Primary conservative treatment for peritonitis-absent symptomatic isolated dissection of the superior mesenteric artery with severely compressed true lumen

Vascular ◽  
2019 ◽  
Vol 28 (2) ◽  
pp. 132-141 ◽  
Author(s):  
Gang Fang ◽  
Genying Xu ◽  
Yuan Fang ◽  
Jue Yang ◽  
Tianyue Pan ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Medical Treatment ◽  
Stent Placement ◽  
Mesenteric Artery ◽  
Treatment Algorithm ◽  
Endovascular Stent ◽  
True Lumen ◽  
The Mean ◽  
Endovascular Stent Placement

Objectives The purpose of this study was to evaluate the safety and efficacy of primary conservative treatment (PCT) for peritonitis-absent symptomatic spontaneous isolated dissection of the superior mesenteric artery (S-SIDSMA) with severely compressed true lumen. Methods From January 2013 to December 2018, PCT was used in 26 cases of peritonitis-absent S-SIDSMA with severely compressed true lumen in our center based on our previous proposed treatment algorithm for S-SIDSMA. The demographics, duration from the onset to the admission, duration from the start of the conservative treatment to the alleviation of the symptoms, and in-hospital and follow-up clinical and angiographic outcomes were prospectively recorded and then analyzed. Results Among the 26 included patients, 84.6% were male. The mean age of the patients was 54.7 years. The mean duration from the onset to the admission was 3.1 days (range, 1–14 days). Symptoms in 22 patients were markedly or completely relieved during the first five-day medical treatment. Endovascular stent placement was attempted in the remaining four patients, which was successfully performed in three (75%) of them. The technical failure occurred in a patient whose compressed true lumen failed to be cannulated. Medical treatment was then continued in this patient, and his symptoms were relieved after a two-day medical treatment. During the mean follow-up period of 14.3 months, endovascular stent placement was performed in three patients due to the recurrence of the abdominal pain and the chronic intestinal ischemia. No patient showed dissection progression during the follow-up. The complete remodeling rate of the stent group was significantly higher than that of the medical group (83.3% vs. 25%, P = 0.021). Conclusions Based on our previous proposed treatment algorithm for S-SIDSMA, PCT could achieve satisfactory results both clinically and morphologically in peritonitis-absent S-SIDSMA with severely compressed true lumen.

scholarly journals Endovascular stent placement for isolated superior mesenteric artery dissection with intestinal ischaemia

VASA ◽  
2019 ◽  
Vol 48 (1) ◽  
pp. 73-78 ◽  
Author(s):  
Baochen Liu ◽  
Chengnan Chu ◽  
Xinxin Fan ◽  
Weiwei Ding ◽  
Xingjiang Wu
Keyword(s):  
Conservative Treatment ◽  
Stent Placement ◽  
Mesenteric Artery ◽  
Intestinal Resection ◽  
Artery Dissection ◽  
Intestinal Ischaemia ◽  
Endovascular Stent ◽  
Endovascular Stent Placement ◽  
Resection And Anastomosis ◽  
Superior Mesenteric Artery Dissection

Abstract. Background: Isolated superior mesenteric artery dissection (ISMAD) is rare, especially when associated with intestinal ischaemia. We report our clinical experience managing this condition. Patients and methods: Medical records from 22 patients with ISMAD and intestinal ischaemia were retrospectively analysed. Conservative treatment was given to all patients as first line therapy. Subsequently, 15 patients received endovascular stent placement and three patients received endovascular stent placement plus intestinal resection and anastomosis. Results: After conservative treatment, the symptoms of three patients were remarkably relieved; however, a repeat contrast CT showed that stenosis was aggravated. Hence, endovascular stent placement was performed in all 15 patients. Enteral nutrition was successfully restored in 12 patients. Three patients showed signs of chronic intestinal ischaemia, including peritonitis and ileus. These patients underwent intestinal resection and anastomosis. Enteral nutrition was restored at postoperative week two. No signs of intestinal ischaemia recurred during two-years of follow-up. Conclusions: We recommend endovascular stent placement as a feasible, effective, and minimally invasive procedure in patients with ISMAD and symptoms of intestinal ischaemia.

Double region of interest timing bolus technique following endovascular aortic repair: Short-term prognosis analysis

Vascular ◽  
2019 ◽  
Vol 28 (3) ◽  
pp. 233-240
Author(s):  
Nobuo Tomizawa ◽  
Shingo Ito ◽  
Tastuya Nakao ◽  
Hiroaki Arakawa ◽  
Kodai Yamamoto ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Stent Placement ◽  
Region Of Interest ◽  
Good Prognosis ◽  
Endovascular Stent ◽  
Kaplan Meier ◽  
Scan Speed ◽  
The Mean ◽  
Endovascular Stent Placement

Objectives To compare the incidence rate of reintervention in patients with and without complication findings at aortic computed tomography using double region of interest timing bolus (DRTB) method after endovascular stent placement of the aorta. Methods We included 40 patients who underwent computed tomography of the aorta using DRTB method after endovascular stent placement. DRTB method allows to scan the aorta with a short injection time of 9 s by synchronizing the scan speed to the aortic flow. Complication findings at computed tomography were defined as endoleak, rupture, occlusion, and infection. The primary endpoint was reintervention, which was defined as any of the following three events: conversion to open repair, graft revision, or secondary intervention. Results The mean contrast medium during computed tomography angiography was 38.6 ± 3.9 mL. Complication findings at computed tomography were present in 10 patients (25%): endoleak ( n = 9) and infection ( n = 1). During a median follow-up of 7 months (interquartile range, 4–11 months), two patients experienced reintervention. Kaplan–Meier curves by complication findings showed that event rate at 6 months was significantly higher in patients with complication findings than in patients without (20% vs 0%, p =  0.01). No patients without complication findings at computed tomography experienced reintervention. Conclusions No complication findings at computed tomography after intervention of the aorta resulted in good prognosis in patients who underwent aortic computed tomography using DRTB method.

Abstract WMP46: Rotational Ischemic Vertebral Artery Compression (RIVAC) Syndrome Due to Cervical Facet Hypertrophy and Uncinate Process Osteophyte: Review of Seven Consecutive Cases

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Stanley H Kim ◽  
Nathan Dhablania ◽  
Joshua Kim ◽  
Rishabh Gulati ◽  
Jefferson Miley ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Stent Placement ◽  
Uncinate Process ◽  
Surgical Decompression ◽  
Imaging Method ◽  
Endovascular Stent ◽  
Cerebral Angiogram ◽  
Endovascular Stent Placement ◽  
Vertebral Artery Compression

Introduction: The authors propose a new terminology, Rotational Ischemic Vertebral Artery Compression (RIVAC) syndrome, to describe patients who present with TIA or stroke from compression of the cervical vertebral artery (VA) below C2 by facet hypertrophy or uncinate process osteophyte associated with rotation of the head. The authors review clinical presentation, radiological findings, and management of 7 consecutive cases. Methods: Prospective analysis of 7 consecutive cases of RIVAC syndrome was performed between 2004 and 2012. We reviewed peri-operative imaging, method of treatment, and clinical and angiographic outcome. Results: A total of 6 patients (mean 66+/- 4 years) presented with stroke (N=2) or TIA including reproducible dizziness, vertigo, or syncope (N=4) associated with rotation of the head. Pre-operative dynamic cerebral angiogram showed near complete occlusion of cervical VA (N=2) or severe stenosis (60 to 80%) (N=5) during rotation of the head. The location of cervical VA compression was as follows: right C3-4 (N=1), left C4-5 (N=3), left C5-6 (N=2) and left C6-7 (N=1). Treatment included endovascular stent placement of VA without open surgery (N=1), endovascular stent placement of VA followed by partial left C5-6 factectomy 2 years later (N=1), posterior surgical decompression of VA along with bilateral facet screw fixation (N=4), and anterior cervical discectomy and fusion (N=1). Follow up dynamic cerebral angiograms and CTA angiogram of neck (6 months to 3 years) showed resolution of VA compression on rotation of head in all patients except for one who had lost in follow up. Clinical evaluation (range of 1 to 48 months) showed no recurrent stroke or TIA in all patients (mRS score of 0, N=6 and mRS of 3, N=1). Conclusion: RIVAC syndrome should be recognized as an important cause of posterior circulation TIA or stroke associated with rotation of head. Pre-operative dynamic cerebral angiogram and CT angiogram of neck are essential in localization and characterization of the level and cause of VA compression. Open surgical decompression and fixation appears to be safe and effective treatment of patients with RIVAC syndrome.

Endovascular Stent Placement for Treatment of Spontaneous Isolated Dissection of the Superior Mesenteric Artery

2014 ◽  
Vol 28 (2) ◽  
pp. 445-451 ◽  
Author(s):  
Nan Li ◽  
Qing-Sheng Lu ◽  
Jian Zhou ◽  
Jun-Min Bao ◽  
Zhi-Qing Zhao ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Stent Placement ◽  
Mesenteric Artery ◽  
Endovascular Stent ◽  
Endovascular Stent Placement

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.

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