Management of Acute Intestinal Ischaemia
Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
The coeliac artery branches from the aorta just below the diaphragmatic hiatus, typically at the level of the T12 vertebral body. It arises almost perpendicularly to the aorta, and it immediately gives off three branches: the left gastric artery, the common hepatic artery and the splenic artery. Together, these branches supply blood to the distal oesophagus, stomach, liver, gall bladder, duodenum, pancreas and spleen. There is extensive collateralisation amongst these branches, which helps protect the stomach from ischaemia. The common hepatic artery gives off the right gastric artery, which meets the left gastric artery along the lesser curve of the stomach. The splenic artery gives off the left gastroepiploic artery, which meets the right gastroepiploic artery (a branch of the hepatic artery) along the greater curve of the stomach. The liver receives approximately 60% to 70% of its blood supply from the portal vein, making the hepatic artery a minor contributor. This dual blood supply also protects the liver from ischaemia during insults to the mesenteric vasculature. The pancreas and duodenum receive blood from the pancreaticoduodenal arteries. The anterior and posterior branches of the superior pancreaticoduodenal artery arise from the common hepatic artery and meet with the anterior and posterior branches of the inferior pancreaticoduodenal artery, which arises from the SMA. The gall bladder receives blood through the cystic artery (usually as a branch of the right hepatic artery).
Test Paper 7
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike in Get Through, 2017
A 70-year-old woman has a computed tomography scan for diverticulitis. An incidental 18 mm aneurysm in the mid-portion of the splenic artery is identified on the scan. Which of the following is the most appropriate treatment for this patient? Catheter angiographyCatheter angiography and coil embolisationCatheter angiography and stentingPercutaneous thrombin injectionConservative management and repeat scan in 6 months
Mesenteric and renal angiography
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
Aneurysms of the mesenteric vessels are uncommon. The majority of patients with these visceral aneurysms are asymptomatic, and these aneurysms are found incidentally during unrelated abdominal imaging.[32,33] However, these aneurysms do carry a risk of rupture and hemorrhage that can be fatal. Splenic artery aneurysms are the most common, occurring in 60% of cases. In a Mayo Clinic series of 217 patients, only 6.4% of patients with splenic artery aneurysms presented with abdominal pain or rupture.[34] The mortality rate for nonpregnant patients with splenic artery aneurysms ranges between 10% and 25% but may be as high as 70% for pregnant females.[35] In general, splenic aneurysms greater than 2 cm in diameter are thought to be of sufficient risk of rupture to warrant treatment. Aneurysms involving the hepatic artery are increasingly common and presently make up 20% of cases. This is probably due to an increase in percutaneous biliary procedures being performed today, as well as increased recognition from incidental imaging.[36]Aneurysms of the SMA are less common, accounting for only 6% of total cases. Aneurysms of the renal arteries are most commonly associated with FMD, which is discussed in the following section. Vasculitis and trauma have also been associated with renal artery aneurysms.[37]
Review spontaneous superior mesenteric artery aneurysm rupture following caesarean section: an uncommon event and review of current literature
Published in Journal of Obstetrics and Gynaecology, 2022
Mustafa Sengul, Halime Sen Selim
A literature search was performed on the current literature regarding aneurysms in pregnancy. The incidence of SMA aneurysms or related conditions of this artery location such as dissection is not well described, and there have been no case reports of this specific situation to our knowledge, thus to comment about a given population’s risk of developing aneurysms and ruptures of such is limited. We have searched on PUBMED ‘Superior mesenteric artery rupture and pregnancy’ only 6 results have found but they haven’t included SMA rupture case; ‘Sma rupture and postpartum period’ 2 results were returned which one of this about middle colic artery and the other one is ‘internal Pudendal artery’. Also, we look at up-to-date data about visceral artery aneurysm, only two sources about this issue, both of them related to the splenic artery.
Two-step complete splenic artery embolization for the management of symptomatic sinistral portal hypertension
Published in Scandinavian Journal of Gastroenterology, 2022
Jiacheng Liu, Jie Meng, Ming Yang, Chen Zhou, Chongtu Yang, Songjiang Huang, Qin Shi, Yingliang Wang, Tongqiang Li, Yang Chen, Bin Xiong
The SAE procedure has been described in detail previously [17,19]. All procedures were performed by the same interventional radiologist. After local disinfection and anesthesia, percutaneous right femoral artery puncture by the modified Seldinger technique was then performed. Next, a 5 F Yashiro catheter (Terumo, Tokyo, Japan) was used to perform arteriography of the celiac trunk, the superior mesenteric artery, and the splenic artery. Indirect portography was performed to observe the manifestations of the portal vein, the splenic vein, and the collateral circulation. Subsequently, a catheter was introduced into the main trunk of the splenic artery. After avoiding the feeding vessels of the pancreas, partial splenic embolization was performed to achieve infarction of up to 60–70% of the splenic volume using polyvinyl alcohol (PVA) particles (300–1000 μm) (Cook Incorporated, USA). The above was the first step.
Association of splenic artery pseudoaneurysm with recurrent pancreatitis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Muhammad Nadeem Yousaf, Fizah S. Chaudhary, Amrat Ehsan, Marcos A. Wolff, Charmian D. Sittambalam
The natural history of asymptomatic SAP is unclear. Compared to the splenic artery aneurysm, SAP is more prone to sudden rupture and results in high morbidity and mortality[7]. Regardless of symptoms, repair of pseudoaneurysms is recommended in all patients with incidentally detected SAP [1,2,7]. Transcatheter embolization is a promising treatment of choice in the hemodynamically stable patient with or without intact SAP. The selective embolization of both the proximal and distal ends to the feeding artery is recommended for effective thrombosis of pseudoaneurysm[4]. This ‘sandwich’ technique results in the preservation of the splenic artery blood flow through collaterals from the surrounding blood vessels. The advantage of this approach is a high success rate, minimal rate of complication, and shorter hospital stay as compared to surgical exploration. In the presence of a pancreatic pseudocyst, the failure rate of this approach may be high due to the fragility of soft tissue structure, making embolization challenging [1]. In patients with poor candidacy for transcatheter embolization, splenectomy with or without distal pancreatectomy is the standard treatment of choice with no reported failure rate. The surgical exploration with ligation of splenic artery is used preferably in patients with hemodynamic instability due to sudden rupture of SAP.
Related Knowledge Centers
- Anastomosis
- Gastroduodenal Artery
- Pancreas
- Spleen
- Stomach
- Blood
- Blood Vessel
- Celiac Artery
- Body
- Right Gastroepiploic Artery