Recanalization and Stenting of the Celiac and the Superior Mesenteric Artery Supported by Use of a Steerable Introducer Sheath: Report on 2 Years’ Experience

2020 ◽  
pp. 153857442097526
Author(s):  
Federico Pedersoli ◽  
Lea Hitpass ◽  
Peter Isfort ◽  
Markus Zimmermann ◽  
Maximilian Schulze-Hagen ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Introducer Sheath ◽  
Technical Success ◽  
Access Site ◽  
Transfemoral Approach ◽  
Technical Parameters ◽  
Reduction Of Radiation Dose ◽  
Indication For Treatment

Purpose: To compare technical parameters and success of recanalization of celiac (CA) or superior mesenteric artery (SMA) with usage of steerable vs not steerable introducer sheaths. Methods: A retrospective analysis was performed on all consecutive patients who underwent recanalization with stent implantation of CA or SMA between 2015 and 2019. Data regarding technical success (successful stent placement with restoration of sufficient blood flow by the first attempt without changing kind of introducer sheath or access site), indication for treatment, vascular access, kind of introducer sheath, fluoroscopy time and radiation dose were collected. Preinterventional CT were analyzed to classify the difficulty of catheterization of target vessels. Technical parameters were compared with independent t-test (p ≤ 0.05). Results: 66 patients underwent recanalization of CA or SMA. Usage of steerable introducer sheaths was associated with higher technical success compared to not steerable introducer sheaths with transfemoral approach respectively of 8/8 vs 15/19 for the CA and 11/11 vs 17/20 for the SMA. Steerable introducer sheaths were used in recanalization considered more technically difficult compared to not steerable introducer sheaths (58% vs 33%). Usage of steerable introducer sheath showed a statistically significant reduction of radiation dose in the recanalization of the SMA (respectively 32035 ± 15716 cGy cm2 vs 60102 ± 28432 cGy cm2; p = 0.005). Conclusion: Even if used in more difficult interventions, steerable introducer sheaths showed a higher technical success compared to not steerable introducer sheaths with transfemoral access.

scholarly journals Endovascular Treatment for Acute Thromboembolic Occlusion of the Superior Mesenteric Artery and the Outcome Comparison between Endovascular and Open Surgical Treatments: A Retrospective Study

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Zhao Zhang ◽  
Dan Wang ◽  
Guoxun Li ◽  
Ximo Wang ◽  
Yuxiang Wang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Superior Mesenteric Artery ◽  
Endovascular Therapy ◽  
Mesenteric Artery ◽  
Bowel Resection ◽  
Average Length ◽  
Medical Center ◽  
Technical Success ◽  
Outcome Comparison ◽  
Surgical Treatments

We reported our experience with endovascular treatment for patients with acute thromboembolic occlusion of the superior mesenteric artery (ATOS) as well as comparing the efficacy between endovascular and traditional open surgical treatments. Eighteen consecutive patients with ATOS who received endovascular treatment and 12 patients who received open surgical treatment between February 2007 and October 2012 at Tianjin Union Medical Center (Tianjin, China) were retrospectively reviewed. Primary clinical outcomes included the technical success, requirement of laparotomy, length of bowel resection, perioperative mortality within 30 days, and surgical complications. The patients were followed up for 0.1 to 98 months. For patients who underwent endovascular treatment, complete technical success was achieved in 8 (44.4%) patients and partial success was achieved in the remaining 10 (55.6%) patients. Laparotomy was required in 6 (33.3%) patients. The 30-day mortality was 16.7%. In comparison to open surgical therapy, endovascular therapy achieved lower requirement of laparotomy (in 33.3% versus in 58.3% of cases,p=0.18), significantly shorter average length of bowel resection (88 ± 44 versus 253 ± 103 cm,p=0.01), and lower mortality rate (16.7% versus 33.3%,p=0.68). The endovascular therapy is a promising treatment alternative for ATOS.

scholarly journals Percutaneous Transcollateral Retrograde Recanalization of Isolated Dissection of the Superior Mesenteric Artery

2019 ◽  
Vol 54 (1) ◽  
pp. 89-92
Author(s):  
Yung Hsu ◽  
Hua-Ming Cheng ◽  
Reng-Hong Wu
Keyword(s):  
Superior Mesenteric Artery ◽  
Stent Placement ◽  
Mesenteric Artery ◽  
Middle Colic Artery ◽  
Colic Artery ◽  
Endovascular Stent ◽  
Retrograde Approach ◽  
Transfemoral Approach ◽  
Rendezvous Technique ◽  
Endovascular Stent Placement

Endovascular stent placement (ESP) for patient with spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is a widely accepted treatment option. However, failed percutaneous ESP is not uncommon and is one of the leading causes for laparotomy. We report a case of 63-year-old man with SIDSMA encountered failed antegrade recanalization via conventional transfemoral approach. We achieved recanalization in a retrograde fashion through middle colic artery using rendezvous technique and successfully placed self-expandable stents inside the dissected superior mesenteric artery. The patient recovered well after percutaneous ESP. We herein describe the transcollateral retrograde approach of percutaneous ESP for SIDSMA as an alternative option when conventional antegrade recanalization fails.

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 Distal Radial Artery Access for Superficial Femoral Artery Interventions

2020 ◽  
pp. 152660282096302
Author(s):  
Zoltán Ruzsa ◽  
Ádám Csavajda ◽  
Balázs Nemes ◽  
Mónika Deák ◽  
Péter Sótonyi ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Fluoroscopy Time ◽  
Complication Rates ◽  
Procedure Time ◽  
Technical Success ◽  
Access Site ◽  
Femoral Access ◽  
Crossover Rate

Purpose: To compare the acute success and complication rates of distal radial (DR) vs proximal radial (PR) artery access for superficial femoral artery (SFA) interventions. Materials and Methods: Between 2016 and 2019, 195 consecutive patients with symptomatic SFA stenosis were treated via DR (n=38) or PR (n=157) access using a sheathless guide. Secondary access was achieved through the pedal artery when necessary. The main outcomes were technical success, major adverse events (MAEs), and access site complications. Secondary outcomes were treatment success, fluoroscopy time, radiation dose, procedure time, and crossover rate to another puncture site. Results: Overall technical success was achieved in 188 patients (96.4%): 37 of 38 patients (97.3%) in the DR group and 151 of 157 patients (96.2%) in the PR group (p=0.9). Dual (transradial and transpedal) access was used in 14 patients (36.8%) in the DR group and 28 patients (18.9%) in the PR group (p<0.01). Chronic total occlusions were recanalized in 25 of 26 DR patients (96.1%) and in 79 of 81 PR patients (92.6%) (p=0.57). The crossover rate to femoral access was 0% in the DR group vs 3.2% in the PR group (p=0.59). Stents were implanted in the SFA in 15 DR patients (39.4%) and in 39 patients (24.8%) in the PR group (p=0.1). The contrast volume, fluoroscopy time, radiation dose, and procedure time were not statistically different between the DR and PR groups, nor were the rates of access site complications (2.6% and 7.0%, respectively). The cumulative incidences of MAE at 6 months in the DR and PR groups were 15.7% vs 14.6%, respectively (p=0.8). Conclusion: SFA interventions can be safely and effectively performed using PR or DR access with acceptable morbidity and a high technical success rate. DR access is associated with few access site complications.

Synchronous celiac axis and superior mesenteric artery embolism

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 495-498 ◽  
Author(s):  
Rajkovic ◽  
Zelic ◽  
Papes ◽  
Cizmek ◽  
Arslani
Keyword(s):  
Atrial Fibrillation ◽  
Small Intestine ◽  
Abdominal Pain ◽  
Ct Scan ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Abdominal Cavity ◽  
Celiac Axis ◽  
Contrast Administration ◽  
Artery Embolism

We present a case of combined celiac axis and superior mesenteric artery embolism in a 70-year-old patient that was examined in emergency department for atrial fibrillation and diffuse abdominal pain. Standard abdominal x-ray showed air in the portal vein. CT scan with contrast showed air in the lumen of the stomach and small intestine, bowel distension with wall thickening, and a free gallstone in the abdominal cavity. Massive embolism of both celiac axis and superior mesenteric artery was seen after contrast administration. On laparotomy, complete necrosis of the liver, spleen, stomach and small intestine was found. Gallbladder was gangrenous and perforated, and the gallstone had migrated into the abdominal cavity. We found free air that crackled on palpation of the veins of the gastric surface. The patient’s condition was incurable and she died of multiple organ failure a few hours after surgery. Acute visceral thromboembolism should always be excluded first if a combination of atrial fibrillation and abdominal pain exists. Determining the serum levels of d-dimers and lactate, combined with CT scan with contrast administration can, in most cases, confirm the diagnosis and lead to faster surgical intervention. It is crucial to act early on clinical suspicion and not to wait for the development of hard evidence.

The Distribution of Vasculokinase in Human Blood Vessels

1962 ◽  
Vol 08 (01) ◽  
pp. 096-100
Author(s):  
Marvin Murray ◽  
Robert Johnson
Keyword(s):  
Inferior Vena Cava ◽  
Superior Mesenteric Artery ◽  
Blood Vessels ◽  
Human Blood ◽  
Iliac Artery ◽  
Popliteal Artery ◽  
Mesenteric Artery ◽  
Inferior Vena ◽  
Vena Cava ◽  
High Concentrations

Summary133 blood vessels were evaluated for vasculokinase concentration in the freshly morbid state. High concentrations of activity were found in the aorta, iliac artery, superior mesenteric artery and popliteal artery. Activity was occasionally found in the inferior vena cava and common iliacs veins. Other vessels evaluated had no activity. Evaluation of the data with respect to vas-culokinase activity and atherosclerosis suggests higher levels of vasculokinase in those vessels having atherosclerosis.

Polyarteritis Nodosa in Superior Mesenteric Artery: A Case Report

1998 ◽  
Vol 38 (3) ◽  
pp. 441
Author(s):  
Young Lan Seo ◽  
Chul Soon Choi ◽  
Ho Chul Kim ◽  
Sang Hoon Bae ◽  
Eil Seong Lee ◽  
...  
Keyword(s):  
Case Report ◽  
Superior Mesenteric Artery ◽  
Polyarteritis Nodosa ◽  
Mesenteric Artery
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