Severe Stenosis of the Celiac Artery
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Abstract:
Seventeen patients with celiac artery stenosis causing abdominal angina or the development of collateral channels were studied. Of 7 patients with abdominal angina, 5 had celiac compression relieved by surgery and 2 had atherosclerosis. Most of the 10 asymptomatic patients were somewhat older, and none were operated upon. Angiographically, the stenosis was believed to be congenital in 3 and atherosclerotic in 7. Abundant collateral vessels were present in all asymptomatic patients. Since the angiographic appearances may be identical in patients with and without symptoms, careful clinical evaluation prior to surgical intervention is necessary.Keywords:
Celiac artery
Collateral circulation
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Maintaining collateral circulation is highly important in the stenosis of celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery (IMA). The SMA compression is commonly reported to be accompanied by the CA compression caused by the median arcuate ligament (MAL) while the synchronous compression of CA and SMA by other ligaments has been rarely reported.In this report, we present a 64-year-old female patient who presented with a postprandial abdominal pain and weight loss. Initial evaluation indicated a synchronous compression of CA and SMA caused by MAL. The patient was planned for laparoscopic MAL division due to the presence of sufficient collateral circulation between the CA and SMA that was facilitated through the superior pancreaticoduodenal artery. Following laparoscopic release, the patient improved clinically and postoperative imaging indicated that the compression on the SMA was still present and the collateral circulation was sufficient.We suggest that laparoscopic MAL division can be the primary method of choice in cases with sufficient collateral circulation between the CA and SMA.
Collateral circulation
Celiac artery
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Celiac artery
Common hepatic artery
Inferior mesenteric artery
Collateral circulation
Mesenteric arteries
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Celiac artery
Common hepatic artery
Inferior mesenteric artery
Collateral circulation
Mesenteric arteries
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Operative reconstruction of the visceral vessels continues to have a high mortality rate. In this report, the authors describe a series of patients in whom a unique method of visceral reconstruction was employed. The single celiac-superior mesenteric artery (SMA) bypass, originating from and patching the celiac origin, and coursing to the SMA, is an effective way to revascularize both of these vessels. Fourteen mesenteric reconstructions performed in 12 patients (eight men and four women, mean age: 66 years) between 1989 and 1996 were reviewed. Eight patients had chronic intestinal ischemia (postprandial pain, mean weight loss 44 lb) for a mean duration of 11 months, and four patients had acute intestinal ischemia with peritonitis. Reconstructive procedures included seven single celiac-SMA bypasses; four bypasses from the aorta to the SMA, celiac artery, or both; one iliosuperior mesenteric bypass; and two visceral patch angioplasties. All single celiac-SMA bypasses remained patent; however, two of four antegrade aortomesenteric reconstructions failed within 24 hours. Operative time was shorter for single celiac-SMA bypasses than for other reconstructions (168 vs 231 min). Mortality rate was 25% (two of eight) in the patients with chronic ischemia, and 100% in those with acute ischemia. Long-term follow-up (15.5 months) in the six survivors operated on for chronic ischemia demonstrated resolution of symptoms in all. The single celiac-SMA bypass is an effective and expeditious method of visceral revascularization, with a short, straight graft. This technique requires two anastomoses instead of three, minimizes intraoperative intestinal ischemia, and is easily performed with prosthetic or autologous material.
Celiac artery
Mesenteric Ischemia
Gastroduodenal artery
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Celiac artery
Gastroduodenal artery
Common hepatic artery
Arterial catheter
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Celiac artery
Mesenteric Ischemia
Inferior mesenteric artery
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An elderly woman developed chronic mesenteric ischemia (CMI) due to severe stenosis of the celiac artery and chronic total occlusion of the superior mesenteric artery (SMA). Stenting of the celiac artery resulted in resolution of CMI, but symptoms recurred 4 months later due to restenosis. We report successful sustained resolution of CMI after percutaneous retrograde revascularization of the SMA via the celiac artery.
Celiac artery
Mesenteric Ischemia
Mesenteric arteries
Common hepatic artery
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Celiac artery
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Median arcuate ligament (MAL) syndrome (MALS) is a rare condition caused by compression of the celiac artery by the MAL. Symptoms include abdominal pain, nausea, and weight loss. Rarely, the MAL can compress both the celiac artery and the superior mesenteric artery (SMA). We describe the case of a young man with MALS involving the celiac artery and SMA. Laparoscopic release of the MAL was performed, and the patient had resolution of his symptoms at 6 months of follow-up. A review of the literature identified only six cases of MALS involving the SMA and celiac artery, making this a rare occurrence.
Celiac artery
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A 42-year-old man had intestinal ischemia 7 weeks after endovascular abdominal aortic aneurysm repair due to sacrifice of the inferior mesenteric artery, which had compensated for the intestinal blood supply because of the total occlusion of the superior mesenteric artery (SMA) and severe stenosis of the celiac artery (CA). He was diagnosed in the active phase of Takayasu arteritis, and an emergency endovascular treatment was performed. After the SMA failed to be recanalized, a stent was successfully placed into the CA; this choice was made based on the preexisting collaterals between them. The symptoms were relieved shortly after the operation. The Kirk arcade, the Barkow arcade, and the enlarged pancreaticoduodenal arcade were visualized on the follow-up computed tomography angiography. Based on this case, a short review of celiomesenteric and intermesenteric collateral circulations is presented.
Inferior mesenteric artery
Celiac artery
Mesenteric Ischemia
Computed Tomography Angiography
Collateral circulation
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