Is visceral flow during intra-aortic balloon pumping size or volume dependent?

Perfusion ◽  
2016 ◽  
Vol 32 (4) ◽  
pp. 285-295 ◽  
Author(s):  
Sandro Gelsomino ◽  
Pieter W.J. Lozekoot ◽  
Monique M.J. de Jong ◽  
Fabiana Lucà ◽  
Orlando Parise ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Superior Mesenteric Artery ◽  
Engineering Design ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Experimental Time ◽  
Intra Aortic Balloon Pump ◽  
Balloon Size ◽  
Visceral Perfusion ◽  
Time Point

Aim: We evaluated the influence of intra-aortic balloon size and volume on mesenteric and renal flows. Methods: Thirty healthy swine underwent 120-minute ligation of the left anterior descending coronary artery followed by 6 hours of reperfusion. Then, they were randomly assigned to the following five groups of animals, with six animals in each group: no intra-aortic balloon pump (IABP), a short 35-mL IABP, a short 40-mL IABP, a long 35-mL IABP and a long 40-mL IABP. Superior mesenteric artery (SMA) and renal flows were measured at baseline (t0), at 2-hour ischemia (t1) and every hour thereafter until 6 hours of reperfusion (from tR1 to tR6). Results: SMA flows increased significantly at tR1 only in the two short IABP groups (p<0.001) and balloon volume did not appear to affect flows which, at any experimental time-point, were comparable using 35 mL or 40 mL balloons (p>0.05). Renal flows appeared to be influenced by balloon length, but not by volume. Indeed, flows in the renal arteries rose during IABP treatment; the increase was significantly higher in the short balloon groups and throughout the whole reperfusion (all, p<0.001). Conclusions: Changes in visceral perfusion during IABP assistance were significantly related to balloon length, but not to its volume. This could be relevant for the evolution of balloon engineering design in order to reduce the incidence of mesenteric ischemia following IABP. Further research is necessary to confirm these findings.

Combined Endovascular and Surgical Retrograde Superior Mesenteric Artery Recanalization

2018 ◽  
Author(s):  
Syed M. Peeran
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Atherosclerotic Lesion ◽  
Acute Mesenteric Ischemia ◽  
Exploratory Laparotomy ◽  
Chronic Mesenteric Ischemia ◽  
Hybrid Technique ◽  
Current Standard ◽  
Stent Deployment

Acute mesenteric ischemia is a life-threatening vascular emergency associated with a very high mortality rate. In the setting of necrotic bowel, the current standard of care requires a laparotomy with bowel resection and surgical or endovascular revascularization of the superior mesenteric artery. Unfortunately, mesenteric bypass confers high perioperative mortality, in some reports up to 45%. A hybrid technique that employs an exploratory laparotomy, catheterization of the distal superior mesenteric artery, and stent deployment across the atherosclerotic lesion was first described in 2004 for the treatment of acute-on-chronic mesenteric ischemia. This chapter describes the appropriate clinical indications, the technical aspects of performing this hybrid procedure, as well as the challenges and common pitfalls encountered.

scholarly journals Necessity of revascularization for acute mesenteric ischemia in symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery

Vascular ◽  
2019 ◽  
Vol 28 (1) ◽  
pp. 109-114
Author(s):  
Hiroyuki Otsuka ◽  
Atsushi Uehata ◽  
Keiji Sakurai ◽  
Toshiki Sato ◽  
Hiromichi Aoki ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Laboratory Data ◽  
Acute Mesenteric Ischemia ◽  
True Lumen ◽  
Bowel Necrosis ◽  
Abnormal Laboratory ◽  
Number Of Patients ◽  
Residual Ratio

Objectives We evaluated the necessity of revascularization for acute mesenteric ischemia in symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery. Methods This retrospective study included 28 consecutive, symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery treated at our hospital between December 2005 and December 2017. Patients with concomitant aortic dissection were excluded. We reviewed the patients’ clinical presentation; laboratory evaluations; computed tomography findings, including the true lumen residual ratio (i.e., the minimum true lumen size compared to the diameter of the transverse section of the dissected artery) at the time of admission; the number of patients who were suspected of having bowel ischemia; and the number of patients who required surgical or endovascular treatment and their outcomes. Additionally, to evaluate the true lumen residual ratio in symptomatic patients with bowel ischemia, the true lumen residual ratio in those with abnormal laboratory data were compared with that in those without abnormal laboratory data. Initial true lumen residual ratio values were also compared with final values. Furthermore, we assessed the clinical details of patients who had bowel necrosis. Categorical variables were compared using the χ2 test or Fisher’s exact test, and continuous values were presented as either the mean ± standard deviation or median (interquartile range 25–75%). Variables were analyzed using Student’s t-test or the Mann–Whitney U test. Results The patients’ age ranged between 41 and 85 years, and 25 were men. Although nine patients were suspected of having acute mesenteric ischemia, only one underwent bowel resection. None of the patients had an indication for revascularization. The true lumen residual ratio of the nine patients with abnormal laboratory data were significantly lower than those of the 19 without abnormal laboratory data (10 [0–25]% vs. 40 [20–50]%, p = 0.005). The patient who underwent bowel resection had a true lumen residual ratio of 10%; however, there was no obvious abnormal laboratory data suggestive of bowel necrosis. Dissections were managed conservatively in all patients. True lumen residual ratio increased from initial value of 30 (10–48)% to 98 (60-100)%at the final imaging study ( p < 0.0001). There were no adverse events related to the mesenteric circulation during the follow-up period of 2–11 years. Conclusions Reintervention is rarely required for spontaneous isolated dissection of the superior mesenteric artery, even in symptomatic patients, and spontaneous resolution of the luminal compromise is the rule.

scholarly journals Stent Placement for Acute Superior Mesenteric Artery Occlusion Associated with Type B Aortic Dissection

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Kazushi Suzuki ◽  
Masashi Shimohira ◽  
Takuya Hashizume ◽  
Yuta Shibamoto
Keyword(s):  
Aortic Dissection ◽  
Superior Mesenteric Artery ◽  
Stent Placement ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Artery Occlusion ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Superior Mesenteric Artery Occlusion ◽  
Mesenteric Artery Occlusion

A 50-year-old man had a mesenteric ischemia related to superior mesenteric artery (SMA) occlusion associated with a type B aortic dissection. We decided to perform stent placement for the SMA and could avoid mesenteric ischemia. We think the stent placement in the SMA might be an option for the treatment of mesenteric ischemia caused by aortic dissection.

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