ABSTRACT
To investigate the clinical diagnostic value of ultrasonographic superb micro‐vascular imaging ( SM I) for abdominal branch arteries′involvement in Stanford B aortic dissection ( AD ) . Methods A total of 34 AD patients underwent conventional ultrasound ,SMI and CTA . The characteristics of the ultrasonographic images of branch artery involvement including coeliac artery ,superior mesenteric artery ,left and right renal artery were analyzed . T he diagnostic performance of conventional ultrasound and SM I were compared and CT A was used as the reference standard . Results Among the 34 patients with AD ,according to the ultrasonographic images′characteristics ,136 branch arteries were categorized into four classes :Class Ⅰ (81/136) ,branch artery perfusion supplied from the aortic true lumen ; Class Ⅱ ( 27/136) , dissection extending into the branch ; Class Ⅲ ( 16/136 ) ,branch artery perfusion supplied from the aortic false lumen ; Class Ⅳ ( 12/136) ,branch artery perfusion supplied from the aortic true and false lumens . T he diagnostic accordance rate of the conventional ultrasound and SM I were 76 .5% ( 104/136 ) and 92 .6%( 126/136) and had significant differences ( P ＜0 .001) . Conclusions SMI can be used to evaluate branch artery involvement in AD patients w hich will guide the practice of pre‐operation and post‐operation .
ABSTRACT
Coeliac artery forms the major blood supply for the structures derived from the foregut up to the major duodenal papillae. During the routine dissection classes for the undergraduates, a very uncommon variation in theorigin of the coeliac trunk was observed. Instead, of the coeliac artery, two trunks were arising directly from theabdominal aorta at the level of T12-L1. The gastrosplenic trunk and the common hepatic artery were apart fromeach other. An aberrant left hepatic artery arose from the left gastric artery, entering into the porta hepatis tosupply the left lobe of the liver. Lesser curvature of the stomach is solely supplied by the left gastric artery.Knowledge regarding such multiple variations in the abdominal region is utmost important for the anatomists,clinicians, a radiologist for performing angiographic studies and hepatic surgeons to avoid any damage to theaberrant artery, as it may result into the ischaemia and necrosis of the related part.
ABSTRACT
A 52-year-old man, who had a background of chronic heart disease and atrial fibrillation, as well as non-compliance with warfarin therapy, presented with a two-week history of worsening upper abdominal pain. Computed tomography mesenteric angiography showed complete embolic occlusion of the coeliac artery with resultant segmental splenic infarction, and thrombus within the left ventricle. A decision was made to proceed with catheter-directed thrombolysis. Subsequent follow-up angiogram at 12 hours showed successful treatment with complete dissolution of the coeliac embolus. The patient's symptoms resolved during his hospitalisation and he was subsequently discharged well on long-term oral anticoagulation therapy. Isolated acute embolic occlusion of the coeliac axis is a rare occurrence that may result in end-organ infarction. Treatment options include systemic anti-coagulation, mechanical thrombectomy, catheter thrombolysis or open surgery. Catheter-directed thrombolysis therapy is a feasible and effective option for treating acute thromboembolic occlusion of the coeliac artery.