Linda M. Reilly, M. D. , Alex D. Ammar, M. D. , Ronald J. Stoney, M. D

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Presentation transcript:

Late results following operative repair for celiac artery compression syndrome Linda M. Reilly, M.D., Alex D. Ammar, M.D. *, Ronald J. Stoney, M.D., William K. Ehrenfeld, M.D. Journal of Vascular Surgery Volume 2, Issue 1, Pages 79-91 (January 1985) DOI: 10.1016/0741-5214(85)90177-6 Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 A, Preoperative selective superior mesenteric artery injection shows retrograde filling of celiac axis (open arrows) through widely dilated gastroduodenal artery (solid arrows). B, Postoperative study shows absence of collateral vessels and no retrograde flow. Journal of Vascular Surgery 1985 2, 79-91DOI: (10.1016/0741-5214(85)90177-6) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Lateral aortogram filmed during inspiration and expiration showing classic appearance of arcuate ligament compression of celiac axis, dramatically exacerbated by diaphragmatic excursion in expiration. Journal of Vascular Surgery 1985 2, 79-91DOI: (10.1016/0741-5214(85)90177-6) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Representation of retrograde transsplenic celiac dilatation. (From Stoney RJ, Lusby RJ. Surgery of celiac and mesenteric arteries. In: Haimovici H, ed. Vascular surgery principles and techniques. New York: Appleton-Century-Crofts, 1984:819.) Journal of Vascular Surgery 1985 2, 79-91DOI: (10.1016/0741-5214(85)90177-6) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 Serial visceral arteriograms showing persistent mild postoperative celiac orifice stenosis in symptomatic patient treated by decompression only. Journal of Vascular Surgery 1985 2, 79-91DOI: (10.1016/0741-5214(85)90177-6) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 A, Preoperative study showing celiac compression. B and C, Serial postoperative studies showing widely patent celiac artery in patient asymptomatic for 15 years. Journal of Vascular Surgery 1985 2, 79-91DOI: (10.1016/0741-5214(85)90177-6) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 6 A, Intraoperative photograph of primary celiac reanastomosis. B, Postoperative study showing widely patent celiac axis. C, Intravenous digital subtraction angiography study obtained 17 years postoperatively shows no celiac compression and patient remains asymptomatic. Journal of Vascular Surgery 1985 2, 79-91DOI: (10.1016/0741-5214(85)90177-6) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 7 A, Preoperative arteriogram showing high-grade celiac compression. B, Postoperative residual celiac stenosis in patient treated by decompression only who was asymptomatic 4 years postoperatively. (From Stoney RJ, Wylie EJ. The recognition and management of visceral ischemic syndromes. Ann Surg 1966;164:719.) Journal of Vascular Surgery 1985 2, 79-91DOI: (10.1016/0741-5214(85)90177-6) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 8 A, Intravenous digital subtraction visceral angiograms showing persistent mild stenosis in good-quality study 18 years postoperatively. B, Patent celiac but poor display of vessel origin 9 years postoperatively. Both patients asymptomatic. Journal of Vascular Surgery 1985 2, 79-91DOI: (10.1016/0741-5214(85)90177-6) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 9 A, Study after initial decompression and dilatation shows widely patent celiac axis. Subsequent occlusion of both vessels required reoperation. B and C, Intravenous digital subtraction angiograms obtained 7 years after second procedure show patent aorto—superior mesenteric artery graft (open arrows) and occluded celiac artery (solid arrows, dotted line). Patient remains symptomatic. Journal of Vascular Surgery 1985 2, 79-91DOI: (10.1016/0741-5214(85)90177-6) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 10 Serial angiograms obtained 2 and 4 years postoperatively showing celiac patency in asymptomatic patient. Journal of Vascular Surgery 1985 2, 79-91DOI: (10.1016/0741-5214(85)90177-6) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 11 Serial angiograms obtained 1 and 4 years postoperatively showing celiac patency in asymptomatic patient. Journal of Vascular Surgery 1985 2, 79-91DOI: (10.1016/0741-5214(85)90177-6) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions