Chronic mesenteric ischemia in childhood and adolescence

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Presentation transcript:

Chronic mesenteric ischemia in childhood and adolescence Patrick W. Meacham, M.D., Richard H. Dean, M.D. Journal of Vascular Surgery Volume 2, Issue 6, Pages 878-885 (November 1985) DOI: 10.1016/0741-5214(85)90138-7 Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 Sequential arteriograms of case 1. A, Lateral aortogram performed 1 week before patient presented with evolving gastrointestinal infarction. Celiac artery is totally occluded. Superior mesenteric artery is severely stenotic. B, First postoperative arteriogram demonstrates marked diminutive changes in celiac branches and moderate stenosis in superior mesenteric artery distal to reimplantation site. C, This arteriogram was performed after vascular revision. Side graft to proper hepatic artery is patent. Splenic artery has occluded distally. Superior mesenteric artery is widely patent; inferior mesenteric artery remains patent. Journal of Vascular Surgery 1985 2, 878-885DOI: (10.1016/0741-5214(85)90138-7) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Photomicrograph of superior mesenteric artery (Case 1). Note disarray of media and internal elastic lamina, with subintimal fibroplasia. There is no active inflammatory cellular infiltrate or collagenous replacement of vessel wall. (Hematoxylin-cosin stain; original magnification, × 300.) Journal of Vascular Surgery 1985 2, 878-885DOI: (10.1016/0741-5214(85)90138-7) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Lateral aortogram (case 2) obtained before renal revascularization. This demonstrates severe stenoses of celiac, superior mesenteric, and inferior mesenteric arteries. Patient was without symptoms at time of this study. Journal of Vascular Surgery 1985 2, 878-885DOI: (10.1016/0741-5214(85)90138-7) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 Follow-up arteriograms, case 2. A, Early postoperative arteriogram demonstrates patency of aortomesenteric graft (arrow). B, Arteriogram 7 years after mesenteric bypass shows severe aneurysmal degeneration of iliac vein graft (arrow). Note extremely large gastroduodenal collateral vessel supplying celiac arteries (arrow). Journal of Vascular Surgery 1985 2, 878-885DOI: (10.1016/0741-5214(85)90138-7) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Serial arteriograms, case 3. A, Preoperative lateral aortogram demonstrating severe superior mesenteric artery stenosis with moderate stenosis of celiac trunk. B, Postoperative aortogram showing wide patency of reimplanted superior mesenteric artery. Journal of Vascular Surgery 1985 2, 878-885DOI: (10.1016/0741-5214(85)90138-7) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 6 Operative photographs, case 4. A, Entire length of abdominal aorta has been exposed with its branches. Note marked external narrowing of celiac and superior mesenteric arteries (arrow). B, This was operative appearance after bilateral renal artery bypass and superior mesenteric reimplantation (arrow). Journal of Vascular Surgery 1985 2, 878-885DOI: (10.1016/0741-5214(85)90138-7) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 7 Artist's sketch of superior mesenteric artery reimplantation. Artery is spatulated and reimplanted onto immediate infrarenal aorta. Journal of Vascular Surgery 1985 2, 878-885DOI: (10.1016/0741-5214(85)90138-7) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions