An Acute Embolic Event Affecting the Superior Mesenteric Artery
Savio George Barreto, Shailesh V. Shrikhande in Dilemmas in Abdominal Surgery, 2020
The superior mesenteric artery is the second unpaired branch of the abdominal aorta arising from its ventral surface 1 cm below the origin of the celiac artery. The arc of Buhler is the collateral vessel between the celiac artery and superior mesenteric artery. Thromboembolism of the superior mesenteric artery is the most common cause for mesenteric ischemia accounting for 67% of cases with superior mesenteric venous thrombosis and non-occlusive mesenteric ischemia accounting for the rest. Ischemia secondary to thrombosis of the superior mesenteric artery even when acute in nature, tends to be insidious in progression and most patients report prior symptoms consistent with chronic mesenteric ischemia. In thrombotic disease, the occlusion commences at the origin of the superior mesenteric artery and extends down contiguously resulting in the involvement of the proximal jejunal vessels, unlike the case of embolism.
Visceral and renal artery interventions
Peter A. Schneider in Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
The operator must decide whether to approach the visceral arteries through a femoral access or an upper extremity access. The distance is slightly longer, but passage of a crossing wire and placement of a stent become simpler when the direction of the platform is consistent with the overall direction of the visceral vessel being treated. The celiac artery trajectory from the aorta may be perpendicular, or nearly so, and if this is the case, there is no particular advantage to one or the other approach to an occlusion. The technique of renal angioplasty and stenting has been greatly simplified by the introduction of the 0.014-inch diameter systems in renal revascularization. The operator then knows where other disease is located that may potentially cause complications during intervention. Smaller caliber guidewire systems have the advantages of crossing critical lesions with lower-profile guidewires, permitting balloon angioplasty with a very low-profile balloon, and allowing complex intervention through smaller caliber sheaths.
Late Results Following Operative Repair for Celiac Artery Compression Syndrome
Samuel Eric Wilson in 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
The clinical significance of celiac artery compression by the median arcuate ligament of the diaphragm remains unsettled. The controversy stems from an undefined pathophysiologic mechanism and the existence of celiac compression in asymptomatic patients. This chapter discusses a study conducted to evaluate the late results of operative therapy among patients and identify parameters that might correlate with sustained symptom relief. Findings suggest that persistent clinical improvement in patients with symptomatic celiac axis compression can be achieved by an operative technique that ensures celiac axis patency. Two mechanisms are proposed for the development of symptoms in Median Arcuate Ligament Syndrome (MALS). The first is arterial insufficiency from the MAL compressing the celiac artery leading to end-organ ischemia and pain. The other is physical compression of the celiac ganglion by the MAL leading to subsequent somatic pain.
Percutaneous retrograde recanalization of an occluded celiac artery complicating acute aortic dissection
Published in Acta Chirurgica Belgica, 2017
Haruka Oki, Ryota Kawasaki, Koji Sugimoto
A 79-year-old woman with a complaint of persistent upper abdominal pain was admitted to our hospital for the treatment of thrombosed acute type B aortic dissection. Computed tomography showed the complete static occlusion of the celiac artery. Because of progressive symptom with elevation of liver enzymes and metabolic acidosis 11 h after admission, endovascular revascularization was attempted on an emergent basis. After a failed catheterization of the celiac ostium in an antegrade fashion due to a hard occlusion, we succeeded in a retrograde recanalization through the pancreaticoduodenal arcade via the superior mesenteric artery with stent placement using a pull-through technique. This technique is useful and safe when an antegrade approach seems difficult.
Intraoperative measurement of pressure gradient in median arcuate ligament syndrome as a rationale for radical surgical approach
Published in Acta Chirurgica Belgica, 2018
Tomas Grus, Lukas Lambert, Tomas Vidim, Gabriela Grusova, Tomas Klika
Background: Median arcuate ligament syndrome (MALS) describes clinical symptoms in patients with stenosis of the celiac artery due to external compression by the ligament. There is an ongoing debate, whether sole release of the median arcuate ligament warrants long-term relief of the symptoms. Materials and methods: Eight patients diagnosed with MALS underwent open surgical treatment beginning with the release of the ligament. Systemic pressure and pressure in the left gastric artery were measured before and after division of the median arcuate ligament and release of the celiac artery. In patients with persistent gradient above 15 mm Hg after the release a PTFE bypass was performed. Results: After the release, the pressure gradient decreased from 66 ± 19 to 48 ± 14 mm Hg (p = .001) and therefore in all patients either an aorto-celiac bypass (n = 6) or aorto-hepatic bypass (n = 2) was created. Consequently, the gradient decreased to 7 ± 2 mm Hg (p = .0001). One month postoperatively, three patients were free of symptoms and the rest reported relief of symptoms. Conclusions: Release of the celiac artery resulted in insufficient decrease of pressure gradient, which was achieved by bypassing the segment with favorable mid-term outcome. We believe that the effect of the release should always be assessed to decide on subsequent treatment.
Celiac Artery Disease and Fatal Rupture of a Hepatic Artery Aneurysm in the Ehlers-Danlos Syndrome
Published in Baylor University Medical Center Proceedings, 2014
Amritpal Nat, Tanya George, Gregory Mak, Amit Sharma, Amitpal Nat, Robert Lebel
Isolated visceral arteriopathies of the celiac and hepatic artery are rare. We present a case of a Caucasian man who presented with abdominal pain and was found to have a spontaneous celiac artery dissection. Genetic analysis revealed a mutation consistent with Ehlers-Danlos syndrome type IV. The patient died 2 months later from a spontaneous rupture of his hepatic artery.