Portal venous phase CT appeared sensitive in diagnosing MVT. As activated protein C resistance was a strong risk factor, lifelong anticoagulation should be considered.

aortitis may contribute to the spectrum of aortic diseases, perhaps linking patients with Takayasu disease and the various subgroups of degenerative and genetically related TAAs. Epidemiology, Risk and Prognostic Factors in Mesenteric VenousThrombosis Acosta S, Alhadad A, Svensson P, et al. Br J Surg 2008;95:1245-1251 Conclusion: Mesenteric venous thrombosis (MVT) can be accurately diagnosed with portal venous-phase computed tomography (CT) scanning, and activated protein C resistance is associated with MVT.Summary: The authors used an inpatient and autopsy registry to identify patients at their hospital with MVT from 2000 to 2006. MVT was diagnosed in 51 patients. The diagnosis was made at autopsy in six patients. Patients aged 70 to 79 years had the highest incidence of MVT (11.3 per 100,000 person-years). Testing for activated protein C resistance was done in 29 patients, and 13 were positive. D-dimer levels were assessed in five patients, and all had elevated D-dimer. Multidetector row CT scans were done in the portal venous phase in 20 patients. The examination was positive in all 20 patients. There were 12 patients with surgery, with a median length of bowel resection of 0.6 m (range, 0.1-2.2 m). The 30-day mortality for the entire group was 20%. Increased mortality was associated with intestinal infarction (P ϭ .046), treatment on a nonsurgical ward (P ϭ .001), and lack of performance of CT scan (P ϭ .022). Long-term mortality was associated with presence of cancer, with a hazard ratio of 4.03 (95% CI, 1.03-15.85; P ϭ .046).Comment: MVT, at least symptomatic MVT, occurs infrequently. The diagnosis is difficult because symptoms are generally nonspecific. Mortality rates can be high. The authors' data are consistent with what one would suspect. CT scanning with a venous phase works well for diagnosis, and many of these patients will have a hypercoagulable state with, at least in this study, factor V Leiden mutation identified as the most prevalent abnormality. The study highlights the current standard of care for patients with possible MVT: a CT scan for diagnosis, anticoagulation for most patients, bowel resection for those with peritonitis, and an aggressive evaluation for hypercoagulable state with likely long-term anticoagulation. Long-term prognosis is largely related to the presence of malignancy.

Fibromuscular dysplasia (FMD) mainly affects renal arteries. Percutaneous transluminal renal angioplasty (PTRA) and surgery are effective treatments, but longtime follow-up is lacking. Retrospective follow-up for 7.074.7 years of 69 consecutive patients (age 44713 years) treated for hypertension due to FMD, 59 patients underwent PTRA and eight patients surgery. In two patients no PTRA was performed. Technical success was achieved in 56 (95%) patients undergoing PTRA and all eight undergoing surgery. After successful PTRA, both systolic and diastolic blood pressures (SBP and DBP) had decreased at discharge (from 174733/ 100713 to 138719/80715 mmHg; Po0.0001), and remained lower at 1 month, 1 year, and last follow-up after 7.074.7 years (140725/83712 mmHg; Po0.0001). Serum-creatinine had decreased both at 1 year (from 84728 to 75713 lmol/l; P ¼ 0.0030) and last follow-up (75716 lmol/l; P ¼ 0.0017). The number of antihypertensive drugs decreased (from 2.371.2 before PTRA to 1.471.3 at discharge and at 1 month; Po0.0001, and 1.671.5 at last follow-up; P ¼ 0.0011). SBP decreased more after PTRA among patients with FMD only in the main renal artery than in those with branch artery involvement (43729 vs 20741 mmHg; P ¼ 0.0198). Beneficial effects on BP, creatinine and antihypertensive drugs also occurred after surgery. Patients on antihypertensive drugs at last follow-up had longer hypertension duration before PTRA than those without (5.977.7 vs 1.874.1 years; P ¼ 0.0349). Cure was achieved in 16 (24%), improvement in another 26(39%), and benefit in 42(63%). In conclusion, renal artery FMD, PTRA and surgery have beneficial long-term effects, negatively affected by hypertension duration and branch artery involvement.

There exists no systematic evaluation on the findings in multi-detector row computed tomography (MDCT) with portal phase enhancement in patients with mesenteric venous thrombosis (MVT). Patients with MVT between 2004 and 2006 were identified at Malmö University Hospital, Sweden. Thirty patients had MVT. Median age was 58 years (interquartile range, 46-72), and 57% (17) were men. MDCT with portal phase enhancement showed MVT in 19 out of 20 investigated patients at first evaluation, even though there was clinical suspicion in only one, and conservative management was possible in 19 (95%). Central and peripheral MVT was seen in 20 (100%) and six (30%) cases, respectively. Extra-hepatic and intra-hepatic portal and splenic vein thrombosis was seen in 17 (85%), nine (45%) and 15 (75%) cases, respectively. Venous collaterals were visible in 12 (60%) cases. The most frequent extra-vascular pathologies were mesenteric oedema (50%), ascites (40%), small bowel wall oedema (25%) and local small bowel wall dilatation (20%). The vascular findings in MVT are more pronounced than the intestinal findings in MDCT with portal phase enhancement, and evaluation of the mesenteric vessels should be included in routine MDCT scans for unclear acute abdomen.

Thrombus embolization during CDT is a common phenomenon in patients with proximal DVT. Placement of a retrievable IVC filter during thrombolytic therapy can prevent silent and symptomatic pulmonary embolism.