Coil compaction after embolization of the superior mesenteric artery pseudoaneurysm

European Radiology - A 58-year-old man with an abscess of the psoas muscle was returned to our hospital with hematemesis. Two years earlier, he had undergone coil embolization for a superior...     

Coil compaction after embolization of the superior mesenteric artery pseudoaneurysm

A 58-year-old man with an abscess of the psoas muscle was returned to our hospital with hematemesis. Two years earlier, he had undergone coil embolization for a superior mesenteric artery (SMA) pseudoaneurysm secondary to pancreatitis. Based on the physical examination, serum amylase level, and abdominal radiographs, a diagnosis of acute exacerbation of pancreatitis and coil compaction of the SMA pseudoaneurysm was made. The patient underwent re-embolization for the coil compaction using interlocking detachable coils. His condition improved gradually, and he was discharged 3 weeks later. To our knowledge, this is the first report of coil compaction of SMA pseudoaneurysm.     

Transcatheter embolization of a superior mesenteric artery pseudoaneurysm. A case report

A 61-year-old man, with pseudoaneurysm of the superior mesenteric artery presenting with gastrointestinal bleeding, was successfully treated by transcatheter embolization using interlocking detachable coils. During the following observation time of 10 months, the patient had no sign of gastrointestinal bleeding. We underline the importance and feasibility of transcatheter embolization as the first-line treatment in such pseudoaneurysms.     

Isolated dissection of the superior mesenteric artery

Isolated spontaneous dissection of the superior mesenteric artery is uncommon. We report a case complicated by arterial rupture and discuss diagnostic imaging work-up. Diagnosis is usually made by conventional arteriography. But, dissection can also be diagnosed noninvasively by computed tomography angiography and ultrasound.     

A case of superior mesenteric artery syndrome

Superior mesenteric artery (SMA) syndrome, also known as Cast syndrome, Wilkie''s syndrome, or duodenal ileus, is a rare condition involving compression of the duodenum between the aorta and the SMA, primarily attributed to loss of the intervening mesenteric fat pad. Clinical symptoms include postprandial epigastric abdominal pain, nausea, emesis, and weight loss. At-risk individuals include those with rapid weight loss, debilitating illness, malignancy, malabsorption syndromes, trauma, neurologic injury, eating disorders, and substance abuse. Here, we present a case of SMA syndrome in a 24-year-old woman presenting with nausea, vomiting, and abdominal pain who improved with conservative management.     

Intra-arterial fibrinolysis of superior mesenteric artery embolism

Intra arterial fibrinolysis for acute mesenteric embolism. Acute mesenteric ischemia has a poor prognosis because the diagnosis is often too late (greater than 12 h), leading to a difficult surgery in old patients. The lesions of the bowel don't always allow a single operative embolectomy but often need a resection when there is a long time interval between onset of symptoms and therapy. We report a case of acute embolism in the superior mesenteric artery with the clot located in its terminal part. A rapid diagnosis was made by arteriography and intra-arterial fibrinolysis was attempted with success permitting the complete cure of the affection, without sequellae. This treatment is only likely to be successful if it is carried out within 10-12 hours of the onset of clinical signs and symptoms.     

Angioplasty and stenting of the superior mesenteric artery in acute mesenteric ischaemia

Acute mesenteric ischaemia is a challenging diagnostic problem with a very high mortality. Traditionally, laparotomy is required for definitive management. We describe a successful case of angioplasty and stenting of the superior mesenteric artery in a surgically unfit patient. We recommend that stenting be considered only in situations where the diagnosis has been made prior to bowel infarction, and if the patient poses a poor operative risk.     

Simultaneous thrombosis of superior mesenteric artery and superior mesenteric vein following chemotherapy: MDCT findings

A case of acute mesenteric ischemia due to thrombosis of superior mesenteric artery and vein in a 44-year-old woman following chemotherapy for invasive laryngeal carcinoma was diagnosed on a multi-detector CT scan. Although the link between malignancy and thromboembolism is widely recognized in patients with cancer, chemotherapy further elevates the risk of thrombosis. Acute mesenteric ischemia associated or not associated with chemotherapy rarely occurs in patients with cancer. Moreover, co-occurrence of superior mesenteric artery and superior mesenteric vein thrombosis is reported for the first time.     

Reperfusion hemorrhage following superior mesenteric artery stenting

Percutaneous transluminal angioplasty and stent placement is now an established treatment option for chronic mesenteric ischemia and is associated with low mortality and morbidity rates. We present a case of reperfusion hemorrhage complicating endovascular repair of superior mesenteric artery stenosis. Although a recognized complication following repair of carotid stenosis, hemorrhage has not previously been reported following mesenteric endovascular reperfusion. We describe both spontaneous cessation of bleeding and treatment with coil embolization.     

Local fibrinolysis for superior mesenteric artery thromboembolism

A 66-year-old man with atrial fibrillation was referred soon after developing left lower limb and abdominal pain with rectal bleeding. An immediate flush aortogram showed embolic occlusion of the left distal superficial femoral artery and superior mesenteric artery (SMA), 3 cm from its ostium. Recombinant tissue plasminogen activitor (rtPA) 40 mg was selectively in stilled in the SMA in two boluses. Abdominal symptoms resolved within 48 h, and complete recanalization of the SMA was shown on angiography. Exploratory laparotomy after 72 h showed a normal small bowel and right colon, and was completed by femoropopliteal embolectomy. Six months later, the patient remained asymptomatic.     

Dynamic CT in superior mesenteric artery syndrome

In superior mesenteric artery (SMA) syndrome the third portion of the duodenum is entrapped by the aorta and the SMA. We used dynamic CT to study five patients with SMA syndrome due to cachexia, cast syndrome, scleroderma, trauma, and periaortic adenopathy. This method provides diagnostic insight into the etiology and possible therapeutic options in the care of these patients.     

Aneurysms of superior mesenteric artery: CT demonstration

A case of double aneurysms of the superior mesenteric artery diagnosed by CT is reported.     

MSCTA在肠系膜上动脉夹层中的应用

目的探讨多层螺旋CT血管成像(MSCTA)在肠系膜上动脉夹层(SMAD)中的应用价值。方法回顾性分析13例SMAD的MSCT、CTA表现,采用平面重组(MPR)、曲面重建(CPR)、最大密度投影(MIP)、容积再现(VR)重建图像,分析其影像特征。结果 MSCTA结合多种重建图像分辨真腔及假腔11例;清晰显示肠系膜上动脉(SMA)内膜片形成10例,破裂口均位于SMA近心端。Yun分型:Ⅰ型2例,Ⅱa型6例,Ⅱb型4例,Ⅲ型1例。结论 MSCTA能早期诊断SMAD,对及时采取临床治疗具有重要的意义。     

孤立性肠系膜上动脉夹层的治疗策略

目的:探讨孤立性肠系膜上动脉夹层的诊断与治疗策略.方法:分析2010年7月-2014年7月收治于武汉协和医院的19例ISMAD患者资料;13例患者拟行介入治疗,其中1例因术中无法成功置入支架而转行保守治疗,余12例成功完成介入手术(手术方式各异);共7例患者行药物保守治疗.结果:2例支架植入配合弹簧圈填塞假腔患者术后复查,肠系膜上动脉通畅,假腔未见显示;3例单纯支架植入患者,其中2例假腔完全闭塞,1例患者假腔接近闭塞;1例仅假腔填塞弹簧圈患者,术后复查弹簧圈未填塞部分假腔仍存在;3例双层裸支架植入患者术后复查,假腔完全闭塞;3例置管溶栓患者,2例复查示肠系膜上动脉通畅、腹痛症状消失,1例患者有间断性腹痛,但程度降低、疼痛间歇期延长;保守治疗的7例患者随访期未见明显腹痛.所有患者均未出现肠坏死等严重并发症.结论:孤立性肠系膜上动脉夹层治疗方案与分型关系密切,Yun Ⅰ型、Ⅱb型通过抗凝、抗血小板、扩管等保守治疗通常效果较好;Ⅱa型宜选择介入治疗;Ⅲ型患者如果没有肠坏死征象可以置管溶栓治疗并密切观察,必要时行外科手术.     

肠系膜上动脉-腹主动脉夹角在孤立性肠系膜上动脉夹层中的意义

目的探讨肠系膜上动脉(SMA)-腹主动脉(AA)夹角在孤立性肠系膜上动脉夹层(ISMAD)中的意义。方法回顾性分析2010年1月至2019年8月常州市第二人民医院收治的58例ISMAD患者临床和影像资料。采用1∶4病例对照研究设计,对照组纳入同期232例非ISMAD患者。对比两组患者间SMA-AA夹角。根据SMA-AA夹角分布,分为<50°组(n=18)、50～70°组(n=28)、>70°组(n=12),统计组间比值比(OR)。结果 ISMAD组、对照组患者间年龄、性别、体质量指数(BMI)差异均无统计学意义(均P>0.05)。ISMAD组、对照组SMA-AA夹角分别为(58.6±16.5)°、(48.1±16.9)°,差异有统计学意义(P<0.01)。SMA-AA夹角组间比较,差异均有统计学意义(<50°比50～70°:OR=2.324,P=0.011;<50°比>70°:OR=4.233,P=0.001)。SMA-AA夹角判断ISMAD发生的受试者工作特征曲线下面积(AUC)为0.656(P<0.001),灵敏度为81.03%,特异...     

Sonographic diagnosis of an aneurysm of the superior mesenteric artery

This is a report on a patient with a mycotic aneurysm of the superior mesenteric artery proved by histology. Because of a marked intolerance of contrast media we abstained from angiography. It is shown that real-time sonography gives a definite diagnosis, if the multiple vascular structures of the upper abdomen are precisely identified.     

原发性肠系膜上动脉夹层的CT诊断

目的：探讨原发性肠系膜上动脉夹层（PDSMA）的CT表现。方法：回顾性分析资料完整的17例PDSMA患者的CT表现。10例行CTA,7例行全腹部CT平扫加双期增强扫描。由2位经验丰富的腹部专业医师单独阅片,分析病变部位及CT表现,并对瘤体的4个径线进行测量。结果：①17例增强扫描均见明显的真假双腔（17／17）。②15例显示内膜辫征（15／17）。③13例假腔内显示血栓征（13／17）,其中2例假腔完全血栓化。④14例显示内膜破口（14／17）;7例显示假腔出口（7／17）。⑤9例显示肠管缺血征（9／17）。⑥瘤体近端距腹主动脉距离0．5～5．5cm,平均2．1cm。破口距腹主动脉距离1．6～5．6cm,平均2．6cm。瘤腔长度1．5～5．4cm,平均3．5cm。瘤腔宽度0．4～1．2cm,平均0．7cm。结论：CT能准确诊断PDSMA及相应肠管的血供情况,为临床治疗和追踪随访提供有力依据。