Isolated spontaneous dissection of the superior mesenteric artery (SMA) without aortic dissection is a rare cause of acute mesenteric ischemia. A sudden decrease of intestinal blood flow can lead to fatal complications such as ischemic necrosis, shock, and death. Therefore, early diagnosis and therapeutic approach before the occurrence of intestinal infarction are the most important factor to determine the patient's prognosis. A 52-year-old male presented with postprandial periumbilical pain, and isolated spontaneous dissection of the superior mesenteric artery with mural thrombus was detected by abdominal computed tomography with contrast enhancement. By the percutaneous implantation of vascular metallic stent via femoral artery, he was treated successfully. We report a case of isolated spontaneous dissection of the SMA treated by a percutaneous endovascular stent replacement with a review of literature.
Aneurysm, Dissecting/complications/*diagnosis/surgery ; Humans ; Male ; *Mesenteric Artery, Superior/radiography ; Mesenteric Vascular Occlusion/etiology/surgery ; Middle Aged ; *Stents ; Tomography, X-Ray Computed

Isolated spontaneous dissection of the superior mesenteric artery (SMA) without aortic dissection is a rare cause of acute mesenteric ischemia. A sudden decrease of intestinal blood flow can lead to fatal complications such as ischemic necrosis, shock, and death. Therefore, early diagnosis and therapeutic approach before the occurrence of intestinal infarction are the most important factor to determine the patient's prognosis. A 52-year-old male presented with postprandial periumbilical pain, and isolated spontaneous dissection of the superior mesenteric artery with mural thrombus was detected by abdominal computed tomography with contrast enhancement. By the percutaneous implantation of vascular metallic stent via femoral artery, he was treated successfully. We report a case of isolated spontaneous dissection of the SMA treated by a percutaneous endovascular stent replacement with a review of literature.
Aneurysm, Dissecting/complications/*diagnosis/surgery ; Humans ; Male ; *Mesenteric Artery, Superior/radiography ; Mesenteric Vascular Occlusion/etiology/surgery ; Middle Aged ; *Stents ; Tomography, X-Ray Computed

Adult ; Aneurysm, Dissecting ; therapy ; Angioplasty, Balloon ; methods ; Female ; Humans ; Male ; Mesenteric Artery, Superior ; surgery ; Mesenteric Vascular Occlusion ; therapy ; Middle Aged ; Treatment Outcome

OBJECTIVETo examine the outcome of damage control surgery (DCS) in patients with acute mesenteric ischemia (AMI).

METHODSClinical data of 15 consecutive AMI cases treated with DCS from May 2001 to March 2009 at the Research Institute of General Surgery, Jinling Hospital were retrospectively analyzed. Eleven patients had acute superior mesenteric vein thrombosis (MVT) on admission, and 4 suffered from acute mesenteric arterial embolism/thrombosis (MAE/MAT). The staged damage control approach included immediate resection of the involved bowel (but no attempts to restore gastrointestinal continuity), open thrombectomy, transfer of the patients to ICU for resuscitation, and thrombolysis prior to the planned definitive reconstructive procedure.

RESULTSOf 15 patients, 10 (66.7%) survived. The mean remnant small bowel length was (209.0+/-53.8) cm (120 to 280 cm). None of the survived patients was parenteral nutrition-dependent. Of the 5 deaths, 2 died of recurrence of thrombosis and necrosis of the remaining bowel,1 of massive gastrointestinal bleeding. One patient abandoned treatment intra-operatively, and another with total small bowel resection abandoned treatment postoperatively.

CONCLUSIONSDamage control approach improves the survival of patients with AMI. Thrombectomy and thrombolysis are necessary for AMI management to prevent progression or further development of the thrombosis.

Acute Disease ; Adult ; Female ; Humans ; Intraoperative Complications ; Ischemia ; surgery ; therapy ; Male ; Mesenteric Vascular Occlusion ; surgery ; therapy ; Mesentery ; surgery ; Middle Aged ; Retrospective Studies ; Thrombectomy ; Thrombolytic Therapy

OBJECTIVETo study the clinical and pathologic features of ischemic intestinal disease due to mesenteric phlebitis.

METHODThe clinical and pathologic features of the mesenteric venous lesions in 3 patients of ischemic intestinal disease admitted during the period from 2003 to 2004 were studied.

RESULTSAll 3 patients had a clinical history of acute abdominal pain accompanying with a diffuse peritonitis. During operation, an infarcted intestinal segment was identified and was resected respectively in each patient. Histologic examination showed a lymphocytic infiltration and fibrinoid necrosis of the small to medium-sized veins, associated with mural thrombosis and infarction of the corresponding intestinal wall and mesentery. The mesenteric arteries were spared. Two-year follow up of one case showed no evidence of local recurrence or systemic vasculitis.

CONCLUSIONSIschemic intestinal disease due to mesenteric phlebitis is a rare entity with a pathological feature of inflammation of venous wall accompanying with the development of mural thrombosis and subsequent haemorrhagic infarction of intestine. The etiology is unknown and surgical resection of the involved intestinal segment is usually recommended.

Adult ; Aged ; Colitis, Ischemic ; etiology ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Intestinal Diseases ; etiology ; pathology ; surgery ; Intestine, Small ; blood supply ; pathology ; surgery ; Ischemia ; complications ; Male ; Mesenteric Vascular Occlusion ; complications ; Mesenteric Veins ; pathology ; Middle Aged ; Phlebitis ; complications

Acutely aggravated dissecting flap and consequent occlusion of the superior mesenteric artery (SMA) by simple contrast passage during initial angiography for percutaneous stent placement is a uncommon event, which usually is not reported. After analysis of many factors that underlie development of such complications, we present herein one case of successful treatment of isolated SMA dissection and its complications with favorable outcomes during 25 months follow-up after percutaneous stent placement.
Adult ; Aneurysm, Dissecting/*surgery ; Angiography/adverse effects ; Contrast Media/adverse effects ; Embolectomy ; Humans ; Male ; Mesenteric Artery, Superior/radiography/*surgery ; Mesenteric Vascular Occlusion/etiology ; Stents/*adverse effects ; Tomography, X-Ray Computed

Intestinal ischemia is divided into three categories, namely, acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI), and colonic ischemia. AMI can result from arterial or venous thrombi, emboli, and vasoconstriction secondary to low-flow states. It is an urgent condition which can result in high mortality rate. The predominant causative factor of CMI is stenosis or occlusion of the mesenteric arterial circulation, and it is characterized by postprandial abdominal pain and weight loss. Surgery is the treatment of choice for intestinal ischemia. However, it has been recently reported that percutaneous transluminal angioplasty with stent placement and/or thrombolysis is an effective therapy in various types of mesenteric ischemia. We report six cases of mesenteric ischemia which were successfully treated by percutaneous angioplasty, and review the literature from South Korea.
Acute Disease ; Aged ; Aged, 80 and over ; *Angioplasty, Balloon ; Chronic Disease ; Female ; Humans ; Intestines/*blood supply ; Ischemia/surgery/*therapy ; Male ; Mesenteric Artery, Superior ; Mesenteric Vascular Occlusion/surgery ; Middle Aged ; Tomography, X-Ray Computed

Intestinal ischemia is divided into three categories, namely, acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI), and colonic ischemia. AMI can result from arterial or venous thrombi, emboli, and vasoconstriction secondary to low-flow states. It is an urgent condition which can result in high mortality rate. The predominant causative factor of CMI is stenosis or occlusion of the mesenteric arterial circulation, and it is characterized by postprandial abdominal pain and weight loss. Surgery is the treatment of choice for intestinal ischemia. However, it has been recently reported that percutaneous transluminal angioplasty with stent placement and/or thrombolysis is an effective therapy in various types of mesenteric ischemia. We report six cases of mesenteric ischemia which were successfully treated by percutaneous angioplasty, and review the literature from South Korea.
Acute Disease ; Aged ; Aged, 80 and over ; *Angioplasty, Balloon ; Chronic Disease ; Female ; Humans ; Intestines/*blood supply ; Ischemia/surgery/*therapy ; Male ; Mesenteric Artery, Superior ; Mesenteric Vascular Occlusion/surgery ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVE: To evaluate the technical feasibility and clinical outcome of percutaneous aspiration embolectomy for embolic occlusion of the superior mesenteric artery (SMA). MATERIALS AND METHODS: Between January 2010 and December 2013, 9 patients with embolic occlusion of the SMA were treated by percutaneous aspiration embolectomy in 2 academic teaching hospitals. The aspiration embolectomy procedure was performed with the 6-Fr and 7-Fr guiding catheter. Thrombolysis was performed with urokinase using a multiple-sidehole infusion catheter. The clinical outcome was investigated retrospectively. RESULTS: Superior mesenteric artery occlusion was initially diagnosed by computed tomography (CT) in all patients, and all patients had no obvious evidence of bowel infarction on CT scan. Percutaneous aspiration embolectomy was primarily performed in 6 patients, and thrombolysis was initially performed in 3 patients. In 3 patients who received primary thrombolysis, percutaneous aspiration was undertaken because the emboli were resistant to urokinase. Complete angiographic success was achieved in 6 patients and partial angiographic success was accomplished in 3 patients. One patient underwent bowel resection. One patient died of whole bowel necrosis and sepsis, and 8 patients survived without complications. CONCLUSION: Percutaneous aspiration embolectomy is a useful tool in recanalization of embolic occlusion of the SMA in select patients.
Adult ; Aged ; Aged, 80 and over ; Angiography/methods ; Embolectomy/*methods ; Embolism/complications/radiography/*surgery ; Female ; Humans ; Male ; Mesenteric Artery, Superior/radiography/*surgery ; Mesenteric Vascular Occlusion/etiology/radiography/*surgery ; Middle Aged ; Retrospective Studies ; Suction/instrumentation/methods ; Thrombolytic Therapy/methods ; Tomography, X-Ray Computed ; Treatment Outcome ; Urokinase-Type Plasminogen Activator/administration & dosage ; Vascular Access Devices