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Angiographie Anatomy of the Peripheral Vasculature and the Non-invasive Assessment of Peripheral Vascular Disease
Published in Richard R Heuser, Giancarlo Biamino, Peripheral Vascular Stenting, 1999
Philip A. Morales, Richard R. Heuser
The descending thoracic aorta courses inferiorly to continue on as the abdominal aorta when it pierces the diaphragm through the median arcuate ligament (Fig. 2.6). Just inferior to the median arcuate ligament and at the level of the first lumbar vertebral body, the celiac axis arises from the anterior aspect of the aorta. The celiac axis gives rise to the left gastric artery. A rare cause of abdominal angina can be the median arcuate compression syndrome in which the celiac axis arises at the level of the ligament, thus impinging on the artery (Fig. 2.7). Next, the superior mesenteric arises from the anterior surface of the aorta. The superior mesenteric artery is responsible for the vascular supply of the small intestine, right colon and the transverse colon. The most distal anterior branch of the aorta is the inferior mesenteric artery, arising several centimeters above the aortic bifurcation. It is significantly smaller in caliber than either the celiac axis or the superior mesenteric artery. The inferior mesenteric artery is responsible for the vascular supply of the distal portion of the transverse colon, left colon, sigmoid, and a portion of the rectum. The origin of the major visceral branches of the aorta is best seen in the lateral projection (90° left anterior oblique).
Chronic abdominal, groin, and perineal pain of visceral origin
Published in Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen, Clinical Pain Management, 2008
Inadequate blood supply to meet the energy demands of viscera can lead to reports of pain, as occurs with cardiac angina. A similar phenomenon has been noted in the gastrointestinal system whereby severe abdominal pain may be precipitated by the ingestion of a meal.109, 110 Fear of eating with subsequent weight loss and poor nutritional status may further compromise patients already in ill health due to atherosclerotic disease in multiple sites. Poor peripheral pulses, abdominal bruits, and arterio-graphic evidence of stenosis or occlusion in the three main mesenteric arteries are all consistent with the diagnosis of abdominal angina. Similar to cardiac disease, abdominal angina may precede infarction which has devastating life-threatening consequences. Arterial thrombosis, embolic events, venous occlusion, and low flow states due to poor cardiac output may all lead to the same disastrous results. Ischemic colitis represents approximately half of the cases of morbidity due to mesenteric vascular disease. Although usually diagnosed by colonoscopy, 20 percent of patients with ischemic colitis develop evidence of peritonitis requiring surgical diagnosis and treatment. Initial presentation may be with persistent diarrhea, rectal bleeding, or weight loss. Diagnostic work-up for mesenteric ischemia has angiography as the gold standard, but the less invasive magnetic resonance angiography and/or tonometry have diagnostic value.111 Surgical revascularization, thrombectomy, thrombolytic therapy, or angioplasty are definitive treatments for mesenteric vasculopathy but, like all patients with widespread vascular disease, comorbidity may dictate outcome as much as the specific procedure performed. Pharmacologically, there can be short-term value of vasodilators such as papverine and, like most chronic processes with some low grade inflammatory component, there appears to be a role for the use of antioxidants and agents acting via cytokine mechanisms, but at present these treatments are experimental.112
Polyarteritis nodosa: an evolving primary systemic vasculitis
Published in Postgraduate Medicine, 2023
Gastrointestinal involvement is reported to occur in 14–65% of patients [12,20,22]. Gastrointestinal involvement is associated with a higher mortality rate [20]. Patients can present with abdominal pain, commonly presenting as pain after meals or abdominal angina. In severe cases, hematochezia can develop due to ischemic colitis. Transmural bowel wall ischemia can lead to perforations. Rare reports of perforation during colonoscopy have been reported [23]. Involvement of the gallbladder, appendix, pancreas, and liver has also been reported [12,22].