scholarly journals Pancreaticoduodenectomy following total occlusion of the superior mesenteric artery: a case report and literature review

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Reo Ohtsuka ◽  
Hodaka Amano ◽  
Michiyo Hashimoto ◽  
Toshiyasu Iwao
Keyword(s):  
Bile Duct ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Collateral Circulation ◽  
Bile Duct Carcinoma ◽  
Three Dimensional ◽  
Celiac Artery ◽  
Total Occlusion ◽  
Duct Carcinoma ◽  
Chronic Occlusion

Abstract Background Patients with chronic occlusion of the celiac artery and superior mesenteric artery (SMA) are often asymptomatic, and occlusion may be caused by arteriosclerosis or median arcuate ligament compression. Pancreaticoduodenectomy (PD) is occasionally performed for patients with celiac artery occlusion; however, reports on patients with SMA occlusion are rare. We report a patient with cholangiocarcinoma and total atherosclerotic occlusion of the SMA without preoperative stenting or bypass. Case presentation A 73-year-old man suspected to have lower bile duct carcinoma was admitted to our hospital for further treatment. Three-dimensional computed tomography (3DCT) showed a common bile duct tumor and total occlusion of the SMA with collateral circulation of the gastroduodenal artery (GDA) and inferior mesenteric artery (IMA). We performed a PD. During the operation, we used test clamping of the GDA, which revealed no bowel ischemia. The postoperative course was uneventful, and the patient was discharged on postoperative day (POD) 30. 3DCT on POD 98 and POD 307 showed development of collateral circulation between the IMA and SMA. Conclusion Here, we report the case of a patient with total occlusion of the SMA who subsequently underwent PD. 3DCT was instrumental in gathering vascular collateral information and thus we conclude that the assessment of collateral circulation before surgery is important.

scholarly journals Endovascular revascularization of heavily calcified occlusion in superior mesenteric artery using Transcollateral approach

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Kazunori Horie ◽  
Akiko Tanaka ◽  
Norio Tada
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Three Dimensional ◽  
Celiac Trunk ◽  
Celiac Artery ◽  
3D Ct ◽  
Total Occlusion ◽  
Abdominal Angina ◽  
Endovascular Revascularization ◽  
Pull Through

Abstract Background Mesenteric ischaemia is often a manifestation of severe vascular disease involving the superior mesenteric artery (SMA). Endovascular revascularization is challenging in a chronic total occlusion (CTO) of SMA. Case presentation A-73-year-old male patient was referred to our hospital because of a 2-year history of post prandial abdominal angina. Computed tomography (CT) images revealed a heavily calcified CTO in the ostium of SMA and three-dimensional CT (3D-CT) detected pancreaticoduodenal arcade with filling from the celiac artery. Then, endovascular procedure was attempted; however, angiography did not show the collateral route suitable for transcollateral approach. As demonstrated on the CT, we were successful in passing a guidewire through the SMA-CTO via the celiac trunk transcollateral route. After pull-through of the guidewire, two balloon-expandable stents were deployed in the ostium of SMA. During 3 months after stent implantation, the patient had no further episodes of abdominal angina on dual-anti-platelet therapy. Conclusion We demonstrate a case of a heavily calcified SMA occlusion successfully treated with endovascular stenting employing a transcollateral approach, guided by 3D-CT.

Endovascular Revascularization of Heavily Calcified Occlusion in Superior Mesenteric Artery using Transcollateral Approach

2021 ◽  
Author(s):  
Kazunori Horie ◽  
Akiko Tanaka ◽  
Norio Tada
Keyword(s):  
Superior Mesenteric Artery ◽  
Stent Implantation ◽  
Mesenteric Artery ◽  
Guide Wire ◽  
Celiac Artery ◽  
Ct Imaging ◽  
Three Dimension ◽  
Total Occlusion ◽  
Abdominal Angina ◽  
Endovascular Revascularization

Abstract BACKGROUND: Mesenteric ischemia is often a manifestation of severe vascular disease involving the superior mesenteric artery (SMA). Endovascular revascularization is still challenging in a chronic total occlusion (CTO) of SMA.CASE PRESENTATION: An-73-year-old male was referred to our hospital because of a 2-year history of abdominal angina after each meal. Computed tomography (CT) images revealed a heavily calcified CTO in the ostium of SMA. Angiography did not show the collateral route suitable for transcollateral approach (TCA); however, the three-dimension CT detected pancreaticoduodenal arcade from the celiac artery to the occluded SMA. According to CT imaging, transcollateral wire crossing from the celiac artery was successful in the SMA-CTO. After pull-through of the guide wire, two balloon-expandable stents were deployed in the ostium of SMA. During 3 months after the stent implantation, the patient had no further episodes of abdominal angina on dual-anti-platelet therapyCONCLUSIONS: We demonstrated a case of SMA occlusion with heavy calcification treated with stent implantation using TCA guided by CT imaging.

Preoperative assessment of extrahepatic bile duct carcinoma using three-dimensional intraductal US

1999 ◽  
Vol 50 (4) ◽  
pp. 548-554 ◽  
Author(s):  
Kiichi Tamada ◽  
Takeshi Tomiyama ◽  
Akira Ohashi ◽  
Shinichi Wada ◽  
Yukihiro Satoh ◽  
...  
Keyword(s):  
Bile Duct ◽  
Extrahepatic Bile Duct ◽  
Bile Duct Carcinoma ◽  
Three Dimensional ◽  
Preoperative Assessment ◽  
Duct Carcinoma ◽  
Extrahepatic Bile Duct Carcinoma

Clinical and cholangiographic evaluation of bile duct carcinoma

1986 ◽  
Vol 22 (4) ◽  
pp. 536
Author(s):  
Y W Park ◽  
S S Kim ◽  
H J Kim ◽  
Y D Joh ◽  
B H Chun
Keyword(s):  
Bile Duct ◽  
Bile Duct Carcinoma ◽  
Duct Carcinoma

scholarly journals Transcriptional regulation of theN-acetylglucosaminyltransferase V gene in human bile duct carcinoma cells (HuCC-T1) is mediated by Ets-1.

1999 ◽  
Vol 274 (1) ◽  
pp. 554
Author(s):  
Rujun Kang ◽  
Hiroyuki Saito ◽  
Yoshito Ihara ◽  
Eiji Miyoshi ◽  
Nobuto Koyama ◽  
...  
Keyword(s):  
Transcriptional Regulation ◽  
Bile Duct ◽  
Bile Duct Carcinoma ◽  
Carcinoma Cells ◽  
Duct Carcinoma ◽  
Human Bile ◽  
V Gene

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.

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