Mesenteric stenosis, collaterals, and compensatory blood flow

Petersen, André S. van; Kolkman, Jeroen J.; Meerwaldt, Robbert; Huisman, Ad B.; Palen, Job van der; Zeebregts, Clark J.; Geelkerken, Robert H.

doi:10.1016/j.jvs.2014.01.063

Cited by 66 publications

(51 citation statements)

References 33 publications

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“…Collateral pathways among the visceral branches provide protective redundancy and enable the patient to remain asymptomatic if blood flow within a branch vessel is compromised. 2,6 In individu- …”

Section: Discussionmentioning

confidence: 99%

Symptomatic Celiomesenteric Trunk: Variable Presentations and Outcomes in 2 Patients

Kueht

Mills

et al. 2018

Texas Heart Institute Journal

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M esenteric ischemia can have a variety of presentations, ranging from classic and predictable to unusual and occult. For instance, a visceral vascular obstruction from a cardioembolic source tends to be acute and spares the proximal splanchnic vasculature. In contrast, when atherosclerotic disease develops at the origins of the aortic branches, it is typically preceded by chronic symptoms.1,2 Usually, the redundancy of the vascular collaterals between the fore-and midgut, which involves structures such as the pancreaticoduodenal arcade and the arc of Buhler, provides protection against ischemia. However, patients with anatomic variations-such as a celiomesenteric trunk (CMT), in which the superior mesenteric artery (SMA) originates from the celiac axis (CA) (Fig. 1)-lack this protection. In these patients, successful diagnosis and management depends on astute interpretation of radiologic images (usually computed tomographic angiograms [CTAs]).3,4 Misdiagnosis can lead to prolonged suffering or death.We present the cases of 2 patients with symptoms of mesenteric ischemia in whom we diagnosed CMT. Their cases illustrate the different courses of disease and outcomes in this population. Case Reports Patient 1Chronic Mesenteric Ischemia. A 57-year-old woman presented with a 5-year history of severe, postprandial abdominal pain that had led to a fear of eating and a 40-lb weight loss. Over the years before admission, she had undergone endoscopic and ultrasonographic evaluations with unremarkable results. Additionally, she had undergone prolonged empiric treatment for peptic ulcer disease, which was unsuccessful in controlling her symptoms. She had been referred to our clinic after an outpatient CTA revealed no ventral branch in the anticipated location on the SMA, occlusion of the proximal CA, and a CMT (Fig. 2A). The inferior mesenteric artery (IMA) was enlarged (6 mm), as was a tortuous marginal arcade (up to 7.5 mm) (Fig. 2B). Elective surgical exploration confirmed the presence of CMT and revealed compression of the origin of the celiac trunk by the median arcuate ligament (MAL). There were also chronic fibrotic changes in the CMT. Even after lysis of the crural fibers, the CMT remained occluded, and Doppler ultrasound testing of the structure produced poor signals. Therefore, we performed an aortomesenteric bypass with a 6-mm Dacron graft to the confluence of branches originating from the CMT. Exploration of the remainder of the abdomen confirmed a markedly hypertrophic marginal arcade and its Case Reports

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Section: Discussionmentioning

confidence: 99%

Symptomatic Celiomesenteric Trunk: Variable Presentations and Outcomes in 2 Patients

Kueht

Mills

et al. 2018

Texas Heart Institute Journal

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“…In this group of patients, flow in the IMA is likely to be higher. Whether the presence of collaterals is indicative of ischemia development, or conversely, that the lack of collaterals indicates the absence of ischemia, remains to be confirmed (Van Petersen et al, ).…”

Section: Discussionmentioning

confidence: 99%

Median arcuate ligament syndrome: Predictor of ischemic complications?

et al. 2016

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Median arcuate ligament syndrome (MALS) is a pathologic entity that can affect the celiac axis. Due to the extensive collateral network of mesenteric circulation, stenosis of one mesenteric artery does not lead to significant symptoms. The purpose of this study was to describe multidetector computed tomography (MDCT) angiography findings of celiac artery entrapment by the median arcuate ligament and determine those patients with high risks of ischemic complications. From January 2012 to March 2016, 103 patients with celiac artery (CA) compression by median arcuate ligament were detected. In 23 patients collateral circulation was developed. In order to investigate the problem, we managed to estimate the correlation between range of stenosis of CA and presence of collateral circulation between the celiac artery (CA) and superior mesenteric artery (SMA). A statistically significant correlation was found between range of CA stenosis and collateral circulation presence (Spearman's correlation coefficient 0.339, P < 0.0001). In conclusions, based on our observations, we hypothesize that ischemia as a result of mesenteric vessel narrowing by the median arcuate ligament may occur more often than indicated by clinical symptoms and described in literature. Clin. Anat. 29:1025-1030, 2016. © 2016 Wiley Periodicals, Inc.

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“…After coverage of the CA, elevated SMA velocities may be observed in certain patients related to a change in flow patterns due to increased compensatory blood flow in the unaffected vessel and decreased peripheral resistance from the collateral circuit supplying the remainder of the viscera. 10 Evaluation of symptoms and weight loss, increased velocity of the SMA, and radiographic findings should be considered to ensure adequate abdominal perfusion or need for reintervention.…”

Section: Discussionmentioning

confidence: 99%

Outcomes after celiac artery coverage during thoracic endovascular aortic aneurysm repair

Rose

Pearce

Matthews

et al. 2015

Journal of Vascular Surgery

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This analysis of outcomes up to 81 months supports the suitability of covering the CA in selected patients for extending the distal landing zone to the visceral aortic level above the SMA or when alternative branch vessel treatment is unavailable. Preoperative angiographic evaluation of the mesenteric collaterals and early postoperative surveillance may limit postoperative complications. Once the CA is covered, new symptoms do not develop unless the SMA is compromised.

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Mesenteric stenosis, collaterals, and compensatory blood flow

Cited by 66 publications

References 33 publications

Symptomatic Celiomesenteric Trunk: Variable Presentations and Outcomes in 2 Patients

Symptomatic Celiomesenteric Trunk: Variable Presentations and Outcomes in 2 Patients

Median arcuate ligament syndrome: Predictor of ischemic complications?

Outcomes after celiac artery coverage during thoracic endovascular aortic aneurysm repair

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