Three common diseases of the superior mesenteric artery (SMA).
1.Acute SMA embolism
2, chronic SMA stenosis (occlusion)
3, SMA entrapment or pseudoaneurysm
The superior mesenteric artery originates from the anterior wall of the abdominal aorta at the height of the first lumbar vertebra and is at an angle of 50-60° with the abdominal aorta in the shape of a slightly convex arch to the left. The convex side of the arch emits the pancreaticoduodenal artery and more than ten jejunal and ileal arteries in turn, and the concave side of the arch emits the mesocolic artery, right colic artery and ileocolic artery in turn.
Acute SMA embolism—Treatment based on embolization surgery
1.Heart dislodged embolus accounts for 80%~90.9%, 60%~70% concomitant with atrial fibrillation, no atrial fibrillation without acute SMA embolism?
2, clinical manifestations: early stage: Bergan triad: severe and no corresponding signs of epigastric and periumbilical pain, organic and concomitant atrial fibrillation of heart disease, gastrointestinal evacuation performance. Late stage (6-12 hours): paralytic intestinal obstruction with bloody fluid on abdominal puncture.
3.Auxiliary examination: color Doppler, CTA, DSA.
4.Treatment: comprehensive treatment based on superior mesenteric artery dissection and embolization (necrotic bowel segment resection)!
5.Video (SMA dissection and embolization)
Spontaneous superior mesenteric artery entrapment
1. Spontaneous isolated superior mesenteric artery entrapment is clinically rare, with an autopsy incidence of 0.06% in the population.
2. The etiology is unknown. Hypertension, smoking, mesenteric cystic necrosis, atherosclerosis, trauma, congenital connective tissue disease, myofibrillar dysplasia, and medically induced loss are possible causes.
In the acute stage, the clinical manifestations are abdominal and low back pain, and 31% of patients have no clear clinical symptoms.
Indications for interventional therapy
1, patients without ischemic intestinal necrosis or signs of peritonitis, no significant relief of abdominal pain symptoms by conservative treatment.
2. Enlargement of the entrapment, eccentric or saccular shape of the entrapment aneurysm, risk of rupture in the near future, relatively fixed position of the stripped intima, and short segment of the entrapment are ideal anatomical features for stent placement.
3, the application of Wallstent self-expanding stent for the treatment of this disease was first reported by Leung et al. in 2000.
4, the ideal SMA stent: very good propulsion flexibility, precise positioning with little shortening, elasticity good stent thinness and high radial support, not easy to displace…
5, overlapping stents need to be applied carefully in this disease, and care needs to be taken to protect important branch openings.
Chronic SMA stenosis (occlusion)
1, Originally taught as a rare disease, but with the increase in atherosclerotic disease, it has become a major condition that needs to be routinely identified in elderly patients with abdominal pain.
2. Symptomatic SMA stenosis or occlusion can seriously affect the patient’s quality of life and even cause intestinal necrosis, requiring surgical intervention! Do asymptomatic ones need to be treated?
3.Surgical interventions: endoluminal treatment is becoming more and more mainstream and has the tendency to replace endoluminal debridement and diversion.
4.Select the brachial artery approach.
Even if the SMA is completely occluded, as long as there is a “stump”, after patient operation, there is still a possibility of success.
6.Severe stenosis requires small-diameter balloon pre-expansion to facilitate stent delivery and prevent entrapment or rupture.
7. The use of balloon-expanded stents is recommended.
8.Video (SMA stenosis stenting).