Vascular abnormalities visualized by multislice computed tomography of the abdomen: accidental findings or immediate causes of pain syndrome? (topic review)

Abnormalities of the abdominal aorta branches may cause chronic mesenteric ischemia, progressive pathological changes of the internal organs in this setting, and chronic pain syndrome. The causes of chronic mesenteric ischemia may be divided into atherosclerotic and non-atherosclerotic. Atherosclerosis of the unpaired branches of the abdominal aorta involves stenosis or occlusion. Other causes include fibromuscular dysplasia, vasculitis (Takayasu, segmental mediolytic arteriopathy), and median arcuate ligament syndrome. These syndromes, the pathogenesis of some of which remains controversial, lead to nonspecific complaints such as abdominal pain, weight loss, and others. Digital subtraction angiography or duplex ultrasound may provide hemodynamic information in cases of vascular disease in this area. However, multislice spiral computed tomography is in many cases the first choice because it allows for a comprehensive assessment of the state of blood vessels and associated morphological changes of internal organs. Structural changes accompanying these syndromes can also occur in patients who are undergoing a medical examination for other reasons. However, these syndromes should not be diagnosed solely on the basis of imaging; instead, the findings should be compared with the clinical presentation, which implies collaboration of radiologists and clinicians.

CHRONIC MESENTERIC ISCHEMIA IN TYPE 2 DIABETES PATIENTS

BACKGROUND: Type 2 Diabetes mellitus (T2DM) currently effects 8.9% of the world's population.The macrovascular complications of diabetes are 3 times more common than the microvascular complications.Involvement of the vessels of gut in T2DM hasn't been studied exclusively like the other known macrovascular complications.This study focusses on the effect of T2DM on the Coeliac artery(CA) and Superior Mesenteric artery (SMA) which are the main source of blood supply to the organs derived from fore and midgut . METHODS: In our study over 2 years, 72 patients of T2DM were subjected to Duplex Ultrasonography.15 randomly selected patients who satised the Fasting Duplex velocity criteria and 15 randomly selected patients who did not were subjected to CT Angiography. RESULTS: We found that 22 patients (30.55%) out of the 72 had features suggestive of Chronic Mesenteric Ischemia (CMI) in both the coeliac artery and SMA on duplex ultrasound and 8 patients (26.66%) out of 30 had conrmed CMI by CT angiogram. CONCLUSION: th We found that every 4 diabetic had CMI. We would like to emphasize that the vasculature of the gut can be affected in T2DM and this should inspire a lot of research and prospective studies relating CMI to GIT manifestations of T2DM.

Multidetector Computed Tomography in Diagnosis of Mesenteric Vascular ‎Occlusion

Background: Multidetector computed tomography (MDCT) has high sensitivity and ‎specificity for diagnosing acute primary mesenteric ischemia (MI). MDCT findings vary ‎widely depending on the cause and underlying pathophysiology. MDCT findings of ‎mesenteric ischemia should be characterized on the basis of the cause‏ ‏that lead to early ‎diagnosis and intervention. Aim: The aim of the study was to assess the impact of different MDCT phases in ‎diagnosis of mesenteric vascular occlusion (MVO).‎ Patients and Methods: This study that was carried out on 20 patients with suspected mesenteric vascular ‎occlusion who were referred to Tanta University Hospitals and General Surgery ‎Department during a period one year starting from May 2018 till May 2019.‎ Results: Out of the 20 studied patients, 11 (55%) of them was male and 9 (45‎‎%) was female, the age of the studied patients ranged from 40 to 73 years old ‎with mean age 57.10 ± 8.85 years. In our study the predisposing factors for MVO were as follow 6 (30%) had ‎Primary thrombosis, 9 (45%) had cirrhosis, 8 (40%) had Portal hypertension, ‎‎4 (20%) had DM, 4 (20%) had Atherosclerosis, and 2 (10%) had ischemic heart ‎disease.‎ Conclusion: Acute and chronic mesenteric ischemia are morbid conditions that are challenging to ‎diagnose. Patients present with variable, nonspecific signs and symptoms, and the ‎physical examination is often benign. A high index of clinical and radiologic suspicion ‎is thus required for diagnosis MDCT is an accurate, fast, and non-invasive ‎technique which should be used in clinically suspected patients with MVO in order to ‎confirm the diagnosis identify the aetiology and in addition assessing the bowel loop ‎status for adequate management with good prognosis.‎ Familiarity with the MDCT imaging manifestations of mesenteric ischemia allows ‎for a more precise, prompt diagnosis, early institution of therapy and potentially ‎improved patient outcomes.‎

Factors predicting long-term outcomes of percutaneous angioplasty and stenting of the superior mesenteric artery for chronic mesenteric ischemia

Summary: Background: To analyse the long-term outcomes of percutaneous angioplasty and stenting of the superior mesenteric artery (SMA) in the treatment of chronic mesenteric ischemia (CMI), and to assess predictive factors for a better clinical outcome. Patients and methods: Retrospective analysis of 76 consecutive patients, treated percutaneously for CMI between January 1999 and January 2018 and followed up until the end of 2018. Patients’ pre-, peri- and post-interventional clinical and radiological data were gathered from the institutional electronic medical records. The Kaplan Meier method with log rank test or the Cox model were used to analyse overall survival; the cumulative incidence function with Pepe and Mori test or the Fine and Grey model were used to analyse relapse-free survival, considering death as a competing event. Results: Seventy-six consecutive patients with a mean age of 72 years were included in the study. Catheter-angiography revealed an ostial or non-ostial >90% stenosis in n=23 (29.7%) and n=53 (69.7%) of included patients, respectively. Immediate clinical success was achieved in n=68 (89.5%), and procedural complications were observed in n=13 (17.1%) patients. Long-term follow-up revealed relapse of symptoms in n=21 (28.8%) patients, and overall survival estimates are 81.8%, 57.0% and 28.2% after two, five and ten years of follow-up, respectively. A trend towards longer relapse-free survival was found in the circumferential stenosis group (78.2% at five years) compared with the non-circumferential stenosis group (55.5%) (P=0.063). Conclusions: Angioplasty and stenting of the SMA for CMI is relatively safe and effective despite a substantial number of patients experiencing clinical relapse over time. Patients with focal, circumferential stenosis might have longer relapse-free survival than patients with non-circumferential stenosis.