Mesenteric Vascular Disease (eBook)

Current Therapy

Gustavo S. Oderich (Herausgeber)

eBook Download: PDF

2014 | 2015
XVIII, 468 Seiten
Springer New York (Verlag)
978-1-4939-1847-8 (ISBN)

Infos

This book represents the first comprehensive textbook devoted to the standard of care, current guidelines and innovations in the field of mesenteric vascular disease. The book reviews imaging modalities, diagnostic work up, physiologic tests, traditional open surgical techniques and novel endovascular approaches. Technical aspects of both open surgical and endovascular techniques are provided by experts in the field, with illustrations and photographs of key steps for each type of procedure. Results of epidemiologic studies and national databases are summarized, as well as large institutional experiences. An evidence-based approach is used for recommendations regarding best therapies. Diagnostic approaches including imaging and novel physiologic tests, including gastric tonometry and oxygen light spectroscopy are covered.

Mesenteric Vascular Disease: Current Therapy will serve as a very useful resource for clinicians, surgeons, interventionalists, gastroenterologists and researchers dealing with and interested in mesenteric vascular diseases.

Gustavo S. Oderich, MD, FACS

Professor of Surgery

Director of Endovascular Therapy

Division of Vascular and Endovascular Surgery

Mayo Clinic, Rochester, MN, USA

Gonda Vascular Center

Mayo Clinic

Rochester, MN, USA

Inhalt

Dedication 6
Preface 8
Acknowledgments 10
Contents 12
Contributors 16
Part I: Basic Concepts 20
Chapter 1: History of Mesenteric Vascular Disease 21
Surgical Revascularization 22
Mayo Clinic Legacy 23
Endovascular Therapy 23
References 24
Chapter 2: Normal and Variant Mesenteric Anatomy 26
Embryology 26
Normal Anatomy 27
Celiac Artery 27
Superior Mesenteric Artery (SMA) 31
Inferior Mesenteric Artery 32
Collateral Pathways 33
Within Vessel Collaterals [5] 34
Celiac Axis 34
SMA 34
IMA 34
Between Mesenteric Vessels 34
Celiac and SMA Collaterals 34
SMA and IMA Collaterals 35
Mesenteric and Parietal Arterial Collaterals 35
Variant Anatomy 36
Celiac Artery Variants 36
SMA Variants 38
IMA Variants 39
References 39
Chapter 3: Pathophysiology 41
Vascular Anatomy 42
Physiologic Response 43
Collateral Pathways 45
Pathophysiology 46
Conclusion 46
References 47
Chapter 4: Epidemiology and Natural History 49
Chronic Mesenteric Ischemia 49
Epidemiology 49
Natural History 51
Acute Mesenteric Ischemia 52
Epidemiology 52
Thromboembolic 53
Nonocclusive Mesenteric Ischemia 55
Natural History 55
Median Arcuate Ligament Syndrome 56
Epidemiology 56
Natural History 58
Isolated Mesenteric Artery Dissection 58
Epidemiology 58
Natural History 59
Mesenteric Aneurysms 59
Epidemiology 59
Natural History 60
References 61
Chapter 5: Duplex Ultrasound of the Mesenteric Vessels 65
Technique 65
Normal Waveforms 68
Detection of Stenosis 69
Intraoperative Imaging 71
Post-intervention Imaging 73
Other Applications 75
Median Arcuate Ligament Syndrome 75
Acute Mesenteric Ischemia 75
Inflammatory Bowel Disease 76
Mesenteric Artery Dissection and Aneurysms 76
Conclusion 77
References 77
Chapter 6: Functional Testing in the Diagnosis of Chronic Mesenteric Ischemia 79
Gastric Tonometry 80
Background 80
Procedure 81
Gastric Exercise Tonometry 81
24-Hour Tonometry 81
Test Meals 82
Diagnostic Value of Tonometry 83
Sensitivity and Specificity 83
Tonometry After Intervention 83
Visible Light Spectroscopy 83
Background 83
Procedure 84
Diagnostic Value of VLS 85
Sensitivity and Specificity 85
VLS After Intervention 85
Clinical Considerations 85
Comparison Tonometry Versus VLS 85
Limitations of Tonometry 86
Limitations of VLS 86
Conclusion 87
Best Practice 87
Future Aspects 88
Optimizing Tonometry 88
Optimizing VLS 88
Sublingual VLS Measurements 88
Postprandial VLS Measurements 89
Functional Tests of the Small Bowel Mucosa 89
Biomarkers 89
Risk Stratification by Single-Nucleotide Polymorphisms 90
References 90
Chapter 7: Noninvasive Arterial Imaging: Computed Tomography and Magnetic Resonance Angiography 94
Rationale for Computed Tomography and Magnetic Resonance Imaging 94
Computed Tomography 95
Clinical Role and Imaging Considerations for Computed Tomography Angiography (CTA) 95
Magnetic Resonance Angiography (MRA): Clinical Role and Imaging Considerations 96
Chronic Mesenteric Ischemia 97
Acute Mesenteric Ischemia 100
Mesenteric Venous Thrombosis 102
Nonocclusive Mesenteric Ischemia 103
Median Arcuate Ligament Syndrome 104
Mesenteric Artery Dissection or Aneurysm 104
CTA Limitations 105
MRA Limitations 106
Future Directions 107
Summary 107
References 108
Chapter 8: Diagnostic Angiography 110
Technique 111
Conclusion 117
References 117
Part II: Chronic Mesenteric Ischemia 118
Chapter 9: Clinical Presentation, Etiology, and Diagnostic Considerations 119
Clinical Presentation 119
Etiology 121
Diagnostic Considerations 124
Angiography 125
Duplex Ultrasonography 125
Computed Tomographic Angiography 127
Magnetic Resonance Angiography 130
Tonometry 132
Diagnostic Approach at Our Institution 132
References 133
Chapter 10: Non-atherosclerotic Causes of Mesenteric Arterial Disease 137
Anatomic Considerations 138
Classification of Vasculitis 138
Clinical Features 139
Image Findings 143
Duplex Ultrasound 143
Endoscopy and Colonoscopy 143
Computed Tomography 143
Angiography 144
Specific Disorders in Mesenteric Vasculitis 144
Takayasu’s Arteritis 145
Giant Cell Arteritis 145
Polyarteritis Nodosa 145
Wegener Granulomatosis 147
Microscopic Polyangiitis 147
Henoch-Schönlein Syndrome 147
Systemic Lupus Erythematous 148
Rheumatoid Vasculitis 148
Behçet Syndrome 148
Thromboangiitis Obliterans 149
Differential Diagnosis 149
Treatment 152
Medical Treatment 152
Surgical Approach 153
Endovascular Treatment 154
Neurofibromatosis and Other Causes of Mid-aortic Syndrome 154
Conclusion 157
References 157
Chapter 11: Techniques of Open Mesenteric Reconstructions 159
Surgical Treatment 159
Exposure 159
Technique 164
References 170
Chapter 12: Results of Open Mesenteric Reconstructions 171
Outcomes 172
Symptom Relief, Recurrent Symptoms, and Re-intervention 173
Reoperation for Failed Open Mesenteric Reconstructions 175
Patient Survival 175
Summary 176
References 176
Chapter 13: Techniques of Endovascular Mesenteric Revascularization 178
Indications 179
Choice of Open Versus Endovascular Revascularization 179
Pre-procedure Evaluation 181
Selection of Access Site 182
Diagnostic Mesenteric Angiography 182
Selective Catheterization 183
Embolic Protection Devices 184
Choice of Stent 185
Angioplasty and Stenting of Mesenteric Stenosis 186
Specific Situations 188
Recanalization of Mesenteric Occlusions 188
Orbital Atherectomy 190
Bifurcated Stents 192
Retrograde Hybrid Revascularization 192
In-Stent Stenosis 194
Complications 196
Post-procedure Management 196
Conclusion 196
References 197
Chapter 14: Results of Endovascular Mesenteric Revascularization 200
History 200
Early Mesenteric Stent Results 201
Mesenteric Intervention vs. Open Surgery 202
Contemporary Mesenteric Stent Results 204
Conclusions 205
References 207
Part III: Acute Mesenteric Ischemia 209
Chapter 15: Clinical Presentation, Etiology, and Diagnostic Considerations 210
Introduction and History 210
Etiology 211
Clinical Presentation 212
Diagnostic Considerations and Imaging Studies 212
Overview of Management by Etiology 214
Arterial Embolism 215
Acute Arterial Thrombosis 216
Nonocclusive Mesenteric Ischemia 216
Mesenteric Venous Thrombosis 217
References 219
Chapter 16: Technique of Open Mesenteric Catheter Embolectomy 221
Diagnosis of Mesenteric Embolism 223
Patient Population 223
Preoperative Testing 223
Preoperative Imaging 223
Preoperative Considerations 225
Surgical Treatment 226
Embolectomy of the Superior Mesenteric Artery 227
Embolectomy of the Celiac Artery 228
Embolectomy of the Inferior Mesenteric Artery 230
Role of Second Look Laparotomy 230
Other Surgical Options 231
Surgical Outcomes: Short and Long Term 232
References 233
Chapter 17: Techniques of Open and Hybrid Mesenteric Revascularization for Acute Mesenteric Ischemia 235
Diagnosis 235
Initial Treatment and Resuscitation 236
Considerations 236
Exposure of SMA 237
Exposure and Control of the Supraceliac Aorta 238
Thromboendarterectomy 238
Superior Mesenteric Artery Bypass 239
Antegrade Mesenteric Bypass 240
Retrograde Mesenteric Bypass 241
Hybrid Technique: Retrograde Open Mesenteric Stenting (ROMS) 242
SMA Reimplantation 245
Bowel Viability 246
Complications 247
Postoperative Care 247
Outcomes 247
References 248
Chapter 18: Techniques of Endovascular Revascularization for Acute Mesenteric Ischemia 250
History for AMI 250
Endovascular Techniques 251
Results of Endovascular Therapy for Acute Mesenteric Ischemia 259
Conclusions 260
References 260
Chapter 19: Second-Look Laparotomy, the Open Abdomen, and Temporary Abdominal Closure in Acute Mesenteric Ischemia 262
Rationale 263
Timing 264
Technique 265
Temporary and Permanent Abdominal Wall Closure 267
Conclusion 270
References 270
Chapter 20: Results of Open and Endovascular Revascularization for Acute Mesenteric Ischemia 273
Contemporary Results of Open and Endovascular Revascularization 274
Results from the US Nationwide Inpatient Sample 274
Mayo Clinic Experience 276
Contemporary Single-Center Series 279
Population-Based Registry Results 279
Results of Newer Techniques 281
Thrombolysis for SMA Occlusion 281
Hybrid Mesenteric Revascularization 281
Long-Term Outcome 281
Conclusion 282
References 283
Chapter 21: Medical Management of Short Bowel Syndrome and Nutritional Support 285
Definition of Short Bowel Syndrome 285
Signs and Symptoms 286
Types of Short Bowel Syndrome 286
Phases of Short Bowel Syndrome 288
Treatment of Short Bowel Syndrome 289
Nutritional Strategies 289
Dietary Modifications 290
Oral Rehydration Solution 291
Home Parenteral Nutrition 291
Pharmacologic Treatments 292
Antidiarrheal Medications 293
Loperamide 293
Diphenoxylate-Atropine 293
Opioids 294
Antisecretory Medications 294
Octreotide 294
Clonidine 295
Growth Factors 295
Glutamine and Growth Hormone 295
Teduglutide 295
Intestinal Transplantation/Small Bowel Transplantation 296
References 297
Part IV: Mesenteric Venous Thrombosis 300
Chapter 22: Clinical Presentation, Etiology, and Diagnostic Considerations 301
Mesenteric Venous Anatomy 302
Etiopathogenesis 303
Pathogenesis 303
Intraluminal Causes: Changes in Flow Characteristics 305
Extraluminal Effects 305
Thrombophilic Etiologies 306
Clinical Presentation 306
Acute MVT 306
Subacute MVT 307
Chronic MVT 307
Diagnosis 308
Acute MVT 308
Laboratory Investigation 309
Imaging 310
Contrast-Enhanced Computed Tomography 310
Magnetic Resonance Imaging 310
Other Cross-Sectional Imaging 310
Subacute MVT 311
Laboratory Evaluation 311
Imaging 311
Chronic MVT 312
Laboratory Evaluation 312
Imaging 312
Conclusions 312
References 313
Chapter 23: Thrombophilia Testing in Splanchnic Vein Thrombosis 314
Acquired Provoking Factors for Splanchnic Vein Thrombosis 316
Thrombophilia Testing 320
Management 325
Summary 326
References 326
Chapter 24: Treatment of Mesenteric Venous Thrombosis 329
Acute Mesenteric Vein Thrombosis 330
Subacute Mesenteric Vein Thrombosis 334
Chronic Mesenteric Vein Thrombosis 335
Special Situations 337
Conclusion 337
References 337
Part V: Non-Occlusive Mesenteric Ischemia 339
Chapter 25: Clinical Presentation and Diagnosis 340
Etiology 340
Clinical Manifestation 341
Diagnostic Considerations 341
Laboratory Assays 342
Angiography 342
Computed Tomography 343
Magnetic Resonance Imaging 343
Summary 343
References 344
Chapter 26: Management and Results 346
Treatment Goal 347
Pharmacological Treatment 347
Surgical Treatment 348
Recommendations 348
References 349
Part VI: Median Arcuate Ligament Syndrome 350
Chapter 27: Clinical Presentation and Diagnostic Considerations 351
History and Physical 352
Imaging Studies 352
Injection of Celiac Ganglion and Gastric Tonometry 355
Differential Diagnosis 356
References 356
Chapter 28: Open Surgical Treatment 358
Open MAL Release 358
Ganglion Resection 360
Role of Endovascular Treatment 360
Postoperative Care 361
References 361
Chapter 29: Laparoscopic Transperitoneal Approach 362
Classic (Open) Approach to MAL Release 363
Surgical Technique 363
Laparoscopic Transperitoneal Approach for MALS 364
Patient Positioning 364
Surgical Approaches for Laparoscopic Techniques 365
Retrogastric Approach (Gastrocolic Ligament Approach) 365
Operative Technique 365
The Right Crus Approach 366
Operative Technique 366
The Left Crus Approach 367
Operative Technique 368
The Vessel Approach 368
Operative Technique 369
Antegastric Approach (Gastrohepatic Ligament/Pars Flaccida Approach) 369
Operative Technique 369
The Robot-Assisted Technique for MAL Release 370
Operative Technique 371
Essential Equipment 371
Laparoscope 371
The Oblique-Viewing (i.e., 30°, 45°) Laparoscope 371
The Flexible-Tip Laparoscope 372
Laparoscopic Trocars 372
Ultrasonic Dissector 372
The L-Shaped Hook Monopolar Cautery 372
Nathanson Liver Retractor 373
Conclusion 373
References 374
Chapter 30: Results of Open and Laparoscopic Median Arcuate Ligament Release 376
Clinical Presentation and Radiographic Evaluation 377
Clinical Outcomes: Laparoscopic Division of the Median Arcuate Ligament 378
Clinical Outcomes of Open Division of the Median Arcuate Ligament 380
Conclusions 383
References 383
Part VII: Isolated Mesenteric Artery Dissection 386
Chapter 31: Clinical Presentation, Etiology, and Diagnostic Considerations of Isolated Visceral Artery Dissections 387
Pathology 387
Epidemiology 388
Clinical Presentation 388
Superior Mesenteric Artery Dissection (SMAD) 388
Celiac Artery Dissection (CAD) 389
Renal Artery Dissections (RAD) 390
Etiology 391
Superior Mesenteric Artery Dissection (SMAD) 391
Celiac Artery Dissection (CAD) and Hepatic Artery Dissection (HAD) 392
Renal Artery Dissection (RAD) 392
Diagnostic Considerations 393
Duplex Ultrasound Scanning (DUS) 393
Computed Tomographic Angiography (CTA) 394
Magnetic Resonance Angiography (MRA) 398
Selective Contrast Arteriography 398
Laboratory Studies 399
Conclusion 400
References 400
Chapter 32: Open Surgical and Endovascular Revascularizations of Isolated Visceral Artery Dissections 406
Conservative Management 406
Indications for Intervention 407
Open Surgical Revascularizations 407
Superior Mesenteric Artery Dissection (SMAD) 409
Celiac Artery Dissection (CAD) and Hepatic Artery Dissection (HAD) 409
Renal Artery Dissection (RAD) 409
Endovascular Revascularization 410
Catheter-Directed Thrombolytic Therapy 410
Embolization 410
Stenting Visceral Arteries 411
Conclusions 412
References 413
Chapter 33: Results of Medical, Interventional, and Surgical Treatment 417
Role of Medical Management and Results 417
Results of Open Surgical Repair 421
Results of Endovascular Repair 422
References 424
Part VIII: Mesenteric Aneurysms 426
Chapter 34: Clinical Presentation, Etiology, Diagnostic Considerations, Treatment, and Results 427
Clinical Presentation 428
Splenic Artery Aneurysms (SAAs) 428
Hepatic Artery Aneurysms (HAAs) 429
Superior Mesenteric Artery Aneurysms (SMAAs) 429
Celiac Artery Aneurysms (CAAs) 430
Gastric Artery Aneurysms (GAAs) and Gastroepiploic Artery Aneurysms (GEAAs) 430
Pancreaticoduodenal Artery Aneurysms (PDAAs) and Gastroduodenal Artery Aneurysms (GDAAs) 430
Inferior Mesenteric, Jejunal, Ileal, and Colic Artery Aneurysms 431
Epidemiology and Etiology 431
Splenic Artery Aneurysms (SAAs) 432
Hepatic Artery Aneurysms (HAAs) 433
Superior Mesenteric Artery Aneurysms (SMAAs) 433
Celiac Artery Aneurysms (CAAs) 433
Gastric Artery Aneurysms (GAAs) and Gastroepiploic Artery Aneurysms (GEAAs) 434
Pancreaticoduodenal Artery Aneurysms (PDAAs) and Gastroduodenal Artery Aneurysms (GDAAs) 434
Inferior Mesenteric, Jejunal, Ileal, and Colic Artery Aneurysms 434
Rupture Risk 435
Splenic Artery Aneurysms (SAAs) 435
Other Splanchnic Aneurysms 435
Diagnostic Considerations 436
Duplex Ultrasound (DUS) 436
Computed Tomography Angiography (CTA) 436
Magnetic Resonance Angiography (MRA) 436
Selective Arteriography 437
Laboratory Studies 437
Treatment Modalities 438
Observation 438
Indications for Interventions 438
Open Surgical Techniques 439
Endovascular Techniques 439
Transcatheter Embolization 440
Covered Stents and Stent Grafts 441
Flow-Diverting Stents 441
Specific Issues 442
Splenic Artery Aneurysms 442
Hepatic Artery Aneurysms 444
Superior Mesenteric Artery Aneurysms 445
Celiac Artery Aneurysms 446
Pancreaticoduodenal and Gastroduodenal Artery Aneurysms 446
Gastric and Gastroepiploic Artery Aneurysms 446
Inferior Mesenteric, Jejunal, Ileal, and Colic Artery Aneurysms 447
Results 447
Open Surgical Treatment 447
Endovascular Therapy 448
Open vs Endovascular therapy 449
Conclusions 450
References 451
Index 454

Produkt-Details

• Erscheint lt. Verlag: 20.11.2014
• Zusatzinfo: XVIII, 468 p. 155 illus., 101 illus. in color.
• Verlagsort: New York
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizinische Fachgebiete ► Chirurgie ► Herz- / Thorax- / Gefäßchirurgie
• Themenwelt: Medizinische Fachgebiete ► Radiologie / Bildgebende Verfahren ► Radiologie
• Schlagworte: Acute Mesenteric Ischemia • Aortic dissection • Endarterectomy • Mesenteric Arterial Disease • Mesenteric Venous Thrombosis • revascularization
• ISBN-10: 1-4939-1847-8 / 1493918478
• ISBN-13: 978-1-4939-1847-8 / 9781493918478