Incidence, morbidity, and mortality of traumatic superior mesenteric artery injuries compared to other visceral arteries

Vascular ◽  
2019 ◽  
Vol 28 (2) ◽  
pp. 142-151
Author(s):  
Shelley Maithel ◽  
Areg Grigorian ◽  
Roy M Fujitani ◽  
Nii-Kabu Kabutey ◽  
Brian M Sheehan ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Celiac Artery ◽  
Visceral Artery ◽  
Trauma Patients ◽  
Mechanism Of Injury ◽  
Artery Injury ◽  
Risk Of Mortality ◽  
Increased Risk

Objectives Celiac artery, superior mesenteric artery, and inferior mesenteric artery injuries are often grouped together as major visceral artery injuries with an incidence of <1%. The mortality rates range from 38–75% for celiac artery injuries and 25–68% for superior mesenteric artery injuries. No large series have investigated the mortality rate of inferior mesenteric artery injuries. We hypothesize that from all the major visceral artery injuries, superior mesenteric artery injury leads to the highest risk of mortality in adult trauma patients. Methods The Trauma Quality Improvement Program (2010–2016) was queried for patients with injury to the celiac artery, superior mesenteric artery, or inferior mesenteric artery. A multivariable logistic regression model was used for analysis. Separate subset analyses using blunt trauma patients and penetrating trauma patients were performed. Results From 1,403,466 patients, 1730 had single visceral artery injuries with 699 (40.4%) involving the celiac artery, 889 (51.4%) involving the superior mesenteric artery, and 142 (8.2%) involving the inferior mesenteric artery. The majority of patients were male (79.2%) with a median age of 39 years old, and median injury severity score of 22. Compared to celiac artery and inferior mesenteric artery injuries, superior mesenteric artery injuries had a higher rate of severe (grade >3) abbreviated injury scale for the abdomen (57.5% vs. 42.5%, p < 0.001). The overall mortality for patients with a single visceral artery injury was 20%. Patients with superior mesenteric artery injury had higher mortality compared to those with celiac artery and inferior mesenteric artery injuries (23.7% vs. 16.3%, p < 0.001). After controlling for covariates, traumatic superior mesenteric artery injury increased risk of mortality (OR = 1.72, CI = 1.24–2.37, p < 0.01) in adult trauma patients, while celiac artery ( p = 0.59) and inferior mesenteric artery ( p = 0.31) injury did not. After stratifying by mechanism, superior mesenteric artery injury increased risk of mortality (OR = 3.65, CI = 2.01–6.45, p < 0.001) in adult trauma patients with penetrating mechanism of injury but not in those with blunt force mechanism (OR = 1.22, CI = 0.81–1.85, p = 0.34). Conclusions Compared to injuries of the celiac artery and inferior mesenteric artery, traumatic superior mesenteric artery injury is associated with a higher mortality. Moreover, while superior mesenteric artery injury does not act as an independent risk factor for mortality in adult patients with blunt force trauma, it nearly quadruples the risk of mortality in adult trauma patients with penetrating mechanism of injury. Future prospective research is needed to confirm these findings and evaluate factors to improve survival following major visceral artery injury.

Case 16.6

2014 ◽  
pp. 767-768
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Abdominal Pain ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Celiac Artery ◽  
Severe Stenosis

79-year-old with abdominal pain and nausea VR images from 3D CE MRA (Figure 16.6.1) demonstrate occlusion of the celiac artery, severe stenosis of the superior mesenteric artery origin, and a patent inferior mesenteric artery with a prominent arc of Riolan. Coronal SSFSE images (...

scholarly journals Sandwich EVAR occludes Celiac and Superior Mesenteric Artery for Infected Suprarenal Abdominal Aortic Aneurysm Treatment

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Supatcha Prasertcharoensuk ◽  
Narongchai Wongkonkitsin ◽  
Parichat Tunmit ◽  
Su-a-pa Theeragul ◽  
Anucha Ahooja
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Celiac Artery ◽  
Aortic Aneurysms ◽  
Endovascular Technique ◽  
Visceral Organs ◽  
Abdominal Aortic

Introduction. Infected aortoiliac aneurysms are rare, representing only 1% to 2% of all aortic aneurysms; we present a case of infected suprarenal aortic aneurysm with a nearly occluded celiac artery and superior mesenteric artery treated using an endovascular technique to preserve collateral in the retroperitoneal space from the inferior mesenteric artery for supplying visceral organs.

scholarly journals Reimplantation of a Stenotic Inferior Mesenteric Artery for Chronic Visceral Artery Occlusion after Failed Bypass to the Superior Mesenteric Artery

2019 ◽  
Vol 12 (4) ◽  
pp. 559-561
Author(s):  
Wakako Fukuda ◽  
Ikuo Fukuda ◽  
Takeshi Murakami ◽  
Yoshiaki Saito ◽  
Satoshi Taniguchi ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Artery Occlusion ◽  
Visceral Artery

Optimal management strategy for spontaneous isolated dissection of a visceral artery

Vascular ◽  
2017 ◽  
Vol 26 (2) ◽  
pp. 169-174 ◽  
Author(s):  
Hiroyuki Otsuka ◽  
Toshiki Sato ◽  
Hiromichi Aoki ◽  
Yoshihide Nakagawa ◽  
Sadaki Inokuchi
Keyword(s):  
Computed Tomography ◽  
Blood Pressure ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Management Strategy ◽  
Celiac Artery ◽  
Maximum Diameter ◽  
Visceral Artery ◽  
Bowel Infarction

Objectives To describe our clinical experiences and recommend a management strategy for spontaneous isolated dissection of a visceral artery. Methods A retrospective study of patients from December 2005 to December 2015 was performed. Thirty-two patients had spontaneous isolated dissection of a visceral artery. Clinical features, computed tomography findings, the treatment method, and follow-up results were evaluated. Results There were 28 men and 4 women (mean age, 54 years). Dissection locations were the celiac artery in 10, superior mesenteric artery in 17, and celiac artery and superior mesenteric artery in 5 patients. Celiac artery stenosis existed with spontaneous isolated dissection of a visceral artery at a high rate. After diagnosis, the blood pressure of all patients was immediately controlled to a lower level. Three patients with arterial rupture and one patient with bowel infarction underwent operations for complications. Overall, the treatment of dissection involved drug therapy alone. The last follow-up computed tomography results of the true lumen residual ratio and the length of the dissected artery improved compared to the values on admission; the maximum diameter of the dissected artery did not enlarge. Eleven patients almost completely improved. No patients had any adverse event. Conclusions Most patients with spontaneous isolated dissection of a visceral artery can be first treated conservatively for dissection with strict blood pressure control and surveillance.

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.

scholarly journals An unusual case of colon vascularization by the inferior mesenteric artery

2017 ◽  
Vol 16 (1) ◽  
pp. 52-55 ◽  
Author(s):  
Serghei Covanțev ◽  
Natalia Mazuruc ◽  
Olga Belic
Keyword(s):  
Small Intestine ◽  
Superior Mesenteric Artery ◽  
Sigmoid Colon ◽  
Rare Variant ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Unusual Case ◽  
Human Anatomy ◽  
Colon And Rectum ◽  
University Department

Abstract In this article we present a rare variant in which the large intestine was vascularized by the inferior mesenteric artery. It was encountered during macro and microscopic dissection of the cadaver of a 63-year-old woman at a university department of human anatomy. In this case, the ascending, transverse, descending, and sigmoid colon and rectum were vascularized by the inferior mesenteric artery, whereas the small intestine, cecum and appendix were supplied by the superior mesenteric artery.

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