Mesenteric Vascular Problems

Abstract

Mesenteric vascular problems are infrequent, but may be catastrophic. During a 26-year period, 55 private patients were treated for the following disorders: (1) 12 patients with visceral artery aneurysms, (2) 8 with celiac compression syndrome, (3) 13 with chronic mesenteric ischemia, (4) 12 with acute mesenteric ischemia, and (5) 10 with mesenteric ischemia associated with aortic reconstructions. Splenic artery aneurysms were managed by excision and splenectomy, while celiac and hepatic had excision with graft replacement. Patients with celiac compression syndrome underwent lysis of the celiac artery. Two patients had compression of both celiac and superior mesenteric artery (SMA). One patient required vascular reconstruction of both arteries for residual stenoses. Patients having chronic mesenteric ischemia were treated with bypass grafts, with one death (7.7% mortality) and good long-term results. Those with acute mesenteric ischemia were treated by SMA embolectomy, bowel resection, or both, with a mortality of 67%. When associated with aortic reconstructions, mesenteric ischemia carried a mortality of 100% if bowel infarction occurred after operation, but when prophylactic mesenteric revascularization was performed at the time of aortic surgery, prognosis was greatly improved, with only one death among six patients. An aggressive approach including prompt arteriography with early diagnosis and surgical therapy is advocated for these catastrophic acute mesenteric problems.

Diagnosis and management of splanchnic ischemia

“…Acute splanchnic ischemia can result from arterial thrombosis, acute embolism, venous thrombosis or nonocclusive ischemia [34][35][36][37][38][39] . artery is involved.…”

Acute and Chronic Mesenteric Ischemia

“…Most commonly this results from impingement of the diaphragm on the CA, although the surrounding nerve plexus may also contribute to compression [23]. This syndrome, more commonly occurring in females, is known as the median arcuate ligament syndrome, also referred to as celiac compression syndrome [18,24]. This diagnosis should be considered in young patients who have unexplained abdominal pain and normal upper endoscopy, normal liver, pancreatic, and gastric laboratory studies, and particularly in those patients who have an abdominal bruit (from partially obstructed flow in the CA) [23].…”

Imaging of Acute Mesenteric Ischemia Using Multidetector CT and CT Angiography in a Porcine Model

“…It is estimated that nearly 1% of patients presenting with acute abdominal pain have ischemic intestinal disease, 1-3 and it may be responsible for 0.1% of all hospital The lethality of the disease is well documented, with some series reporting mortality rates exceeding 60%. [4][5][6][7] A critical factor for survival of acute mesenteric ischemia is early diagnosis and intervention. In cases of superior mesenteric artery (SMA) embolism in which surgery is performed once the bowel is infarcted, the mortality rate nearly doubles from 35% to 68%.…”