Physician-Modified Endograft With Double Inner Branches for Urgent Repair of Supraceliac Para-Anastomotic Pseudoaneurysm

2019 ◽  
Vol 27 (1) ◽  
pp. 124-129 ◽  
Author(s):  
Mario D’Oria ◽  
Aleem K. Mirza ◽  
Emanuel R. Tenorio ◽  
Jussi M. Kärkkäinen ◽  
Randall R. DeMartino ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Superior Mesenteric Artery ◽  
Stent Graft ◽  
Mesenteric Artery ◽  
Artery Bypass ◽  
Celiac Artery ◽  
Mesenteric Arteries ◽  
Anastomotic Pseudoaneurysm ◽  
Thoracic Stent Graft

Purpose: To demonstrate the feasibility of a physician-modified endograft (PMEG) with inner branches for 2 mesenteric arteries as an alternative to fenestrations or directional branches. Technique: A symptomatic 60-year-old man presented with supraceliac para-anastomotic pseudoaneurysm involving an antegrade aorta to celiac artery and superior mesenteric artery bypass. Since an off-the-shelf multibranched endograft was inappropriate, a Zenith Alpha thoracic stent-graft was modified with 2 inner branches fashioned of 8-mm Viabahn endoprostheses with preloaded guidewires. The procedure was technically successful, and the patient had no postoperative complications. Conclusion: Inner branches might offer an alternative to fenestrations or directional branches in patients with narrow aortas.

scholarly journals Thoracic Stent Graft with Distal Fenestration for the Superior Mesenteric Artery for Treatment of Thoracic Aortic Aneurysm

2014 ◽  
Vol 7 (2) ◽  
pp. 152-155 ◽  
Author(s):  
Ryota Fukunaga ◽  
Takuya Matsumoto ◽  
Yukihiko Aoyagi ◽  
Daisuke Matsuda ◽  
Shinichi Tanaka ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Superior Mesenteric Artery ◽  
Stent Graft ◽  
Mesenteric Artery ◽  
Thoracic Aortic Aneurysm ◽  
Thoracic Stent Graft

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.

Chewing and taste increase blood velocity in the celiac but not the superior mesenteric arteries

2008 ◽  
Vol 295 (6) ◽  
pp. R1921-R1925 ◽  
Author(s):  
Nami Someya ◽  
Naoyuki Hayashi
Keyword(s):  
Blood Flow ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Healthy Subjects ◽  
Celiac Artery ◽  
Blood Velocity ◽  
Mesenteric Arteries ◽  
Baseline Measurement ◽  
The Mean

To investigate the role of chewing and taste in the meal-induced rapid increase in splanchnic blood flow, we compared the blood flow responses in the celiac artery (CA) and superior mesenteric artery (SMA) to chewing solid food with a chocolate taste (FOOD) and paraffin wax without taste (WAX). After 5 min of baseline measurement, 15 healthy subjects repeated chewing and expectorating the FOOD or WAX every 20 s for 4 min followed by 10 min of recovery measurement. We measured the mean blood velocity (MBV) in the CA and SMA. The baseline MBVs in the CA and SMA did not differ between the FOOD and WAX trials. The MBV in the CA was lower than baseline at the 1st min of chewing in both trials. It was higher than baseline at the 3rd min of FOOD chewing, whereas it did not increase during and after WAX chewing. The MBV in the CA was higher in the FOOD trial than in the WAX trial at the 3rd min of chewing and thereafter. In contrast, the MBV in the SMA did not change throughout the protocols. These results suggest that the taste of food plays a role in meal-induced hyperemia in the CA but not the SMA.

scholarly journals Successful Treatment of Acute on Chronic Mesenteric Ischaemia by Common Iliac to Inferior Mesenteric Artery Bypass

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
D. N. Coakley ◽  
F. M. Shaikh ◽  
E. G. Kavanagh
Keyword(s):  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Artery Bypass ◽  
Celiac Artery ◽  
Mesenteric Arteries ◽  
Surgical Patient ◽  
Mesenteric Ischaemia ◽  
Atherosclerotic Stenosis ◽  
Vein Bypass ◽  
Chronic Mesenteric Ischaemia

Chronic mesenteric ischaemia is a rare and potentially fatal condition most commonly due to atherosclerotic stenosis or occlusion of two or more mesenteric arteries. Multivessel revascularisation of both primary mesenteric vessels, the celiac artery and superior mesenteric artery (SMA), is the current mainstay of treatment; however, in a certain cohort of patients, revascularisation one or both vessels may not be possible. Arteries may be technically unreconstructable or the patient may be surgically unfit for the prolonged aortic cross clamping times required. Here we present a case involving a 72-year-old woman with acute on chronic mesenteric ischaemia. She was a high risk surgical patient with severe unreconstructable stenotic disease of the SMA and celiac arteries. She was successfully treated with single vessel revascularisation of the inferior mesenteric artery (IMA) via a common iliac to IMA reversed vein bypass. At two-year follow-up, the graft remains patent and the patient continues to be symptom-free and is maintaining her weight.

scholarly journals Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review

2021 ◽  
pp. 145749692110005
Author(s):  
S. Acosta ◽  
F. B. Gonçalves
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Conservative Therapy ◽  
Case Series ◽  
Celiac Artery ◽  
Artery Dissection ◽  
Covered Stents ◽  
Bowel Infarction

Background and Aims: There are increasing reports on case series on spontaneous isolated mesenteric artery dissection, that is, dissections of the superior mesenteric artery and celiac artery, mainly due to improved diagnostic capacity of high-resolution computed tomography angiography performed around the clock. A few case–control studies are now available, while randomized controlled trials are awaited. Material and Methods: The present systematic review based on 97 original studies offers a comprehensive overview on risk factors, management, conservative therapy, morphological modeling of dissection, and prognosis. Results and Conclusions: Male gender, hypertension, and smoking are risk factors for isolated mesenteric artery dissection, while the frequency of diabetes mellitus is reported to be low. Large aortomesenteric angle has also been considered to be a factor for superior mesenteric artery dissection. The overwhelming majority of patients can be conservatively treated without the need of endovascular or open operations. Conservative therapy consists of blood pressure lowering therapy, analgesics, and initial bowel rest, whereas there is no support for antithrombotic agents. Complete remodeling of the dissection after conservative therapy was found in 43% at mid-term follow-up. One absolute indication for surgery and endovascular stenting of the superior mesenteric artery is development of peritonitis due to bowel infarction, which occurs in 2.1% of superior mesenteric artery dissections and none in celiac artery dissections. The most documented end-organ infarction in celiac artery dissections is splenic infarctions, which occurs in 11.2%, and is a condition that should be treated conservatively. The frequency of ruptured pseudoaneurysm in the superior mesenteric artery and celiac artery dissection is very rare, 0.4%, and none of these patients were in shock at presentation. Endovascular therapy with covered stents should be considered in these patients.

Sign in / Sign up

Export Citation Format

Share Document