Distal Superior Mesenteric Artery Endarterectomy Remains an Excellent Option for Mesenteric Revascularization in the Endovascular Era
Copyright © 2020 Elsevier Inc. All rights reserved..
BACKGROUND: Endovascular treatment of mesenteric lesions has become increasingly prevalent. Mesenteric bypass, however, remains the optimal treatment in the cases of chronic mesenteric ischemia (CMI) in young, medically fit patients given its durability. Endarterectomy has gone by the wayside, but in certain situations, this technique remains surgically relevant and should still be used. Herein, we present 2 cases of distal superior mesenteric artery (SMA) endarterectomy for mesenteric revascularization.
METHODS/RESULTS: Case 1 is a 40-year-old male with history of antithrombin III deficiency, myocardial infarction, bilateral pulmonary embolism, acute aortic thrombus, and mesenteric ischemia status after placement of a proximal SMA stent and was transferred to our institution because of concern for ischemic bowel. Intraoperative angiography showed mid to distal SMA chronic thromboembolism with narrow lumen of recanalization and distal flow. No intervention was performed at that time. He developed worsening abdominal pain and weight loss over several months which required initiation of total parenteral nutrition, complicated by line-associated sepsis. Subsequent distal SMA endarterectomy was performed. He recovered well and had improved enteral intake at 1-month follow-up, and radiographic imaging at 2 months showed patent vessels. Case 2 is a 50-year-old female with extensive smoking history and hyperlipidemia and gastroesophageal reflux who presented with postprandial abdominal pain and a forty-pound weight loss over the past year. Attempted angiographic cannulation with a stent was not successful because of flush occlusion of the SMA approximately 1 centimeter distal to the ostium that was unable to be crossed. Computed tomography angiography confirmed that the SMA origin was free of atherosclerotic disease with a distal focal segment of occlusion. She underwent successful endarterectomy of this occlusion. The postoperative course was uneventful, and at 1-month follow-up, she reported continued improvement in pain and appetite.
CONCLUSIONS: SMA endarterectomy can be successfully performed on mid to distal lesions of the SMA. This operation should remain a viable option in the management of CMI.
| Errataetall: |
CommentIn: Ann Vasc Surg. 2021 Jan;70:e4-e5. - PMID 32927038 |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
|---|---|
| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:70 |
|---|---|
| Enthalten in: |
Annals of vascular surgery - 70(2021) vom: 01. Jan., Seite 386-392 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Xu, Cynthia [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
|---|
| Anmerkungen: |
Date Completed 18.01.2021 Date Revised 12.07.2021 published: Print-Electronic CommentIn: Ann Vasc Surg. 2021 Jan;70:e4-e5. - PMID 32927038 Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.avsg.2020.06.065 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM312121725 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM312121725 | ||
| 003 | DE-627 | ||
| 005 | 20231225143731.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2021 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.avsg.2020.06.065 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1040.xml |
| 035 | |a (DE-627)NLM312121725 | ||
| 035 | |a (NLM)32634563 | ||
| 035 | |a (PII)S0890-5096(20)30567-7 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Xu, Cynthia |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Distal Superior Mesenteric Artery Endarterectomy Remains an Excellent Option for Mesenteric Revascularization in the Endovascular Era |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 18.01.2021 | ||
| 500 | |a Date Revised 12.07.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Ann Vasc Surg. 2021 Jan;70:e4-e5. - PMID 32927038 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Endovascular treatment of mesenteric lesions has become increasingly prevalent. Mesenteric bypass, however, remains the optimal treatment in the cases of chronic mesenteric ischemia (CMI) in young, medically fit patients given its durability. Endarterectomy has gone by the wayside, but in certain situations, this technique remains surgically relevant and should still be used. Herein, we present 2 cases of distal superior mesenteric artery (SMA) endarterectomy for mesenteric revascularization | ||
| 520 | |a METHODS/RESULTS: Case 1 is a 40-year-old male with history of antithrombin III deficiency, myocardial infarction, bilateral pulmonary embolism, acute aortic thrombus, and mesenteric ischemia status after placement of a proximal SMA stent and was transferred to our institution because of concern for ischemic bowel. Intraoperative angiography showed mid to distal SMA chronic thromboembolism with narrow lumen of recanalization and distal flow. No intervention was performed at that time. He developed worsening abdominal pain and weight loss over several months which required initiation of total parenteral nutrition, complicated by line-associated sepsis. Subsequent distal SMA endarterectomy was performed. He recovered well and had improved enteral intake at 1-month follow-up, and radiographic imaging at 2 months showed patent vessels. Case 2 is a 50-year-old female with extensive smoking history and hyperlipidemia and gastroesophageal reflux who presented with postprandial abdominal pain and a forty-pound weight loss over the past year. Attempted angiographic cannulation with a stent was not successful because of flush occlusion of the SMA approximately 1 centimeter distal to the ostium that was unable to be crossed. Computed tomography angiography confirmed that the SMA origin was free of atherosclerotic disease with a distal focal segment of occlusion. She underwent successful endarterectomy of this occlusion. The postoperative course was uneventful, and at 1-month follow-up, she reported continued improvement in pain and appetite | ||
| 520 | |a CONCLUSIONS: SMA endarterectomy can be successfully performed on mid to distal lesions of the SMA. This operation should remain a viable option in the management of CMI | ||
| 650 | 4 | |a Case Reports | |
| 700 | 1 | |a Tolaymat, Besher |e verfasserin |4 aut | |
| 700 | 1 | |a Taylor, Maryclare |e verfasserin |4 aut | |
| 700 | 1 | |a Aicher, Brittany O |e verfasserin |4 aut | |
| 700 | 1 | |a Flentje, Alison O |e verfasserin |4 aut | |
| 700 | 1 | |a Sahajwani, Sunny |e verfasserin |4 aut | |
| 700 | 1 | |a Endicott, Kendal M |e verfasserin |4 aut | |
| 700 | 1 | |a Nagarsheth, Khanjan H |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Annals of vascular surgery |d 1995 |g 70(2021) vom: 01. Jan., Seite 386-392 |w (DE-627)NLM012991953 |x 1615-5947 |7 nnns |
| 773 | 1 | 8 | |g volume:70 |g year:2021 |g day:01 |g month:01 |g pages:386-392 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.avsg.2020.06.065 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 70 |j 2021 |b 01 |c 01 |h 386-392 | ||