Isolated Iliac Artery Aneurysm Caused by Fibromuscular Dysplasia: Report of a Case

Fibromuscular dysplasia (FMD) can develop in many different arteries, but iliac artery aneurysms are rare. A 69-year-old Japanese woman was admitted to our hospital for treatment of a right common iliac artery aneurysm. Aortography revealed aneurysms in both the right common iliac artery and the left internal iliac artery. Notably, the right common iliac artery aneurysm had a string-of-beads appearance. At surgery, the aneurysms were resected, and replaced with Y-shaped vascular prostheses. The histopathological diagnosis was fibromuscular dysplasia (FMD). We report this case of common iliac artery aneurysm caused by FMD due to its rarity.     

Long-term Results After Surgical Reconstruction for Renal Artery Fibromuscular Dysplasia

OBJECTIVES: To study the initial and long-term results of surgery for renal artery fibromuscular dysplasia (RFMD). PATIENTS AND METHODS: All patients undergoing renal artery reconstruction (RAR) performed for RFMD between January 1980 and December 1997, were studied. The preprocedural and postprocedural clinical records of 101 patients (80 women, 21 men; mean age at surgery 43 years) were retrospectively reviewed. All surviving patients were invited for clinical reexamination and colour-coded duplex-ultrasound of the renal arteries (RA). RESULTS: Initial technical success was achieved in 83 of 93 patients (89%), in whom postoperative angiography (90) or renal scintigraphy (three) were performed for assessment of RAR. Early occlusion (four) or stenosis (one) demanded reoperation in five patients (5%). The 30-day mortality and morbidity were 2% and 12% for the entire group. Primary patency rate was 74% at 5 years. Fifteen patients had to be reoperated for restenosis after a mean time of 33 months, resulting in a secondary patency rate of 85% after 5 years. In 61 patients with patent RAR at the time of re-examination, arterial hypertension was cured only in 22 (36%) and improvement in 19 (31%). CONCLUSION: Vascular surgery for RFMD yields good long-term results as to kidney perfusion and function. Surveillance of RAR-patency by means of ultrasound examination is mandatory in case of recurrence of arterial hypertension or deterioration. Rates of cure of hypertension are disappointing.     

急性肠系膜上动脉栓塞的诊治探讨

目的:探讨急性肠系膜上动脉栓塞的发病原因、早期诊断和治疗.方法:对17例患者的临床资料进行回顾性分析.结果:17例患者都实施手术治疗,痊愈8例,死亡9例.结论:Bergan三联征、DSA可作为早期诊断的标准,而及时正确施治是提高治愈率的关键.     

急性肠系膜上动脉栓塞的手术探讨

目的总结手术治疗急性肠系膜上动脉栓塞的临床体会,探讨常见并发血管病变的处理方法。方法1990年1月～2005年12月年收治32例急性肠系膜上动脉栓塞患者,均在全身麻醉下行肠系膜动脉切开取栓,同时处理合并的内脏血管病变。结果30例获得临床治愈,2例分别死于呼吸衰竭和心力衰竭。术后1年复查无栓塞及局部狭窄,CTA示肠系膜上动脉通畅,侧枝循环正常。30例术后随访2～15年,23例无局部狭窄或复发,7例死于心肌梗塞或脑出血。结论早期诊断、早期切开取栓同时处理伴发疾病,可显著提高急性肠系膜上动脉栓塞的临床治愈率。     

Mesenteric infarction in Takayasu's disease

Obstructive lesions of the visceral arteries in Takayasu's disease are common but rarely symptomatic. This report concerns two patients with Takayasu's disease who died of mesenteric infarction due to superior mesenteric artery thrombosis. Prophylactic revascularization of the visceral arteries in Takayasu's disease remains controversial, and lesions can be more severe than classically recognized.Presented at the Annual Meeting of the Société de Chirurgie Vasculaire de Langue Française, Strasbourg, France, June 23–24, 1989.     

Superior mesenteric artery syndrome: Report of two patients and review of the literature

Superior mesenteric artery syndrome is a rare disease that should be considered in the differential diagnosis of upper abdominal pain, vomiting and weight loss. Compression of the third part of the duodenum between the superior mesenteric artery anteriorly and the aorta and the spinal cord posteriorly may result in high intestinal obstruction. Surgical treatment with duodenojejunostomy is indicated if proper conservative treatment has failed. Two patients are reported in the present case. One patient presented with acute surgical abdomen, which was an unusual presentation of superior mesenteric artery syndrome, while the second patient had classic features of the syndrome. Both patients were successfully treated with duodenojejunostomy. The pathophysiology, clinical presentation, investigation and management of this condition are discussed.      

急性肠系膜上静脉血栓形成18例诊治体会

目的总结急性肠系膜上静脉血栓形成(superiormesentericvenousthrombosis,SMVT)的诊治经验。方法18例急性SMVT患者,6例行抗凝、溶栓治疗(其中1例中转手术),另12例行手术治疗,切除坏死肠管及含有静脉血栓的全部肠系膜。结果6例抗凝、溶栓治疗患者中顺利溶栓、症状体征消失者5例(83.3%);另1例患者于非手术治疗17h后出现明显的腹膜炎体征而中转手术。13例开腹探查的患者中治愈9例(69.2%),死亡4例(30.8%),死于小肠广泛坏死短肠综合征、多系统器官功能衰竭各2例。结论早期诊断及抗凝、溶栓治疗使非手术疗法成为首选,但对于已出现腹膜炎、穿孔等肠缺血坏死征象的患者则应考虑手术治疗。     

急性肠系膜上动脉栓塞预后的影响因素分析

目的:研究影响急性肠系膜上动脉栓塞相关因素与预后的关系。方法:选取我院2015年1月—2019年12月收治的患者85例,回顾性研究85例急性肠系膜上动脉栓塞患者的相关临床资料,分析相关因素及其与预后之间的关系。结果:本组85例中治愈46例,占54.1%,死亡36例,占45.9%。死亡组中病程>6 h、有腹膜炎、主干栓塞、未保留导管溶栓、未手术患者的比例高于治愈组,差异有统计学意义(P<0.05),两组的年龄、性别及有无合并症比例差异无统计学意义(P>0.05)。结论:急性肠系膜上动脉栓塞以老年患者为主,预后极差。对合并有心血管疾病的外科腹痛,"症状与体征不符"时,需要高度怀疑肠系膜血管病,高度重视腹部强化CT检查。介入溶栓及外科手术治疗有效。     

Spontaneous dissecting aneurysm of the main trunk of the superior mesenteric artery: Report of a case

A 47-year-old man with a sudden onset of abdominal pain was diagnosed as having an aneurysm of the main trunk of the superior mesenteric artery (SMA), which induced ischemic colitis of the transverse colon probably because of a transient decrease in the SMA blood flow. The patient was successfully treated by resection of the aneurysm and an end-to-side anastomosis of the SMA to the aorta. A histological examination revealed a spontaneous dissecting aneurysm of the SMA.     

腹腔干、肠系膜上动脉共干部动脉瘤的切除和血管重建探讨

目的探讨腹腔干、肠系膜上动脉畸形共干部真性动脉瘤的切除以及血管重建的手术治疗方法。方法回顾性总结1998年2月至2006年4月6例患者临床资料,均在全身麻醉下行动脉瘤切除,肾下主动脉与肝动脉、脾动脉、肠系膜上动脉行转流手术5例,行主动脉肝动脉转流、肠系膜上动脉成形术1例。结果均获得临床治愈,随访观察2月~8年,无一例复发。结论腹腔干、肠系膜上动脉畸形共干部动脉瘤切除,主动脉与内脏动脉转流或重建是一种安全有效的治疗方法。     

Isolated Superior Mesenteric Vein Injury from Blunt Abdominal Trauma: Report of a Case

Solitary injury of the superior mesenteric vein (SMV) after blunt abdominal trauma is a rare but frequently fatal injury. A 63-year-old man was admitted to our hospital after falling on his right side from a height of 5 m. Computed tomography (CT) showed blood in the peritoneal cavity, but no liver or spleen injury. Emergency laparotomy revealed complete disruption of the SMV across the site of confluence with the splenic vein. We performed primary reconstruction by connecting both ends of the vein as an end-to-end anastomosis. Following restoration of gastrointestinal passage the patient was discharged in good health. At his 6-month follow-up, angio-CT showed an unobstructed SMV and portal vein. There was slight stenosis at the site of the suture and no sign of development of collateral venous circulation into the liver. This case report shows that primary repair of an SMV injury can be done in a stable patient without concomitant life-threatening injuries once proximal and distal control of bleeding has been achieved. Ligation should be reserved for patients with multiple injuries and an unstable condition.     

肠系膜上静脉血栓形成的诊治

目的：探讨肠系膜上静脉血栓形成的临床诊治经验。方法：回顾性分析20例肠系膜上静脉血栓形成的临床资料。手术者10例,8例行坏死肠管切除吻合,2例行坏死肠管切除0281期造瘘。其余10例行抗凝溶栓祛聚治疗。结果：18例治愈,2例术后死于并发症。结论：肠系膜上静脉血栓形成无腹膜炎体征者可行非手术治疗,有腹膜炎体征或肠已坏死者,应即时手术治疗。     

急性肠系膜上动脉栓塞的外科治疗

目的:探讨急性肠系膜上动脉栓塞的诊断方法和治疗原则。方法:13例病人中10例病程在12h内,采用Fogaty导管取栓并配合药物抗凝、溶栓治疗。3例病程在24h以上,术中发现肠管坏死,行肠管切除术。结果:3例肠坏死者术后5d、7d、9d因原发疾病严重并多器官功能衰竭而死亡,10例治愈。1~5年随访,3例死于心脏病,7例均未再发生肠系膜栓塞。治愈率53.8%,死亡率46.2%。结论:痉挛性腹痛、器质性心脏病、胃肠道排空异常是本病早期诊断的主要临床特点,早期诊断和及时手术取栓是治疗的有效手段。     

Segmental Odontomaxillary Dysplasia: Report of 3 Cases and Literature Review

Segmental Odontomaxillary Dysplasia (SOD) is an uncommon developmental disorder of unknown etiology that causes a unilateral alteration of the maxilla associated with an abnormal growth and maturation of bone, lack of one or both premolars and delayed tooth eruption on the affected side, alteration of adjacent gingival tissue with or without facial cutaneous lesions. Radiographically is observed an irregular trabecular pattern and reduction of the maxillary sinus. There are 50 cases reported in the English-language literature. A literature review is herein presented emphasizing the clinical, radiographic, and histological features, and three additional cases of SOD affecting a 22 years-old woman, a 18 years-old man, and a 5 years-old boy, respectively are described.     

Multivisceral Fibromuscular Dysplasia in Childhood: Case Report and Review of the Literature

We report here a 9-year-old girl with fibromuscular dysplasia of many muscular arteries including both renal and internal carotid arteries, the celiac artery, superior mesenteric artery, and one external carotid artery. She suffered from severe renovascular hypertension with beginning secondary cardiac decompensation, typical angina abdominalis, and neurological signs, including severe headaches and hemianopsia. Surgery was performed for all major vessels and the outcome is good 2.5 years after the operation. The clinical presentation, differential diagnosis, and treatment options of fibromuscular dysplasia in childhood are discussed and the literature is reviewed.     

Fibromuscular dysplasia of the renal arteries: a radiological review

Fibromuscular dysplasia is the most common cause of renovascular hypertension in young patients. Digital subtraction angiography is still the best investigation used to determine the location, extent and complication of renal artery involvement. String of beads appearance (reflecting multiple stenoses), aneurysms, focal or tubular stenosis are classic angiographic appearances. The aim of this pictorial essay is to illustrate the various imaging findings of renal artery fibromuscular dysplasia.     

Multiple aneurysms of the visceral arteries with migrating vascular bruit on postural change: A case report

Multiple aneurysms of the gastroepiploic artery and the ileocecal branch of the superior mesenteric artery were found in a 68-year-old male patient by angiography. The patient presented with one-hour postprandial epigastric pain of 10 years duration. Abdominal bruit was auscultated at the two different sites, one of which shifted downwards upon upright position. From the freely movable nature of the great omentum, this bruit, migrating upon postural change, was most likely from the gastroepiploic artery aneurysms. The aneurysms were excised and the abdominal bruit disappeared. The etiology of the aneurysms was suggested to be arterial fibrodysplasia histologically. From this experience, it was stressed that postural change should be added to a routine physical examination to rule out an aneurysm from the freely movable great omentum.     

Acute Mesenteric Ischemia: The Challenge of Gastroenterology

Intestinal ischemia has been classified into three major categories based on its clinical features, namely, acute mesenteric ischemia (AMI), chronic mesenteric ischemia (intestinal angina), and colonic ischemia (ischemic colitis). Acute mesenteric ischemia is not an isolated clinical entity, but a complex of diseases, including acute mesenteric arterial embolus and thrombus, mesenteric venous thrombus, and nonocclusive mesenteric ischemia (NOMI). These diseases have common clinical features caused by impaired blood perfusion to the intestine, bacterial translocation, and systemic inflammatory response syndrome. Reperfusion injury, which exacerbates the ischemic damage of the intestinal microcirculation, is another important feature of AMI. There is substantial evidence that the mortality associated with AMI varies according to its cause. Nonocclusive mesenteric ischemia is the most lethal form of AMI because of the poor understanding of its pathophysiology and its mild and nonspecific symptoms, which often delay its diagnosis. Mesenteric venous thrombosis is much less lethal than acute thromboembolism of the superior mesenteric artery and NOMI. We present an overview of the current understanding of AMI based on reported evidence. Although AMI is still lethal and in-hospital mortality rates have remained high over the last few decades, accumulated knowledge on this condition is expected to improve its prognosis.