cardiovascular-agents and Mesenteric-Vascular-Occlusion

To evaluate the efficacy and clinical outcomes of endovascular treatment for superior mesenteric artery dissection (SMAD) and its effect on superior mesenteric artery (SMA) remodeling compared with medical management alone after successful initial medical management.. In this retrospective analysis, all patients with spontaneous SMAD at a single institution were identified from March 2007 to August 2019. The primary outcomes were freedom from major adverse events (MAEs, a composite of dissection-related death, the recurrence of mesenteric ischemia symptoms, and a requirement for intervention). The secondary outcomes were morphologic remodeling of the dissections and stenosis or occlusion of the SMA.. A total of 94 patients with SMAD who underwent successful initial medical management (91 males; mean age, 50.4 ± 6.3 years) were enrolled in the study. Fifty-seven (60.6%) received medical management alone, and 37 (39.4%) underwent endovascular repair after initial medical management. In the endovascular group, the technical success rate was 86.5% (32 of 37). During a mean follow-up period of 33.6 ± 26.2 months (range, 1-120 months), nine (9.6%) patients experienced a recurrence of abdominal pain, and six had additional interventions for SMAD. The patients in the endovascular group showed more complete or partial remodeling (22 [81.1%] vs 24 [44.4%]; P < .0001) or unchanged dissections (5 [13.5%] vs 23 [42.6%]; P = .0001) than those in the conservative group. Survival analysis showed that the estimated MAE-free survival rates were 95.6%, 88.9%, and 85.4% at 1, 3, and 5 years, respectively. There was a higher freedom from SMA stenosis or occlusion in the endovascular group (log rank P = .046).. Endovascular treatment and medical management alone result in similar MAE-free survival for patients with SMAD after successful initial medical management. Moreover, endovascular therapy is associated with a higher complete remodeling rate and greater freedom from SMA stenosis or occlusion.

Topics: Adult; Aged; Aortic Dissection; Cardiovascular Agents; Endovascular Procedures; Female; Humans; Male; Mesenteric Artery, Superior; Mesenteric Ischemia; Mesenteric Vascular Occlusion; Middle Aged; Progression-Free Survival; Recurrence; Retreatment; Retrospective Studies; Stents; Time Factors; Vascular Remodeling

Management of acute mesenteric ischemia is still a matter of concern for physicians. This disorder has been associated to an increased mortality mainly because of a late diagnosis and controversial treatment options.. We describe the case of a multidisciplinary approach to a cardiogenic thrombotic occlusion of superior mesenteric artery resulting in acute mesenteric ischemia. After rapid diagnosis with Duplex scan, we brought the patient to our catheterization laboratory and managed it with the common tools used for primary percutaneous coronary intervention. Among the specific issues of this case report, we observed some of the common complications of the acute myocardial infarction managed in the catheterization laboratory and treated them with the same tools used in the "myocardial area.". We showed how an "interventional cardiologist's" approach to acute mesenteric ischemia was effective in restoring superior mesenteric artery patency and in aborting a mesenteric infarction.

Topics: Acute Disease; Atrial Fibrillation; Cardiovascular Agents; Combined Modality Therapy; Female; Humans; Ischemia; Mesenteric Artery, Superior; Mesenteric Vascular Occlusion; Middle Aged; Patient Care Team; Radiography; Stents; Thrombolytic Therapy; Thrombosis; Treatment Outcome; Ultrasonography, Doppler, Duplex; Vascular Patency

Stent implantation is an alternative, safe, and reliable strategy for the treatment of chronic mesenteric ischemia, especially for patients at high surgical risk. However, in-stent restenosis (the Achille's hill of bare metal stent) may occur in up to 20% of cases at 6 months and 53% at 1 year. We describe a case of celiac trunk stenosis treated by bare metal stent complicated by recalcitrant in-stent restenosis and treated by paclitaxel-eluting stent implantation.

Topics: Aged; Angioplasty, Balloon; Arterial Occlusive Diseases; Cardiovascular Agents; Celiac Artery; Chronic Disease; Constriction, Pathologic; Drug-Eluting Stents; Female; Humans; Ischemia; Magnetic Resonance Angiography; Mesenteric Vascular Occlusion; Metals; Paclitaxel; Prosthesis Design; Recurrence; Stents; Tomography, X-Ray Computed; Treatment Outcome

To report the use of a drug-eluting stent (DES) for treatment of symptomatic in-stent restenosis (ISR) in the superior mesenteric artery (SMA).. A 79-year-old woman suffering from chronic renal failure and needing dialysis was admitted for vomiting, postprandial abdominal pain, and weight loss for 3 months. Computed tomographic angiography (CTA) documented massive calcification of the vascular bed, mainly in the aorta, and a very tight ostial stenosis of the SMA. A 4.5-x20-mm Genesis stent was deployed at the ostium, with good angiographic result and immediate symptomatic benefit. After 3 months, symptoms recurred; angiography demonstrated ISR. Percutaneous angioplasty with a 4-x15-mm cutting balloon was performed. The patient remained asymptomatic for only 2 months; recurrent ISR at this time was treated with a 3.5-x24-mm coronary TAXUS Express paclitaxel-eluting coronary stent deployed inside the previously implanted stent. Under prolonged double antiplatelet regimen, the patient was asymptomatic at the 8-month follow-up; CTA demonstrated patency of the SMA.. Considering the high rate of restenosis and the periprocedural complications described with endovascular treatment of SMA stenosis, a drug-eluting stent may be a good option not only for the treatment of restenosis but also in de novo lesions, at least when the vessel diameter is <4.5 mm.

Topics: Aged; Angiography, Digital Subtraction; Angioplasty, Balloon; Cardiovascular Agents; Drug-Eluting Stents; Female; Humans; Mesenteric Artery, Superior; Mesenteric Vascular Occlusion; Paclitaxel; Platelet Aggregation Inhibitors; Secondary Prevention; Stents; Tomography, X-Ray Computed; Treatment Outcome; Vascular Patency

Perfusion of the abdomen is determined by cardiac function and circulation. Intestinal ischemia can be caused by Non occlusive bowel ischemia (NOD) that is important in internal as well as surgical intensive care medicine. Cardiac medication can influence perfusion of the bowel: 1) digitalis increases muscular tonus and decreases perfusion regulation b) diuretics lead to hypovolemia, hypotonia and malperfusion, c) antihypertensive medication can cause intraoperative hypotension that demands catecholamines, d) catecholamines can reduce perfusion by pathologic vasoconstriction in the splanchnicus area. Preoperative medication should respect 1) preoperatively taken ACE-inhibitors should be given postoperatively, as they have protective influence on the microcirculation of the bowel, 2) beta-blockers stabilize the myogenic tonus of the abdominal vessels, reduce an overshot of the parasympatheticus and diminish the risk of neurogenic abdominal shock, 3) catecholamines should be used with respect to ischemia of the bowel. Therapy of NOD should be focused on the primary vascular and hemodynamic causes and also take care for bacterial translocation and consecutive sepsis.

Topics: Aged; Cardiovascular Agents; Coronary Circulation; Hemodynamics; Humans; Intestines; Ischemia; Male; Mesenteric Vascular Occlusion; Risk Factors; Shock, Cardiogenic; Splanchnic Circulation; Systemic Inflammatory Response Syndrome; Thrombosis