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1.
Rev. argent. reumatolg. (En línea) ; 33(3): 173-185, set. 2022. tab, graf
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1423005

RESUMO

El signo del dedo azul (SDA) es una condición poco frecuente causada principalmente por la oclusión de la vasculatura periférica. Clínicamente puede manifestarse como una coloración azulada o eritrocianótica en uno o varios dedos en ausencia de traumatismo y condiciones propias de congelación. Las etiologías son múltiples e incluyen obstrucción del flujo arterial, disminución del flujo venoso y alteración en la viscosidad sanguínea. La importancia de reconocer el signo como motivo de consulta radica en encaminar un diagnóstico temprano e instaurar un tratamiento que evite la evolución natural de la enfermedad hacia la necrosis, amputación o muerte del paciente. Proponemos un algoritmo diagnóstico para reconocer los elementos de la historia clínica que guíen la etiología y los paraclínicos disponibles desde el Servicio de Urgencias.


Blue finger sign (BFS) is a rare condition caused mainly by occlusion of peripheral vasculature. Clinically it may manifest as a bluish, or erythrocyanotic discoloration of one or more fingers in the absence of trauma and freezing conditions. The etiologies are multiple and include arterial flow obstruction, decreased venous flow, and altered blood viscosity. The importance of recognizing the sign as a reason for consultation lies in the early diagnosis and the establishment of a treatment that finally avoids the natural evolution of the disease towards necrosis and finally amputation or death of the patient. We propose a diagnostic algorithm based on recognizing elements of the clinical history that guide the etiology and paraclinical available from the Emergency Department.


Assuntos
Sinais e Sintomas , Isquemia , Oclusão Vascular Mesentérica
2.
J. vasc. bras ; 21: e20210157, 2022. graf
Artigo em Português | LILACS | ID: biblio-1365071

RESUMO

Resumo A dissecção da artéria mesentérica superior é uma causa rara de dor abdominal, com quadro clínico variável. Seu diagnóstico é difícil, e não existe consenso sobre suas opções terapêuticas; elas variam em torno de tratamento conservador, correção aberta, endovascular ou combinada. Descrevemos o caso de um homem de 45 anos com dissecção isolada da artéria mesentérica superior, com quadro de dor abdominal persistente após tentativa de tratamento conservador. Ele foi submetido à revascularização cirúrgica aberta devido à localização e complexidade da dissecção. O tratamento com endarterectomia, arterioplastia com remendo de pericárdio bovino e acesso retrógrado para abertura da mesentérica com stent foi realizado com sucesso. A angina abdominal foi totalmente resolvida após estabilização do quadro. A combinação de abordagem aberta e endovascular deve ser considerada como terapia para casos de dissecção complexa isolada da artéria mesentérica superior.


Abstract Dissection of the superior mesenteric artery is a rare cause of abdominal pain, with a variable clinical picture. It is difficult to diagnose and there is no consensus on treatment options, which range from conservative treatment to open, endovascular, or combination repair. We describe the case of a 45-year-old man with isolated dissection of the superior mesenteric artery and persistent abdominal pain after conservative treatment had been attempted. He underwent open surgical revascularization due to the location and complexity of the dissection. Treatment consisting of endarterectomy, arterioplasty with bovine pericardium patch, and retrograde access to open the mesenteric artery with a stent was successful. Abdominal angina was completely resolved after the condition had stabilized. A combination of open and endovascular approaches should be considered as treatment for cases of isolated complex dissection of the superior mesenteric artery.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Angioplastia , Endarterectomia , Procedimentos Endovasculares , Oclusão Vascular Mesentérica , Stents , Artéria Mesentérica Superior , Oclusão Vascular Mesentérica/diagnóstico por imagem
3.
Rev. Asoc. Méd. Argent ; 133(1): 21-24, mar. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1097699

RESUMO

La isquemia mesentérica aguda (IMA) es consecuencia de la oclusión de la arteria mesentérica superior (AMS) por trombosis o embolia, y es considerada la más letal del síndrome de abdomen agudo. Se presenta el caso de paciente femenina de 69 años con clínica difusa y confirmación diagnóstica radiológica, El objetivo de este caso clínico es proporcionar una revisión bibliográfica actual del tema y facilitar la adecuada actuación ante este problema de salud de amplio compromiso sistémico, y de aparición no tan infrecuente. (AU)


Acute mesenteric ischemia (IMA) is a consequence of occlusion of the superior mesenteric artery (AMS) by thrombosis or embolism; and it is considered the most lethal of acute abdomen syndrome. The case of a 69 years old female patient with diffuse clinic and radiological diagnostic confirmation is presented. The objective of this clinical case is to provide a current bibliographic review of the topic and facilitate adequate action in the face of this health problem with a broad systemic commitment, and with no appearance so infrequent. (AU)


Assuntos
Humanos , Feminino , Idoso , Artéria Mesentérica Superior/diagnóstico por imagem , Isquemia Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/complicações , Doença Aguda , Artéria Mesentérica Superior/cirurgia , Tomografia Computadorizada Multidetectores , Isquemia Mesentérica/etiologia , Isquemia Mesentérica/terapia
4.
Rev. medica electron ; 41(3): 725-732, mayo.-jun. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-1094079

RESUMO

RESUMEN Se presentó un caso de una paciente de 78 años de edad, procedente del municipio de Calimete, con antecedentes patológicos personales de infarto agudo miocárdico sin elevación del segmento ST e hipertensión arterial. Llegó a la Unidad de Cuidados Intensivos de Emergencia, de Colón con un estado toxico infeccioso severo. Fue intervenida quirúrgicamente con el diagnóstico presuntivo de una trombosis mesentérica. Se constató dicho diagnóstico complementario a una neoplasia maligna de colon sigmoides. Falleció producto a un shock séptico refractario a aminas. En la necropsia se reportaron hallazgos de interés.


ABSTRACT The authors present the case of a 78-years-old female patient from the municipality of Calimete, with personal pathological antecedents of acute myocardial infarct without ST segment elevation and arterial hypertension. She arrived to the Emergency Intensive Care Unit of Colon with a severe toxic-infectious status. She underwent a surgery with a presumptive mesenteric thrombosis. It was stated that diagnosis, complementary to a sigmoid colon malignant neoplasia. She died as a product of an amine-refractory septic shock. The autopsy showed findings of interest.


Assuntos
Humanos , Feminino , Idoso , Doenças do Colo Sigmoide/complicações , Doenças do Colo Sigmoide/diagnóstico , Neoplasias do Colo Sigmoide/cirurgia , Neoplasias do Colo Sigmoide/complicações , Neoplasias do Colo Sigmoide/diagnóstico , Neoplasias do Colo Sigmoide/mortalidade , Neoplasias Colorretais/complicações , Neoplasias Colorretais/diagnóstico , Oclusão Vascular Mesentérica/complicações , Oclusão Vascular Mesentérica/diagnóstico , Peritonite , Choque Séptico , Colostomia , Sistema Cardiovascular/fisiopatologia , Dor Abdominal/diagnóstico , Sigmoidoscopia , Taxa de Filtração Glomerular , Falência Renal Crônica , Laparotomia , Neoplasias
5.
São Paulo; HSPM; 2018.
Não convencional em Português | SMS-SP, ColecionaSUS, LILACS, HSPM-Producao, SMS-SP | ID: biblio-1281826

RESUMO

RESUMO A isquemia mesentérica crônica é uma incomum doença dentre os eventos vasculares abdominais que gera difícil diagnóstico e dúvida com outras enfermidades viscerais. A sua epidemiologia não está bem estabelecida e o principal agente etiológico é a aterosclerose. O diagnóstico deve se embasar na suspeita clínica e exames complementares, como a arteriografia, que evidencia a oclusão arterial parcial ou total. Dentre as opções terapêuticas, existem a correção laparotômica ­ padrão ouro - e o tratamento endovascular. Este relato de caso apresenta uma paciente feminina, 62 anos, hipertensa e dislipidêmica, com dor abdominal, com quadro de isquemia mesentérica crônica, com manifestações clássicas da doença, que foi submetida a abordagem terapêutica de exceção, com tratamento híbrido (combinação de cirurgia aberta com endovascular), com boa resposta ao tratamento no seguimento a curto prazo. Palavras-chave: Isquemia mesentérica; Procedimentos endovasculares; Oclusão vascular mesentérica.


Assuntos
Humanos , Masculino , Feminino , Procedimentos Endovasculares , Isquemia Mesentérica , Oclusão Vascular Mesentérica
6.
Korean Journal of Medicine ; : 55-60, 2018.
Artigo em Coreano | WPRIM | ID: wpr-741111

RESUMO

Mesenteric venous thrombosis has a low prevalence and nonspecific clinical symptoms, and it may cause bowel infarction and death. Early diagnosis and prompt surgical intervention with anticoagulants are important to patients. We examined a 27-year-old woman complaining of diffuse abdominal pain and hematochezia, and diagnosed extensive mesenteric venous thrombosis with intestinal infarction and pulmonary thromboembolism. In light of the patient's symptoms, an operation seemed necessary. However, because of the high risk of mortality, we decided to look for another option. The patient was successfully treated with intensive medical care and a radiological procedure in spite of intestinal infarction.


Assuntos
Adulto , Feminino , Humanos , Dor Abdominal , Anticoagulantes , Diagnóstico Precoce , Hemorragia Gastrointestinal , Infarto , Isquemia Mesentérica , Oclusão Vascular Mesentérica , Mortalidade , Prevalência , Embolia Pulmonar , Trombectomia , Terapia Trombolítica , Trombose , Ativador de Plasminogênio Tipo Uroquinase
7.
Rev. colomb. cir ; 32(3): 229-235, 20170000. fig
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-905171

RESUMO

El dolor abdominal es una causa frecuente de consulta al servicio de urgencias y la población anciana no es ajena a esta situación. En este grupo de pacientes, la dificultad en el enfoque diagnóstico radica en sus características particulares, como múltiples enfermedades concomitantes, medicación múltiple, deterioro cognitivo y cuidadores con pobre información, situaciones que favorecen múltiples consultas que llevan a diagnósticos erróneos y tardíos. Una de las causas de dolor abdominal en los ancianos son las catástrofes vasculares, como la angina mesentérica, enfermedad poco frecuente y con gran mortalidad, dado que su diagnóstico y su tratamiento son tardíos por la presentación atípica en esta población. Se reporta el caso de una paciente con antecedentes de demencia vascular, que consultó por dolor abdominal crónico y a quien se le diagnosticó angina mesentérica crónica


Abdominal pain is a common cause of visit to the emergency room and the elderly population is prone to present this situation. In this group of patients the difficulty lies in its particular features, like multiple comorbidities and multiple medications, cognitive impairment and poorly informed caregivers, a situations that favors multiple consultations leading to inaccurate and delayed diagnoses. A cause of abdominal pain in the elderly includes vascular catastrophes, such as mesenteric angina, an infrequent disease associated high mortality because diagnosis and treatment are delayed by virtue of the atypical presentation in this population. We report the case of an elderly female with history of vascular dementia who consulted for chronic abdominal pain that was diagnosed as chronic mesenteric angina


Assuntos
Humanos , Isquemia Mesentérica , Demência Vascular , Saúde do Idoso , Oclusão Vascular Mesentérica
8.
Acta cir. bras ; 30(6): 407-413, 06/2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-749649

RESUMO

PURPOSE: Vogt´s antioxidant solution (red blood cells, Ringer's solution, sodium bicarbonate, mannitol, allopurinol and 50% glucose) or its modification including hydroxyethyl starch (HES) were tested for the prevention of splanchnic artery occlusion shock. METHODS: Seventy rats were distributed in treatment (3), control (1), and sham (3) groups. Ischemia and reperfusion were induced by celiac, superior mesenteric and inferior mesenteric arteries occlusion for 40 min, followed by 60 min reperfusion or sham procedures. Controls received saline, both treatment and sham groups received the Vogt's solution, modified Vogt's solution (replacing Ringer's solution by HES), or HES. Mean arterial blood pressure (MABP), ileal malondialdehyde (MDA) and plasmatic MDA were determined, and a histologic grading system was used. RESULTS: At reperfusion, MABP dropped in all I/R groups. Only HES treatment was able to restore final MABP to the levels of sham groups. Plasmatic MDA did not show differences between groups. Ileum MDA was significantly higher in the control and treatment groups as compared to the sham group. Histology ranking was higher in the only in control group. CONCLUSIONS: Hydroxyethyl starch was able to prevent hemodynamic shock but not intestinal lesions. Both treatments with Vogt's solutions did not show any improvement. .


Assuntos
Animais , Masculino , Derivados de Hidroxietil Amido/farmacologia , Artérias Mesentéricas/efeitos dos fármacos , Oclusão Vascular Mesentérica/prevenção & controle , Substitutos do Plasma/farmacologia , Traumatismo por Reperfusão/prevenção & controle , Modelos Animais de Doenças , Hemodinâmica/efeitos dos fármacos , Derivados de Hidroxietil Amido/uso terapêutico , Íleo/irrigação sanguínea , Íleo/patologia , Isquemia/prevenção & controle , Soluções Isotônicas/farmacologia , Soluções Isotônicas/uso terapêutico , Malondialdeído/análise , Artérias Mesentéricas/patologia , Oclusão Vascular Mesentérica/patologia , Substitutos do Plasma/uso terapêutico , Ratos Wistar , Reprodutibilidade dos Testes , Circulação Esplâncnica/efeitos dos fármacos , Fatores de Tempo , Resultado do Tratamento
9.
Korean Journal of Radiology ; : 736-743, 2015.
Artigo em Inglês | WPRIM | ID: wpr-22497

RESUMO

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.


Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Angiografia/métodos , Embolectomia/métodos , Embolia/complicações , Artéria Mesentérica Superior/diagnóstico por imagem , Oclusão Vascular Mesentérica/etiologia , Estudos Retrospectivos , Sucção/instrumentação , Terapia Trombolítica/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagem , Dispositivos de Acesso Vascular
10.
Rev. bras. cir. cardiovasc ; 29(4): 521-526, Oct-Dec/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-741729

RESUMO

Introduction: Ischemic postconditioning has been recognized as effective in the prevention of reperfusion injury in situations of ischemia and reperfusion in various organs and tissues. However, it remains unclear what would be the best way to accomplish it, since studies show great variation in the method of their application. Objective: To assess the protective effect of ischemic postconditioning on ischemia and reperfusion in rats undergoing five alternating cycles of reperfusion and ischemia of 30 seconds each one. Methods: We studied 25 Wistar rats distributed in three groups: group A (10 rats), which underwent mesenteric ischemia (30 minutes) and reperfusion (60 minutes); Group B (10 rats), undergoing ischemia (30 minutes) and reperfusion (60 minutes), intercalated by postconditioning (5 alternating cycles of reperfusion and ischemia of 30 seconds each one); and group C - SHAM (5 rats), undergoing only laparotomy and manipulation of mesenteric artery. All animals underwent resection of an ileum segment for histological analysis. Results: The mean lesions degree according to Chiu et al. were: group A, 2.77, group B, 2.67 and group C, 0.12. There was no difference between groups A and B (P>0.05). Conclusion: Ischemic postconditioning was not able to minimize or prevent the intestinal tissue injury in rats undergoing ischemia and reperfusion process when used five cycles lasting 30 seconds each one. .


Introdução: O pós-condicionamento isquêmico tem sido reconhecido como eficaz na prevenção das lesões de reperfusão em situações de isquemia e reperfusão em vários órgãos e tecidos. Entretanto, não está ainda claro qual seria a melhor maneira de realizá-lo, já que as publicações mostram grande variação de método no seu emprego. Objetivo: Avaliar o efeito protetor do pós-condicionamento isquêmico na isquemia e reperfusão intestinal em ratos, através de cinco ciclos alternados de 30 segundos de isquemia e 30 segundos de reperfusão. Métodos: Foram estudados 25 ratos Wistar, distribuídos em três grupos: grupo A (10 ratos), em que se realizou isquemia (30 minutos) e reperfusão (60 minutos) mesentérica; grupo B (10 ratos), isquemia e reperfusão, seguidos de pós-condicionamento isquêmico com 5 ciclos alternados de reperfusão e reoclusão, de 30 segundos cada; e grupo C (5 ratos), controle (SHAM). Ao final, ressecou-se um segmento do intestino delgado para análise histológica. Avaliaram-se os resultados pela classificação de Chiu et al. e procedeu-se ao tratamento estatístico. Resultados: As médias dos graus de lesão tecidual segundo a classificação de Chiu et al. foram: no grupo A, 2,77; no grupo B, 2,67; e no grupo C, 0,12. A diferença entre o resultado do grupo A com o resultado do grupo B não teve significância estatística (P>0,05). Conclusão: O pós-condicionamento isquêmico não foi capaz de minimizar ou prevenir a lesão tecidual intestinal de ratos submetidos ao processo de isquemia e reperfusão mesentérica quando utilizados cinco ciclos com duração de 30 segundos cada. .


Assuntos
Animais , Masculino , Intestinos/irrigação sanguínea , Pós-Condicionamento Isquêmico/métodos , Isquemia Mesentérica/prevenção & controle , Traumatismo por Reperfusão/prevenção & controle , Mucosa Intestinal/irrigação sanguínea , Mucosa Intestinal/patologia , Intestinos/patologia , Modelos Animais , Artérias Mesentéricas/patologia , Oclusão Vascular Mesentérica/patologia , Ratos Wistar , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Fatores de Tempo
11.
Acta cir. bras ; 29(6): 359-364, 06/2014. graf
Artigo em Inglês | LILACS | ID: lil-711592

RESUMO

PURPOSE: To determine the role of mesenteric lymph reperfusion (MLR) on endotoxin translocation in brain to discuss the mechanism of brain injury subjected to superior mesenteric artery occlusion (SMAO) shock. METHODS: Twenty-four rats were randomly assigned to MLR, SMAO, MLR+SMAO and sham groups. MLR was performed by clamping the mesenteric lymph duct (MLD) for 1 h and then allowing reperfusion for 2 h in the MLR group; SMAO involved clamping the superior mesenteric artery (SMA) for 1 h, followed by reperfusion for 2 h in the SMAO group; occlusion of both the SMA and MLD for 1 h was followed by reperfusion for 2 h in the MLR+SMAO group rats. RESULTS: SMAO shock induced severe increased levels of the endotoxin, lipopolysaccharide receptor, lipopolysaccharide-binding protein, intercellular adhesion molecule-1 and tumor necrosis factor-α. Concurrently, MLR after SMAO shock further aggravates these deleterious effects. CONCLUSION: Mesenteric lymph reperfusion exacerbated the endotoxin translocation in brain; thereby increased inflammatory response occurred, suggesting that the intestinal lymph pathway plays an important role in the brain injury after superior mesenteric artery occlusion shock. .


Assuntos
Animais , Masculino , Translocação Bacteriana/fisiologia , Lesões Encefálicas/etiologia , Endotoxinas/fisiologia , Vasos Linfáticos/fisiologia , Mesentério , Oclusão Vascular Mesentérica/fisiopatologia , Traumatismo por Reperfusão/fisiopatologia , Proteínas de Fase Aguda/análise , /análise , Lesões Encefálicas/metabolismo , Proteínas de Transporte/análise , Modelos Animais de Doenças , Ensaio de Imunoadsorção Enzimática , Endotoxinas/análise , Molécula 1 de Adesão Intercelular/análise , Ligadura , Vasos Linfáticos/cirurgia , Artéria Mesentérica Superior , Glicoproteínas de Membrana/análise , Oclusão Vascular Mesentérica/complicações , Distribuição Aleatória , Ratos Wistar , Traumatismo por Reperfusão/complicações , Fatores de Tempo , Fator de Necrose Tumoral alfa/análise
12.
Braz. j. med. biol. res ; 47(5): 376-383, 02/05/2014. graf
Artigo em Inglês | LILACS | ID: lil-709439

RESUMO

The intestinal lymph pathway plays an important role in the pathogenesis of organ injury following superior mesenteric artery occlusion (SMAO) shock. We hypothesized that mesenteric lymph reperfusion (MLR) is a major cause of spleen injury after SMAO shock. To test this hypothesis, SMAO shock was induced in Wistar rats by clamping the superior mesenteric artery (SMA) for 1 h, followed by reperfusion for 2 h. Similarly, MLR was performed by clamping the mesenteric lymph duct (MLD) for 1 h, followed by reperfusion for 2 h. In the MLR+SMAO group rats, both the SMA and MLD were clamped and then released for reperfusion for 2 h. SMAO shock alone elicited: 1) splenic structure injury, 2) increased levels of malondialdehyde, nitric oxide (NO), intercellular adhesion molecule-1, endotoxin, lipopolysaccharide receptor (CD14), lipopolysaccharide-binding protein, and tumor necrosis factor-α, 3) enhanced activities of NO synthase and myeloperoxidase, and 4) decreased activities of superoxide dismutase and ATPase. MLR following SMAO shock further aggravated these deleterious effects. We conclude that MLR exacerbates spleen injury caused by SMAO shock, which itself is associated with oxidative stress, excessive release of NO, recruitment of polymorphonuclear neutrophils, endotoxin translocation, and enhanced inflammatory responses.


Assuntos
Animais , Masculino , Linfa/metabolismo , Oclusão Vascular Mesentérica/complicações , Traumatismo por Reperfusão/etiologia , Reperfusão/efeitos adversos , Baço/lesões , Proteínas de Fase Aguda/análise , Adenosina Trifosfatases/análise , /análise , Proteínas de Transporte/análise , Endotoxinas/análise , Molécula 1 de Adesão Intercelular/análise , Intestinos/irrigação sanguínea , Artéria Mesentérica Superior , Malondialdeído/análise , Glicoproteínas de Membrana/análise , Óxido Nítrico Sintase/análise , Óxido Nítrico/análise , Peroxidase/análise , Ratos Wistar , Baço/patologia , Superóxido Dismutase/análise , Fator de Necrose Tumoral alfa/análise
13.
Chinese Journal of Gastrointestinal Surgery ; (12): 1018-1021, 2014.
Artigo em Chinês | WPRIM | ID: wpr-254370

RESUMO

<p><b>OBJECTIVE</b>To investigate the efficacy of catheter aspiration or combined with thrombolysis in the treatment of superior mesenteric artery embolism(SMAE).</p><p><b>METHODS</b>Clinical and imaging data of 25 SMAE patients who underwent catheter aspiration or combined with urokinase thrombolysis in the First People's Hospital and the Second People's Hospital of Changzhou from January 2005 to July 2013 were retrospectively analyzed.</p><p><b>RESULTS</b>Twenty patients were confirmed as SMA trunk embolism and 5 as SMA branch artery embolism. The embolic SMA trunks were completely recannulated by catheter aspiration in the above 20 cases, but small emboli embolized distal branch artery in 6 cases. These 6 patients plus above 5 patients with branch artery embolism received catheter aspiration combined with thrombolytic therapy. Among these 11 patients, complete open, partial open and non-open of branch arteries were found in 5, 3, 3 cases respectively, while collateral circulation increased significantly in non-open patients. During the follow-up period of (4.1±2.2) months, clinical symptom relief and digestive function recovery were observed in 24 cases. Only one case underwent bowel resection because of intestinal necrosis 24 hours after treatment and developed short bowel syndrome.</p><p><b>CONCLUSION</b>Catheter aspiration or combined with thrombolysis is a safe and effective method in treating SMAE.</p>


Assuntos
Humanos , Embolia , Terapêutica , Enteropatias , Artéria Mesentérica Superior , Oclusão Vascular Mesentérica , Terapêutica , Estudos Retrospectivos , Terapia Trombolítica
15.
Korean Journal of Radiology ; : 38-44, 2013.
Artigo em Inglês | WPRIM | ID: wpr-44597

RESUMO

OBJECTIVE: To compare the ancillary CT findings between superior mesenteric artery thromboembolism (SMAT) and superior mesenteric vein thrombosis (SMVT), and to determine the independent CT findings of life-threatening mesenteric occlusion. MATERIALS AND METHODS: Our study was approved by the institution review board. We included 43 patients (21 SMAT and 22 SMVT between 1999 and 2008) of their median age of 60.0 years, and retrospectively analyzed their CT scans. Medical records were reviewed for demographics, management, surgical pathology diagnosis, and outcome. We compared CT findings between SMAT and SMVT groups. Multivariate analysis was conducted to determine the independent CT findings of life-threatening mesenteric occlusion. RESULTS: Of 43 patients, 24 had life-threatening mesenteric occlusion. Death related to mesenteric occlusion was 32.6%. A thick bowel wall (p < 0.001), mesenteric edema (p < 0.001), and ascites (p = 0.009) were more frequently associated with SMVT, whereas diminished bowel enhancement (p = 0.003) and paralytic ileus (p = 0.039) were more frequent in SMAT. Diminished bowel enhancement (OR = 20; p = 0.007) and paralytic ileus (OR = 16; p = 0.033) were independent findings suggesting life-threatening mesenteric occlusion. CONCLUSION: The ancillary CT findings occur with different frequencies in SMAT and SMVT. However, the independent findings indicating life-threatening mesenteric occlusion are diminished bowel wall enhancement and paralytic ileus.


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artérias , Meios de Contraste , Iohexol , Oclusão Vascular Mesentérica/mortalidade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos , Veias
16.
Rev. colomb. cir ; 27(1): 55-62, ene.-mar. 2012.
Artigo em Espanhol | LILACS | ID: lil-639911

RESUMO

Los problemas vasculares mesentéricos son infrecuentes pero, cuando se presentan, pueden ser catastróficos. La isquemia mesentérica crónica es una entidad caracterizada por la obstrucción de los vasos mesentéricos; se manifiesta por dolor abdominal después de las comidas, desnutrición y miedo a comer. La mortalidad de la isquemia aguda es de 50 a 70 %. El manejo quirúrgico es la terapia de elección con excelentes resultados. El objetivo del tratamiento de la isquemia mesentérica crónica es solucionar los síntomas con un procedimiento efectivo y duradero, disminuyendo el riesgo de isquemia aguda. El tratamiento óptimo aun es discutido aunque la cirugía abierta se considera el método de referencia del manejo; no obstante, se asocia a una morbimortalidad importante. Presentamos el caso de un paciente con una isquemia mesentérica crónica, que se manejó con cirugía abierta y excelente resultado clínico y nutricional. Se hace una revisión extensa de la literatura científica actual.


Mesenteric vascular problems are infrequent, but may be catastrophic. Chronic mesenteric ischemia (CMI) is a morbid disease that results from progressive stenotic disease of the mesenteric vessels. CMI presents with postprandial abdominal pain, inanition, fear of food And weight loss. Untreated,The mortality in acute intestinal ischemia is high (50%-70%). Vascular reconstruction is remarkably successful in relieving the symptoms of chronic intestinal ischemia . The goal of treatment for CMI is a safe and effective revascularization that provides the patient with immediate and durable relief of symptoms, minimal procedural risk, and protection from morbidity and mortality associated with intestinal ischemia. Optimal treatment for patients with CMI remains controversial and challenging. Open surgical revascularization is still considered the standard of care, but may be associated with significant morbidity and mortality. We presented a patient with severe abdominal pain after meals, repeatedly. Angiography revealed severe stenosis and occlusion of the super mesenteric artery (SMA). Endovascular treatment was initially unsuccessful, after that we did a open bypass with full clinical and nutritional recovery.


Assuntos
Procedimentos Cirúrgicos Vasculares , Oclusão Vascular Mesentérica , Prótese Vascular , Procedimentos Endovasculares , Isquemia Mesentérica
17.
Acta cir. bras ; 26(4): 285-288, July-Aug. 2011. ilus, tab
Artigo em Inglês | LILACS | ID: lil-594348

RESUMO

PURPOSE: To evaluate the histopathology alterations of the intestinal mucosa of rabbits submitted to mesenteric artery ischemia and reperfusion with and without ischemic preconditioning. METHODS: Two groups of ten male New Zealand white rabbits body (weight 2.2-3.0, average 2.5 kg). For mesenteric ischemia induction in all animals the small bowel and mesentery were cut 30cm and 60cm far from the gastroduodenal pyloric transition before the proximal mesenteric artery occlusion. In the Group 1 animals, the proximal mesenteric artery was occluded for 45 min with an atraumatic vascular clamp, followed by reperfusion for 30 min. In the Group 2 the 45 min ischemic phase was preceded by three cycles of ischemia (2 minutes each) alternated with three cycles of reperfusion (2 minutes each). For istopathology study small bowel biopsies were obtained before ischemia (control), after 45 min of mesenteric ischemia and at 30 min. of mesenteric artery reperfusion. RESULTS: In the Group I animals, the followings histopathology grade results were observed: t1, mean 2,8; t2, mean 3,3. Using the Kruskal-Wallis non-parameter test, differences between t0 and t1 and t0 and t2 were significants (p<0.05), but not significant between t1 and t2 (p>0.05). In the Group 2 animals histopathology grade results were: t1 mean 2,6 and t2, mean 2,1. Differences between t0 and t1, t0 and t2 were significant (p<0.05). It was not observed differences (p>0.05) between results of t1 in both groups but histopathology injury observed in Group 1 t2 biopsies were higher (p<0.05) than observed in the same period (t2) of Group 2 animals. CONCLUSION: Microscopic examination of the biopsies revealed significant evidence of preconditioning protection against small bowel wall ischemia-reperfusion injury.


OBJETIVO: Avaliar as alterações histopatológicas da mucosa intestinal de coelhos submetidos a isquemia-reperfusão com e sem precondicionamento isquêmicol. MÉTODOS: Foram estudados dois grupos de dez coelhos Nova Zelândia machos com pesos variáveis entre 2,2 e 3,0 kg (média de 2,5 kg) de peso corpóreo. Para indução da isquemia, em todos os animais, o intestino delgado e o mesentério foram seccionados 30 cm e 60 cm após a transição pilórica gastroduodenal, antes da oclusão da artéria mesentérica cranial. Nos animais do Grupo 1, a artéria mesentérica proximal foi ocluida por pinçamento atraumático durante 45 min., seguido de reperfusão por 30 min. No Grupo 2, foi realizado precondicionamento por três ciclos de 2 min. de oclusão mesentérica intercalados com três ciclos de 2 min. de reperfusão, seguido de oclusão mantida por 45 min e reperfusão de 30min. como no Grupo I. Para estudo histopatológico, foram obtidas biópsias da parede intestinal antes da isquemia (t0-controle), após 45 min. de isquemia (t1) e após 30 min. de reperfusão (t2). RESULTADOS: No Grupo I foram observados os seguintes graus de lesões: t1, média de 2,8 e t2, média 3,3, Foram significantes as diferenças entre t0 e t1 e t0 e t2, mas não foram significantes as variações entre t1 e t2 (p>0,05). No Grupo 2, obteve-se em t1,média de 2,6 e t2, média 2,1. Foram significantes (p<0,05) as diferenças entre t0 e t1, t0 e t2 e entre t1 e t2. . Não ocorreu diferença significante (p>0,05) entre os resultados de t1 nos dois Grupos, mas foram significantes (p<0,05) as diferenças entre os resultados histopatológicos das biopsias de t2 dos Grupos 1 e 2. CONCLUSÃO: O precondicionamento isquêmico reduziu significantemente a degeneração histopatológica determinada pela reperfusão pós-isquêmica da parede intestinal.


Assuntos
Animais , Masculino , Coelhos , Precondicionamento Isquêmico , Mucosa Intestinal/patologia , Traumatismo por Reperfusão/patologia , Biópsia , Estudos de Casos e Controles , Enteropatias/patologia , Enteropatias/prevenção & controle , Mucosa Intestinal/irrigação sanguínea , Oclusão Vascular Mesentérica/patologia , Traumatismo por Reperfusão/prevenção & controle , Fatores de Tempo , Resultado do Tratamento
18.
Rev. chil. cir ; 63(1): 81-86, feb. 2011. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-582952

RESUMO

Chronic mesenteric ischemia is uncommon and often not recognized by clinicians. We report two patients with the disease. A 61 years old female with a two years history of abdominal pain, diarrhea, anorexia and weight loss. A mesenteric arteriography showed a critical stenosis of the celiac artery. The patient was operated and a retrograde bypass from the iliac to the mesenteric artery was placed. Digestive symptoms ceased and the patient gained weight. A 49 years old smoker female, with a two years history of abdominal pain and weight loss, without diarrhea. A doppler ultrasonography of abdominal arteries showed a critical stenosis of the celiac artery. The angiography confirmed the stenosis and disclosed also a complete occlusion of the common hepatic artery. The patient was operated placing anterograde aortic-mesenteric and aortic- hepatic bypasses. During the follow up, the patient is in good conditions.


La isquemia mesentérica crónica es una enfermedad que pone en riesgo la vida, que puede provocar la muerte por inanición o infarto mesentérico. El diagnóstico se realiza tardíamente debido a la inespecificidad de sus síntomas. El método diagnóstico no invasivo de elección es la ecografía doppler, por el cual se determina la presencia de estenosis u oclusión de las arterias viscerales comprometidas. La arteriografía se utiliza para definir la anatomía de las lesiones y planificar la cirugía. El tratamiento de elección sigue siendo la revascularización. Presentamos dos pacientes tratadas en nuestro servicio con buenos resultados, las que presentaban historia de síntomas abdominales inespecíficos y baja de peso. En la primera paciente, con antecedentes de hipercolesterolemia, su estudio demostró ateromatosis calcica difusa de aorta abdominal, ilíacas comunes, tronco celíaco, renales y mesentérica superior; se le realizó bypass ilíaco-mesentérico superior. En la segunda paciente, con antecedentes de tabaquismo crónico, su estudio demostró lesiones críticas de tronco celíaco y arteria mesentérica superior e inferior, se le realizó bypass aorto-mesentérico superior y aorto-hepático común. En los controles, ambas pacientes presentan alza de peso sostenida y se mantienen asintomáticas.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Isquemia/cirurgia , Isquemia/diagnóstico , Oclusão Vascular Mesentérica/cirurgia , Oclusão Vascular Mesentérica/diagnóstico , Angiografia , Artérias Mesentéricas/cirurgia , Prótese Vascular , Doença Crônica , Ultrassonografia , Procedimentos Cirúrgicos Vasculares
19.
Yonsei Medical Journal ; : 859-862, 2011.
Artigo em Inglês | WPRIM | ID: wpr-182765

RESUMO

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.


Assuntos
Adulto , Humanos , Masculino , Dissecção Aórtica/cirurgia , Angiografia/efeitos adversos , Meios de Contraste/efeitos adversos , Embolectomia , Artéria Mesentérica Superior/diagnóstico por imagem , Oclusão Vascular Mesentérica/etiologia , Stents/efeitos adversos , Tomografia Computadorizada por Raios X
20.
The Korean Journal of Gastroenterology ; : 243-248, 2011.
Artigo em Inglês | WPRIM | ID: wpr-142686

RESUMO

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.


Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Aguda , Angioplastia com Balão , Doença Crônica , Intestinos/irrigação sanguínea , Isquemia/cirurgia , Artéria Mesentérica Superior , Oclusão Vascular Mesentérica/cirurgia , Tomografia Computadorizada por Raios X
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