共查询到20条相似文献,搜索用时 31 毫秒
1.
Giovanni Torsello Aysel Can Thomas Umscheid J?rg Tessarek 《Journal of endovascular therapy》2007,14(3):342-346
PURPOSE: To describe a hybrid technique involving combined antegrade revascularization of both supra-aortic and visceral arteries and complete exclusion of a dissecting thoracoabdominal aortic aneurysm (TAAA). TECHNIQUE: A 46-year-old man had a dissecting TAAA involving the left subclavian artery (LSA) and the descending thoracic and abdominal aorta down to the left common iliac artery. The ascending aorta was the only feasible source of inflow to the cerebral and visceral vessels. Via a median thoracolaparotomy, the supra-aortic and visceral arteries were dissected, and an octopus graft was implanted using 3 bifurcated Dacron grafts. An 18-x9-mm bifurcated Dacron graft was anastomosed in an end-to-side fashion to the ascending aorta, the brachiocephalic trunk, and the left common carotid artery. A 16-x8-mm bifurcated Dacron graft was sutured end-to-side to the celiac artery and superior mesenteric artery. A third 12-x7-mm bifurcated graft was sutured to both renal arteries. In a second step, 3 tapered custom-made thoracic Zenith TX2 endografts were used to repair the thoracic and the thoracoabdominal aorta. A bifurcated Zenith AAA device was used to treat the aneurysm at the level of the infrarenal aorta and both iliac arteries. Despite covering the LSA and all intercostal and lumbar arteries, the patient developed only a temporary paresis of the left leg. Computed tomography showed complete exclusion of the aneurysm and normal flow to the supra-aortic and visceral arteries. CONCLUSION: In selected cases, this hybrid approach using the ascending aorta for antegrade revascularization of cerebral and visceral arteries is feasible, with acceptable perioperative morbidity. However, its role for the treatment of complex thoracoabdominal aortic disease must be evaluated further. 相似文献
2.
Yuki Okamoto Kazuo Yamamoto Tsutomu Sugimoto Fuyuki Asami Ayako Nagasawa Satoru Shiraiwa Norihito Nakamura Shinpei Yoshii 《Heart and vessels》2014,29(6):864-866
We encountered a surgical case of middle aortic syndrome (MAS) in a 56-year-old man who had resistant hypertension. Computed tomography showed severe stenosis of the abdominal aorta from below the superior mesenteric artery to above the inferior mesenteric artery. Although bilateral renal artery stenosis was confirmed, renal function was within normal limits. A 10-mm vascular prosthetic graft was used to perform a descending aorta to left external iliac artery bypass. His hypertension was well controlled without medication. This extra-anatomic bypass may be a simple and useful approach for treating MAS if it is not necessary to reconstruct the renal artery or visceral artery. 相似文献
3.
Von Recklinghausen's vasculopathy 总被引:1,自引:0,他引:1
D Zochodne 《The American journal of the medical sciences》1984,287(1):64-65
Vasculopathy in the syndrome of Von Recklinghausen's neurofibromatosis is a well known but clinically underestimated phenomenon. Its manifestations have included renovascular hypertension, occlusive cerebrovascular disease and visceral ischemia. The progressive arterial disease may involve small vessels on a regular basis and large vessels in a variety of angiographic patterns. A young neurofibromatosis patient is described with an aneurysm of the superior mesenteric artery complicating renovascular hypertension associated with aortic coarctation and renal artery stenosis. This unique angiographic demonstration illustrates the therapeutic dilemmas posed by the vascular disease associated with Von Recklinghausen's neurofibromatosis. 相似文献
4.
A 82 year old lady presented with haemorraghic erosive gastritis, progressing lost of weight, hypertension, diabetes mellitus and renal dysfunction. Colour flow duplex scanning and MRA revealed subtotal stenosis of the celiac artery and the right renal artery, proximal occlusion of the superior mesenteric artery and complete occlusion of the inferior mesenteric artery. There were also stenoses in the left renal artery. The patient was accessed via the left brachial artery, because of the relatively unfavourable angle of the mesenteric arteries. The procedures were done using F8-sheath-, F7-guiding catheter and vertebral shaped F5-diagonstic catheter. The celiac trunk und the right renal artery were initially treated with 7 x 12 and 5 x 17 mm balloon-expanding Stents. 7 x 40 mm self-expanding stent (Carotid wallstent) was inserted in the superior mesenteric artery following balloon dilatation with 5-mm-PTA-ballon. Dilatation of the superior mesenteric artery was done also after placement of the stent with 7-mm-PTA-ballon. One stage successful endovascular treatment was performed in the three vascular territories. A follow-up of 3 months period with colour duplex sonography revealed the stent to be patent with normal flow, better control of the hypertension and improvement of the renal function. 相似文献
5.
The watermelon rectum 总被引:3,自引:0,他引:3
We report a case of chronic mesenteric ischemia that caused abdominal angina and weight loss in an 80-year-old woman. A mesenteric angiogram revealed total occlusion of the superior mesenteric artery and 90% stenosis of the celiac and inferior mesenteric arteries. Balloon angioplasty of the celiac artery failed because of elastic recoil. A 15-mm Palmaz-Schatz stent was dilated to 6 mm in the proximal celiac artery with an excellent angiographic result and complete resolution of symptoms. A clinical, 1-year follow-up demonstrated success with no recurrence of pain. This case report illustrates the value of balloon dilatation and stent implantation in a patient with atherosclerotic narrowing of multiple abdominal visceral arteries. 相似文献
6.
Takuro Saito Takao Tsuchiya Akira Kenjo Takashi Kimura Yoshihiro Sato Takaharu Saito Takayuki Anazawa Shinya Takase Hirono Satokawa Youichi Satoh Hitoshi Yokoyama Hiromasa Ohira Tsuyoshi Rai Mitsukazu Gotoh 《Journal of hepato-biliary-pancreatic sciences》2008,15(4):444-448
Pseudoaneurysm after pancreas resection poses serious complications, including rupture and hemorrhage. Here we report a case of delayed massive hemorrhage from celiac and superior mesenteric arteries, which was successfully treated with a combined endovascular and surgical approach. The patient was a 52-year-old man who presented with pseudoaneurysms of the celiac and superior mesenteric arteries after distal pancreatectomy. Following the detection of sentinel bleeding from the abdominal drain, emergency angiography of the celiac and superior mesenteric arteries revealed stenosis of the celiac artery and pseudoaneurysms in the superior mesenteric artery. We occluded these lesions with a platinum coil, using an interventional radiological technique combined with bypass grafting between the abdominal aorta and the SMA, using the saphenous vein. However, re-bleeding into the abdominal cavity occurred from the proximal SMA pseudoaneurysm. We inserted an endoluminal stent-graft into the abdominal aorta and completed bypass grafting between the aorta and bilateral renal arteries. The hemorrhage ceased and the postoperative course was uneventful. The patient was discharged 34 days after the treatment (149 days after the initial operation). In conclusion, this combined endovascular and surgical approach is feasible and seems appropriate for pseudoaneurysms arising from proximal sites in visceral arteries. 相似文献
7.
Gregoric ID Gupta K Jacobs MJ Poglajen G Suvorov N Dougherty KG Krajcer Z 《Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital》2005,32(3):416-420
Historically, open surgical repair of thoracoabdominal aortic aneurysms has been associated with high morbidity and mortality rates. Furthermore, endovascular exclusion alone can restrict blood flow to visceral arteries. We report a case of thoracoabdominal aortic aneurysm that was repaired using a hybrid approach: surgery followed by an endovascular procedure. A 53-year-old woman was admitted to our hospital for endovascular exclusion of a thoracoabdominal aortic aneurysm that included the superior mesenteric artery and the celiac artery. Aorto-mesenteric and aorto-celiac artery bypass grafting was performed to create a landing zone for subsequent endovascular exclusion of the aneurysm, which was completed successfully 6 weeks after the bypass procedure. For thoracoabdominal aortic aneurysms that extend beyond the superior mesenteric artery and the celiac or renal arteries, a hybrid approach, consisting of limited surgical treatment followed by endovascular exclusion of the aneurysm, may yield optimal results in selected patients with serious preoperative comorbidities. 相似文献
8.
W T Chang H L Kao C S Liau Y T Lee 《Catheterization and cardiovascular interventions》2001,52(1):112-115
Aortic dissection complicated with limb and visceral ischemia is a clinical dilemma since surgical intervention carries high risk of morbidity and mortality. The management is further complicated when renal perfusion is impaired and thus associated with severe renovascular hypertension. As catheterization techniques advanced over the past decade, percutaneous endovascular intervention provides a less invasive alternative for management of such cases. We report a case of chronic Stanford type B aortic dissection complicated with visceral and limb ischemia presenting with marked renovascular hypertension, which was successfully treated with percutaneous endovascular aortic stenting. 相似文献
9.
M Aizaki S Ishikawa A Ohtaki T Takahashi T Koyano S Ohki T Ohki T Ibe Y Ohtani Y Morishita 《Japanese heart journal》2001,42(5):651-655
A 61-year-old Japanese female was referred to our hospital for surgical treatment of a localized heavily calcified abdominal aorta. Preoperative angiograms and computed tomograms revealed severe stenosis of the aorta, resembling a slit. Bypass grafting between the thoracic and abdominal aorta was successfully performed together with the reconstruction of the celiac artery, superior mesenteric artery, and bilateral renal arteries without extracorporeal circulation. Postoperative angiograms showed patency of the graft and branches. A localized heavily calcified abdominal aorta is relatively rare, and the cause of this entity might be Takayasu's aortitis. 相似文献
10.
We describe a novel hybrid open and endovascular repair for a dumbbell shaped lower thoracic and abdominal aortic aneurysm (AAA) in a high risk patient, with celiac trunk and superior mesenteric artery occlusions. We used a two-staged approach consisting of an open infrarenal AAA repair with a by-pass to superior mesenteric artery and reimplantation of inferior mesenteric artery. This was followed by an antegrade insertion of a thoracic endograft via a PFTE graft on the thoracic aorta to allow precise deployment of the stent graft above the renal arteries. 相似文献
11.
Isolated arterial dissection, which occurs with the absence of aortic dissection, has been reported in carotid and renal arteries but rarely in visceral arteries. A case of isolated celiac artery dissection is reported here. A healthy 58-year-old man experienced sudden upper abdominal pain, which continued for several days. A body computed tomogram (CT) showed a multiple low-density wedge-shaped area in the spleen, which was diagnosed as splenic infarction, and an aneurysm with thrombus in the celiac artery. A selective angiogram showed dilatation of the celiac artery with wall irregularity, and proximal occlusion of the hepatic artery. The distal hepatic artery was fed by collateral arteries from the superior mesenteric artery. Splenic infarction was probably due to the embolism from the thrombus in the dissected celiac artery. The absence of other vascular lesions and causes or risks for the arterial dissection would suggest the occurrence of spontaneous dissection. The dissection of visceral arteries should be considered in diagnosing acute abdominal pain. 相似文献
12.
Wilson DB Mostafavi K Craven TE Ayerdi J Edwards MS Hansen KJ 《Archives of internal medicine》2006,166(19):2095-2100
BACKGROUND: To examine prospectively the relationship between stenosis or occlusion of the celiac and superior mesenteric arteries and symptoms of chronic intestinal ischemia in free-living elderly patients in the United States. METHODS: As part of an ancillary study to the Cardiovascular Health Study, participants in the Forsyth County (North Carolina) cohort underwent visceral duplex ultrasonography of the celiac and superior mesenteric arteries. Critical mesenteric artery stenosis (MAS) or occlusion was defined by Doppler flow ultrasound-derived criteria. Clinical outcomes were assessed at annual follow-up examinations and review of death certificates. Multivariate associations between the presence of MAS and all-cause mortality and adverse cardiovascular events were analyzed. Participants with MAS were contacted to determine the presence of symptoms consistent with chronic intestinal ischemia. RESULTS: Of 553 participants who underwent visceral duplex ultrasonography, 97 (17.5%) had disease of the celiac or superior mesenteric artery. At a mean follow-up of 6(1/2) years, 20 participants with MAS (20.6%) and 93 without MAS (20.4%) had died (relative risk, 1.01; 95% confidence interval, 0.66-1.55). No deaths were attributed to intestinal infarction. No association existed between the presence of MAS and prevalent cardiovascular disease, all-cause mortality, or adverse cardiovascular events. A questionnaire was completed by 71% of the surviving participants with MAS. No participant reported symptoms or weight loss consistent with chronic intestinal ischemia. CONCLUSIONS: Mesenteric artery stenosis was a common finding in free-living elderly patients. At long-term follow-up, the presence of asymptomatic MAS was not associated with death or adverse cardiovascular events. Participants with asymptomatic MAS by duplex ultrasonographic criteria did not experience intestinal infarction or develop chronic intestinal ischemia. 相似文献
13.
Renal artery stenosis is considered to be one of the more frequent causes of secondary arterial hypertension. Through its progression renal artery stenosis can cause renal insufficiency, uncontrolled hypertension, and increased cardiovascular morbidity. A thorough clinical examination and the presence of a typical abdominal bruit may provide helpful hints to identify hypertensive patients with possible renal artery stenosis. Testing for renovascular hypertension includes renal artery imaging, assessment of its functional significance, and evaluation for possible revascularization. Renal artery stenosis secondary to fibromuscular dysplasia should be mechanically corrected. For atherosclerotic renal artery stenosis, medical management can be attempted so long as it does not cause a decline of kidney function. In patients who are candidates for renovascular revascularization, surgical intervention can be helpful in improving blood pressure control and possibly halting the progression of renal failure. Randomized controlled trials comparing direct stenting with other surgical methods are necessary to define the best revascularization strategy in patients with renovascular hypertension. A careful follow-up study after renal artery revascularization should evaluate possible benefits in halting the deterioration of chronic renal insufficiency. 相似文献
14.
Tudor D. Vagaonescu MD PhD ; George Dangas MD PhD 《Journal of clinical hypertension (Greenwich, Conn.)》2000,4(5):363-370
Renal artery stenosis is considered to be one of the more frequent causes of secondary arterial hypertension. Through its progression renal artery stenosis can cause renal insufficiency, uncontrolled hypertension, and increased cardiovascular morbidity. A thorough clinical examination and the presence of a typical abdominal bruit may provide helpful hints to identify hypertensive patients with possible renal artery stenosis. Testing for renovascular hypertension includes renal artery imaging, assessment of its functional significance, and evaluation for possible revascularization. Renal artery stenosis secondary to fibromuscular dysplasia should be mechanically corrected. For atherosclerotic renal artery stenosis, medical management can be attempted so long as it does not cause a decline of kidney function. In patients who are candidates for renovascular revascularization, surgical intervention can be helpful in improving blood pressure control and possibly halting the progression of renal failure. Randomized controlled trials comparing direct stenting with other surgical methods are necessary to define the best revascularization strategy in patients with renovascular hypertension. A careful follow-up study after renal artery revascularization should evaluate possible benefits in halting the deterioration of chronic renal insufficiency. 相似文献
15.
Wissam Al-Jundi Yama Haqzad Khalil Madbak Phillip Chan 《The International journal of angiology》2013,22(4):259-262
The treatment of chronic mesenteric ischemia remains challenging and controversy exists over the best interventional option. Endovascular treatment has emerged as first-line management due to its associated lower morbidity and mortality than surgical reconstruction. However, open mesenteric reconstructions continue to play an important role in patients with lesions that are unsuitable for an endovascular option. Mesenteric operations utilize the aorta or iliac artery as the inflow source for a vein or prosthetic bypass to the celiac artery or superior mesenteric artery. We describe an exceptional case of chronic mesenteric ischemia due to atherosclerosis that was treated successfully with a novel ileocolic to right iliac arterial transposition. 相似文献
16.
Y Kyoraku J Kato Y Nishi T Kita K Kitamura M Asato S Tamura K Tanabe H Toma T Eto 《Hypertension research》1999,22(2):141-143
A 36-yr-old male was found to have renovascular hypertension due to an occluded right renal artery and 70% stenosis in the left renal artery, caused by fibromuscular dysplasia. The right kidney was supplied by collateral blood flow, and secreted more renin than the left kidney. Two differential therapeutic approaches were taken: autotransplantation for the right kidney and percutaneous transluminal renal angioplasty followed by stent implantation for the left. The renovascular hypertension was treated with these therapies, preserving renal function in this patient. 相似文献
17.
Michel Batt Stéphan Haulon Pierre-Jean Bouillanne Jean Baqué Verena Fassbender Pierre Haudebourg Réda Hassen-Khodja Elixène Jean-Baptiste 《Journal of endovascular therapy》2007,14(3):416-420
Purpose: To report a technique for fenestrated stent-graft repair involving a conduit implanted at the origin of a patent aneurysmal common iliac artery (CIA) in a patient with a pararenal aortic aneurysm and iliac artery occlusion. Case Report: A 60-year-old man with multiple comorbidities presented with an 8-cm abdominal aortic aneurysm (AAA) with no infrarenal neck according to computed tomography (CT). Both CIAs were aneurysmal; the left was occluded, as were the left internal and external iliac arteries and the inferior mesenteric artery. Two patent accessory renal arteries were depicted. Because an infrarenal neck was absent, treatment with a fenestrated endograft was performed under general anesthesia. The right CIA was approached via an oblique retroperitoneal incision. A 10-mm polytetrafluoroethylene tube graft was implanted on the origin of the right CIA aneurysm in an end-to-side fashion to facilitate delivery of a Zenith endograft constructed with 2 small fenestrations for the renal arteries, 1 large strut-free fenestration for the superior mesenteric artery, and a scallop for the celiac trunk. The proximal fenestrated body of the Zenith device was introduced via the right iliac artery by direct puncture of the common femoral artery. The conduit was used to cannulate the 3 fenestrations for subsequent deployment and for delivery of the distal Zenith aortomonoiliac device. The procedure was completed successfully, but 12 hours after surgery, the patient developed a significant right retroperitoneal hematoma, which was treated surgically. CT confirmed patency of all visceral arteries and no endoleak. One month after the initial procedure, he had recovered totally and was discharged. Conclusion: Iliac conduits could widen the feasibility of fenestrated endografting in patients unfit for open surgery with pararenal aneurysms and challenging iliac anatomy. However, this adjunctive procedure has its own morbidity. 相似文献
18.
Iatrogenic subclavian artery and aortic dissection with mesenteric ischemia following subclavian artery angioplasty: Endovascular management
下载免费PDF全文
![点击此处可从《Catheterization and cardiovascular interventions》网站下载免费的PDF全文](/ch/ext_images/free.gif)
Xavier Millán MD Lorenzo Azzalini MD MSC Jean‐François Dorval MD 《Catheterization and cardiovascular interventions》2015,86(4):E194-E199
Subclavian stenosis affects up to 5% of patients referred for coronary artery bypass grafting. Albeit usually asymptomatic, this condition can cause myocardial ischemia due to a steal phenomenon from the distal subclavian artery when the left internal mammary artery is used as a coronary bypass. We describe a case of proximal subclavian artery angioplasty complicated with aortic dissection and subsequent life‐threatening mesenteric ischemia. For the first time, we illustrate an endovascular approach to both complications consisting in urgent stenting of the celiac trunk and the superior mesenteric artery followed by staged thoracic endovascular aortic repair due to progressive aortic dilatation. © 2015 Wiley Periodicals, Inc. 相似文献
19.
Anoop TM Manjula R Pappachan JM Biju MV Sebastian A Sujathan P 《European Journal of Internal Medicine》2007,18(8):597-599
Renal artery aneurysms are uncommon and are usually detected when renal angiography is performed for other indications. Less often, they may present with loin pain, hematuria, renovascular hypertension, and a palpable mass. Renal artery aneurysms larger than 1.0 cm presenting with resistant hypertension and all aneurysms larger than 2.0 cm are the usual indications for surgical intervention. The most important indications for surgical repair appear to be the presence of concurrent hypertension and female gender (because of the higher chances of catastrophic rupture of the aneurysm during pregnancy). Surgery may result in better control of hypertension in some cases. In this report, we highlight a rare case of a huge aneurysm of the left renal artery presenting with resistant renovascular hypertension and heart failure. Aneurysmectomy, followed by repair of the renal artery, resulted in good control of heart failure and hypertension. 相似文献
20.
Pardo R Somalo L Málaga S Santos F 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2008,28(2):216-217
Hypertension affect about 1% of patients with neurofibromatosis type 1 (NF1). Major causes are concomitant pheocromocytoma in adults and renovascular hypertension in children. In most cases, NF1 is associated with renal artery stenosis, smooth cell proliferation and advential fibrosis. We describe a 16 year old girl with hypertension complicating NF1 secondary to severe coarctation of abdominal aorta and tight stenosis of right renal artery, a very uncommon case. She was first diagnosed when she was 3-years-old and managed with antihypertensive drugs (atenolol, hidralazine and nifedipine); she experienced progressive uncontrollable hypertension but no symptoms, thus she was admitted to repeat studies. Laboratory evaluation (including creatinine, serum electrolytes, urinalysis, urine catecholamines and creatinine clearance) was normal Percutaneous transfemoral magnetic resonance angiography disclosed severe coarctation of abdominal aorta, functional occlusion of superior mesenteric artery and tight stenosis of right renal artery with poststenotic dilatation. Patient underwent surgery with aorto-aortic by-pass and right kidney artery reimplantation. Periodical controls confirmed no hypertension, even four years after surgery and normal flow patterns in Doppler ultrasonography. Patients with NF1 must be screened for pheochromoctyoma and renovascular hypertension. If hypertension appears, careful management is mandatory, as periodical follow-up even after surgery, since the long-term recurrence rate of renovascular lesions is not well established. 相似文献