed all patients with CMI treated endovascularly with stent revascularisation from January 2008 to January 2011.CMI diagnosis was made according to clinical symptoms, including postprandial abdominal pain, food fear, and weight loss. Additionally, the diagnosis was confirmed by duplex ultrasonography and/or computed tomography angiography and/or contrast-enhanced magnetic resonance angiography. Results: All 45 patients presented with typical CMI symptoms: 45/45 (100 %) had postprandial pain, 31/45 (68.8 %) had a weight loss of more than 10 kilograms, and 11/45 (24.4 %) suffered from ischemic colitis combined with lower gastrointestinal bleeding. In three patients occlusion could not be crossed, therefore considered as technical failure. A total of 55 arteries were stented in the remaining 42 patients. Nineteen patients underwent SMA stenting alone, eight underwent celiac stenting, alone and three patients underwent stenting of inferior mesenteric artery (IMA) alone. We performed combined stenting of the celiac artery and superior mesenteric artery in ten patients, and one patient underwent a combined stenting of the celiac artery and the IMA. All three mesenteric arteries were stented in only one patient. Primary technical success was achieved in 42/45 (94.8 %) patients. Clinical symptom relief was achieved in 39/45 (86.6 %) patients with abdominal pain. Increased body weight was observed in 28/31 (90.3 %) patients with an average weight gain of 8.8 kilograms (5 - 12 kilograms), and 10/11 (90.9 %) patients recovered from ischaemic colitis/lower gastrointestinal bleeding. Conclusions: Stent revascularisation can be considered as the first-line therapy for patients with chronic mesenteric ischemia.

scholarly journals Clinical implications of chronic mesenteric ischemia in elderly and senile patients

2020 ◽  
Vol 92 (2) ◽  
pp. 74-80
Author(s):  
A. I. Dolgushina ◽  
A. S. Kuznecova ◽  
A. A. Seljanina ◽  
V. V. Genkel ◽  
A. G. Vasilenko
Keyword(s):  
Weight Loss ◽  
Abdominal Pain ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Celiac Trunk ◽  
Mesenteric Arteries ◽  
Chronic Mesenteric Ischemia ◽  
Clinical Criteria

Aim.To evaluate the sensitivity and specificity of the clinical criteria for the diagnosis of chronic mesenteric ischemia in elderly and senile patients with mesenteric atherosclerosis. Materials and methods.The study included 142 patients (82 men and 60 women). The median age of patients is 66.0 [62.0; 72.0] years. Results.According to MDCT atherosclerotic lesions of the abdominal aorta and its unpaired visceral branches were diagnosed in 105 (73.9%) patients. A combination of atherosclerosis of the celiac trunk and the superior mesenteric artery with the presence of hemodynamically insignificant stenosis was revealed. Hemodynamically significant atherosclerotic narrowing of at least one mesenteric artery was present in 15% of cases. Among them, a single vascular lesion was found in 6 patients (4.2%), a combination of hemodynamically significant lesions of two arteries in 15 (11%) patients. Depending on the clinical manifestations, all patients are divided into two groups: the first group 30 (21.1%) patients with the presence of symptoms characteristic of chronic mesenteric ischemia (CMI). The second group consisted of 112 (78.8%) patients without a characteristic triad of symptoms. The clinical symptom complex of СMI, including postprandial abdominal pain, intestinal dysfunction and progressive weight loss, as a diagnostic criterion showed low sensitivity 13.3% and specificity 77.9%. At the same time, the sensitivity of such a clinical combination as a combination of atherosclerosis of the arteries of the lower extremities, weight loss and abdominal pain syndrome with a severity of more than 5.5 points, with respect to the detection of hemodynamically significant stenoses of two or more mesenteric arteries was sensitivity 86.7%, specificity 74.0%.

scholarly journals Intestinal Ischemia Mirrors Cardiac Angina- A Case Report

2021 ◽  
pp. 5-9
Author(s):  
Sunil Dighe ◽  
Kalyan Munde ◽  
Piyush Kalantri ◽  
Mahesh Bodke
Keyword(s):  
Blood Flow ◽  
Abdominal Pain ◽  
Endovascular Treatment ◽  
Mesenteric Artery ◽  
Celiac Artery ◽  
The Body ◽  
Mesenteric Arteries ◽  
Long Term Results ◽  
Chronic Mesenteric Ischemia ◽  
Interventional Devices

Chronic mesenteric ischemia (intestinal angina) is a condition that is caused by stenosis or occlusion of the mesenteric arteries (Superior mesenteric artery, inferior mesenteric artery and celiac artery) and usually manifest as abdominal pain which is usually post - prandial in nature. If plaque or lesion in an artery supplying the intestines narrows the vessel so severely that sluggish blood flow causes a clot, blood flow through that artery can become completely blocked, which can lead to ischemia .While surgical revascularization has been the standard treatment for symptomatic patients in past , recent advances in interventional devices and techniques have made endovascular treatment easily available and effective treatment. Endovascular treatment is considered as minimally invasive means of obtaining good long-term results. The Coronary arteries are common hiding places for cholesterol-filled plaque and blood clots. Plaque can limit blood flow during exercise or stress, causing the chest pain or pressure known as angina. Clots may completely block blood flow, causing a heart attack or cardiac arrest. These two leading perpetrators can do similar things elsewhere in the body. When they interfere with blood flow to the digestive system, the effects can range from a stomach ache after every meal to a life threatening emergency. We report a similar case who present with unstable angina. During hospitalization he was having persistent abdominal pain and who was investigated with CT abdomen and later Angioplasty was done which further showed significant benefit to patient.

Postprandial lower limb pain: An unusual presentation of visceral arteries occlusion

Vascular ◽  
2014 ◽  
Vol 23 (3) ◽  
pp. 316-318 ◽  
Author(s):  
Nikolaos Patelis ◽  
Konstantinos Papoutsis ◽  
Dimitrios Liakopoulos ◽  
Andreas Koutsoumpelis ◽  
Christos Bakogiannis ◽  
...  
Keyword(s):  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Celiac Artery ◽  
Mesenteric Arteries ◽  
Lower Limbs ◽  
Chronic Mesenteric Ischemia ◽  
Time Curve ◽  
Lower Limb Pain ◽  
Visceral Arteries

This case report describes an atypical and unique presentation of mesenteric arteries occlusive disease. The patient presented with typical symptoms of chronic mesenteric ischemia, as well as with an atypical new symptom; postprandial buttock and lower limbs pain. Pain followed the time curve of the postprandial abdominal discomfort, starting 30 min after meals and gradually resolving within 2 h. The patient had been tolerating the signs of chronic mesenteric ischemia quite well by adjusting the quantity of food per meal to relieve symptoms. Angiography showed that the celiac artery, the superior mesenteric artery, and distal aorta were occluded, leaving the inferior mesenteric artery as the only feeding vessel of all abdominal viscera and both the lower limbs. Since an English medical literature search returned only one marginally similar case, we consider this case of iliac arteries’ “steal syndrome” from the inferior mesenteric artery unique.

scholarly journals Percutaneous retrograde revascularization of chronic occlusions of the superior mesenteric artery via collaterals of the celiac artery

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Wilhelm H. Kersjes ◽  
Alexander Hesse
Keyword(s):  
Abdominal Pain ◽  
Clinical Outcome ◽  
Superior Mesenteric Artery ◽  
Abdominal Aorta ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Celiac Artery ◽  
Chronic Mesenteric Ischemia ◽  
Technical Success ◽  
Chronic Total Occlusions

Abstract Purpose To evaluate the technical success of percutaneous retrograde revascularization of the superior mesenteric artery (SMA) via the celiac artery (CA) in patients with chronic mesenteric ischemia (CMI). Methods We performed a retrospective review of three patients with chronic total occlusions (CTOs) of the origin of SMA which were recanalized retrograde via collaterals of the CA after frustrating attempt of antegrade revascularization from the abdominal aorta in our institute between May 2019 and June 2020. Results All technical procedures of retrograde revascularization of CTOs of SMA via collaterals of the CA were successful. The clinical outcome resulted in a sustained resolution of abdominal pain in all cases. Conclusion Retrograde recanalization of SMA via collaterals from the CA seems to be a successful endovascular option for patients with CMI and a chronically occluded superior mesenteric artery when antegrade recanalization fails as far as it can be concluded from the small number of presented cases.

scholarly journals Mesenteric artery calcium scoring: a potential screening method for chronic mesenteric ischemia

2020 ◽  
Author(s):  
Luke G. Terlouw ◽  
Desirée van Noord ◽  
Theo van Walsum ◽  
Marco J. Bruno ◽  
Adriaan Moelker
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Interobserver Agreement ◽  
Screening Tool ◽  
Screening Method ◽  
Calcium Score ◽  
Celiac Artery ◽  
Mesenteric Arteries ◽  
Chronic Mesenteric Ischemia

Abstract Objective A practical screening tool for chronic mesenteric ischemia (CMI) could facilitate early recognition and reduce undertreatment and diagnostic delay. This study explored the ability to discriminate CMI from non-CMI patients with a mesenteric artery calcium score (MACS). Methods This retrospective study included CTAs of consecutive patients with suspected CMI in a tertiary referral center between April 2016 and October 2019. A custom-built software module, using the Agatston definition, was developed and used to calculate the MACS for the celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery. Scoring was performed by two blinded observers. Interobserver agreement was determined using 39 CTAs scored independently by both observers. CMI was defined as sustained symptom improvement after treatment. Non-CMI patients were patients not diagnosed with CMI after a diagnostic workup and patients not responding to treatment. Results The MACS was obtained in 184 patients, 49 CMI and 135 non-CMI. Interobserver agreement was excellent (intraclass correlation coefficient 0.910). The MACS of all mesenteric arteries was significantly higher in CMI patients than in non-CMI patients. ROC analysis of the combined MACS of CA + SMA showed an acceptable AUC (0.767), high sensitivity (87.8%), and high NPV (92.1%), when using a ≥ 29.7 CA + SMA MACS cutoff. Comparison of two CTAs, obtained in the same patient at different points in time with different scan and reconstruction parameters, was performed in 29 patients and revealed significant differences in MACSs. Conclusion MACS seems a promising screening method for CMI, but correction for scan and reconstruction parameters is warranted. Key Points • A mesenteric artery calcium score obtained in celiac artery and superior mesenteric artery has a high negative predictive value for chronic mesenteric ischemia and could serve as a screening tool. • Interobserver agreement of the mesenteric artery calcium score is excellent. • Scan and reconstruction parameters influence the mesenteric artery calcium score and warrant the development of a method to correct for these parameters.

Chronic mesenteric ischemia with only mild abdominal pain and extreme weight loss

2000 ◽  
Vol 95 (9) ◽  
pp. 2618-2619
Author(s):  
Kanwarjit Arora ◽  
Nazmul Hoque ◽  
Bashar Attar M ◽  
Anthony Williams D ◽  
Muhammed Siddiq ◽  
...  
Keyword(s):  
Weight Loss ◽  
Abdominal Pain ◽  
Mesenteric Ischemia ◽  
Chronic Mesenteric Ischemia ◽  
Mild Abdominal Pain

Abstract 495: Mouse Model of Mesenteric Ischemia Secondary to Vascular Calcification and Atherosclerosis

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Konstantinos Damiris ◽  
Filippo Romanelli ◽  
Alexei Savinov ◽  
José Luis Millan ◽  
Jes Kuruvilla ◽  
...  
Keyword(s):  
Weight Loss ◽  
Mouse Model ◽  
Mesenteric Ischemia ◽  
Intestinal Ischemia ◽  
Density Lipoprotein ◽  
Body Weight Loss ◽  
Goblet Cells ◽  
Mesenteric Arteries ◽  
Chronic Mesenteric Ischemia

Objective: Atherosclerosis is a leading cause of chronic mesenteric ischemia (CMI), defined as intestinal hypoperfusion resulting from stenosis of mesenteric arteries. Symptoms of CMI range from non-specific abdominal pain and weight loss to aversion of food resulting in cachexia. In this study we aim to define intestinal ischemia and its effects on gastrointestinal structure and function in an in vivo model of atherosclerosis. Hypothesis: Overexpression of tissue-nonspecific alkaline phosphatase (TNAP) under conditions of hypercholesterolemia in a mouse model will lead to atherosclerosis causing intestinal ischemia. Methods and Results: We have previously established that endothelial TNAP overexpression (eTNAP) results in calcification of medium-sized arteries including mesenteric. In this study eTNAP was combined with a point mutation in the low-density lipoprotein receptor ( ldlr ^WHC). When fed an atherogenic diet (Paigen’s diet, starting at 8 weeks of age), WHC-eTNAP mice developed acute body weight loss (>15% from baseline), whereas WHC mice continued to gain weight. Examination of the mesenteries of WHC-eTNAP demonstrated eccentric vascular remodeling and stiffening, as well as calcification of atherosclerotic plaques (n=4). Mesenteric arteries of WHC were not affected (n=3). WHC-eTNAP (n=2) mice developed extensive atherosclerosis of submucosal arterioles in the colon where most vessels were narrowed or occluded. Examination of the small intestine in WHC-eTNAP mice showed structurally distressed villi accompanied with an increase in goblet cells and fragmentation of the epithelial layer possibly reflecting cell death. The colon demonstrated loss of goblet cells and signs of denuding of the epithelium. Conclusion: Atherosclerosis induced by overexpression of TNAP causes occlusion of mesenteric arteries as well as structural pathology in the small and large intestine

scholarly journals Ischemic Gastropathic Ulcer Mimics Gastric Cancer

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Saleh Daher ◽  
Ziv Lahav ◽  
Ayman Abu Rmeileh ◽  
Meir Mizrahi ◽  
Tawfik Khoury
Keyword(s):  
Abdominal Pain ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Celiac Trunk ◽  
Gastric Ulcers ◽  
Chronic Mesenteric Ischemia ◽  
Surgical Revascularization ◽  
Medical Interventions ◽  
Ischemic Gastropathy ◽  
Medical Evaluation

Gastric ulcer due to mesenteric ischemia is a rare clinical finding. As a result, few reports of ischemic gastric ulcers have been reported in the literature. The diagnosis of ischemic gastropathy is seldom considered in patients presenting with abdominal pain and gastric ulcers. In this case report, we describe a patient with increasing abdominal pain, weight loss, and gastric ulcers, who underwent extensive medical evaluation and whose symptoms were resistant to medical interventions. Finally he was diagnosed with chronic mesenteric ischemia, and his clinical and endoscopic abnormalities resolved after surgical revascularization of both the superior mesenteric artery and the celiac trunk.

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