Surgical and Endovascular Management of Patients with Chronic Mesenteric Ischemia: A Single Center Experience

2017 ◽  
Vol 83 (12) ◽  
pp. 1453-1457 ◽  
Author(s):  
Panagiotis Paliogiannis ◽  
Giorgio C. Ginesu ◽  
Alessandro Fancellu ◽  
Aldo Pischedda ◽  
Mario Maiore ◽  
...  
Keyword(s):  
Mesenteric Ischemia ◽  
Celiac Trunk ◽  
Chronic Mesenteric Ischemia ◽  
Therapeutic Approaches ◽  
Single Center Experience ◽  
Appropriate Treatment ◽  
The Mean ◽  
Clinical Records ◽  
Prognostic Data ◽  
Selection Of

Chronic mesenteric ischemia is a rare intestinal disorder, with a potential evolution toward intestinal infraction. The choice of the appropriate treatment is currently the most crucial issue in the management of patients with chronic mesenteric ischemia. We describe our experience with 16 cases, and we discuss the current diagnostic and therapeutic approaches. A retrospective review of the clinical records was performed, and demographic, clinical, therapeutic, and prognostic data were collected. Six patients were females (37%), and the mean age was 62 years. Postprandial pain was present in all the cases, whereas sitophobia and weight loss were detected in 87 per cent of them. Eight patients were treated with open surgery; no perioperative deaths or relevant complications occurred. One patient had a restenosis of the celiac trunk and superior mesenteric artery 10 months after surgery. No deaths or relevant complications occurred in the remaining patients, who underwent an endovascular procedure. One patient presented a restenosis distal to the vascular stent, whereas two patients died due to comorbidities. The low rates of postoperative morbidity, mortality, and restenosis obtained suggest that surgical or endovascular correction of chronic mesenteric ischemia is satisfactory when performed by experienced surgeons, with an adequate selection of the patients.

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

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.

Management of chronic atherosclerotic mesenteric ischemia

VASA ◽  
2011 ◽  
Vol 40 (2) ◽  
pp. 99-107 ◽  
Author(s):  
Zeller ◽  
Macharzina
Keyword(s):  
Mesenteric Ischemia ◽  
Delayed Diagnosis ◽  
Clinical Signs ◽  
Duplex Ultrasound ◽  
Celiac Trunk ◽  
Mesenteric Arteries ◽  
Clinical Aspects ◽  
High Morbidity ◽  
Chronic Mesenteric Ischemia ◽  
External Compression

Chronic mesenteric ischemia (CMI) is most likely caused by atherosclerosis and less frequently by external compression, fibromuscular dysplasia and vasculitis. Symptomatic CMI is an uncommon, potentially under-diagnosed condition caused by fixed stenoses or occlusion of in most conditions at least two visceral arteries. If only one of the three major bowel providing arteries - the celiac trunk, the superior and inferior mesenteric arteries - is affected, the patient is usually asymptomatic due to a tight collateral network. Symptoms and clinical signs of CMI may vary from the classical triad of postprandial pain, weight loss and upper abdominal bruit to nonspecific symptoms thus frequently resulting in delayed diagnosis. Established non-invasive diagnostic means are duplex ultrasound or CT- and MR-angiography offering excellent three dimensional reconstruction of the vessel pathology facilitating the decision for the appropriate revascularisation strategy. During the last decade, despite higher restenosis rates endovascular revascularization has replaced surgical revascularization as therapy of choice in most centers. If untreated CMI of atherosclerotic origin is associated with a high morbidity and mortality. This manuscript reviews the most relevant clinical aspects of the disease and the current practice of diagnosis and treatment of CMI.

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 Tratamento da Isquemia Mesentérica Crônica através da Angioplastia do Tronco Celíaco: Série de Casos / Treatment of Chronic Mesenteric Ischemia through Celiac Trunk Angioplasty: Case Series

2016 ◽  
Vol 6 (3) ◽  
pp. 142-151
Author(s):  
Dante Togeiro Bastos Filgueiras ◽  
Fábio de Castro Sampaio ◽  
Seleno Glauber de Jesus-Silva ◽  
Melissa Andreia de Moraes Silva ◽  
Rodolfo Souza Cardoso
Keyword(s):  
Mesenteric Ischemia ◽  
Case Reports ◽  
Case Series ◽  
Multislice Ct ◽  
Celiac Trunk ◽  
Primary Patency ◽  
Chronic Mesenteric Ischemia ◽  
Complication Rates ◽  
Femoral Access ◽  
Atherosclerotic Stenosis

Introdução: A estenose aterosclerótica das artérias viscerais pode ser responsável pela manifestação da Isquemia Mesentérica Crônica (IMC). Apesar de o Tronco Celíaco (TC) ser o vaso mais frequentemente acometido, o tratamento cirúrgico é cada vez menos utilizado. O tratamento endovascular, apesar de possuir perviedade inferior a longo prazo, tornou-se o método de escolha devido à fácil execução e baixo índice de complicações. Relato de Casos: Descreve-se quatro casos de revascularização endovascular do TC com implante de stent em pacientes com sintomas de IMC. A avaliação diagnóstica foi realizada através de angioTC helicoidal. Três casos foram realizados por meio do acesso femoral. O sucesso técnico foi de 100%, entretanto um caso necessitou de conversão para acesso braquial. Houve um caso de migração proximal do stent. Todos os pacientes apresentaram melhora subjetiva dos sintomas. Conclusão: Os métodos de imagem são fundamentais para o diagnóstico e planejamento terapêutico. O tratamento endovascular para as lesões estenóticas do TC é o método de escolha na atualidade, devido aos baixos índices de complicações e aceitável taxa de perviedade primária no curto e médio prazo. A aplicação objetiva de questionários de qualidade de vida, entretanto, é necessária para confirmar a eficácia clínica do tratamento.Palavras-chave: Isquemia Mesentérica, Artéria Celíaca, Angiografia Digital, Implante de Prótese Vascular, Oclusão Vascular Mesentérica, Relatos de CasosABSTRACTIntroduction: Atherosclerotic stenosis of visceral arteries may be responsible for the manifestation of Chronic Mesenteric Ischemia (CMI). Although the Celiac Trunk (CT) is the most commonly affected vessel, surgical treatment has been less used. Endovascular treatment, despite lower long-term patency, has become the method of choice due to feasibility and low complication rates. Cases Report: Four cases of endovascular revascularization of CT with stenting are described in patients with suggestive symptoms of CMI. The diagnostic evaluation was performed using multislice CT angiography. Three cases were performed through femoral access. Technical success was 100%, however in one patient conversion to brachial access was needed. There was one case of proximal stent migration. All patients had subjective improvement of symptoms. Conclusion: Imaging methods are essential for diagnosis and treatment planning. Stenting of CT stenosis is the current method of choice, because of low complication rates of and acceptable short and mid-term primary patency. The objective application of QOL questionnaires, however, is required to confirm clinical efficacy.Keywords: Mesenteric Ischemia, Celiac Artery, Digital Subtraction Angiography, Blood Vessel Prosthesis Implantation, Mesenteric Vascular Occlusion, Case Reports

Celiac and Superior/Inferior Mesenteric Angioplasty and Stenting for Chronic Mesenteric Ischemia: A Single-Center Experience

Angiology ◽  
2016 ◽  
Vol 68 (7) ◽  
pp. 571-574 ◽  
Author(s):  
Kanapathi Rajaratnam ◽  
Kosmas I. Paraskevas ◽  
Ahmad Hariz Ramli ◽  
Amro Shehata ◽  
Ralph Jackson ◽  
...  
Keyword(s):  
Mesenteric Ischemia ◽  
Chronic Mesenteric Ischemia ◽  
Single Center ◽  
Single Center Experience ◽  
Angioplasty And Stenting

scholarly journals Selection of treatment for hepatic epithelioid hemangioendothelioma: a single-center experience

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Linping Cao ◽  
Jiawei Hong ◽  
Lingfeng Zhou ◽  
Yufu Ye ◽  
Yuanxing Liu ◽  
...  
Keyword(s):  
Treatment Options ◽  
Needle Aspiration ◽  
Epithelioid Hemangioendothelioma ◽  
Multiple Strategies ◽  
Single Center Experience ◽  
Appropriate Treatment ◽  
Significant Disease ◽  
Selection Of ◽  
Observation Period

Abstract Background Hepatic epithelioid hemangioendothelioma (HEHE) is a rare angiogenic tumor with no recognized effective treatment. Treatment options used worldwide include liver transplantation (LT), liver resection (LR), radiofrequency ablation (RFA), chemotherapy, and observation. The aim of this study was to describe the efficacy of different treatment options used for HEHE at our center. Methods The medical charts of 12 patients with HEHE (9 women and 3 men) who were diagnosed and treated at the First Affiliated Hospital of Zhejiang University, China, between January 2011 and December 2017 were retrospectively reviewed. Results The patients were diagnosed by postoperative histopathology or fine needle aspiration biopsy. Two patients with diffuse lesions received LT and were alive without recurrence at the last follow-up. Three patients received LR as the initial treatment, and all of them developed recurrence during the follow-up period. One patient received RFA and remained free of disease, while the remaining six patients opted for simple observation rather than treatment. One of the patients who received LR passed away because of tumor recurrence within 32 months after surgery; the other patients showed no significant disease activity after treatments for their recurrent lesions. As of April 2018, the mean follow-up duration was 39.6 ± 20.1 months (15–82 months). Conclusions There are multiple strategies for HEHE. Considering its indolent course, initial observation for assessment of the lesion behavior may aid in the selection of appropriate treatment. Surgery or LT is suitable for patients with disease progression during the observation period. However, our sample size was small, and further studies are required to gather more information that can aid in optimal treatment selection.

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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