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Distal Superior Mesenteric Artery Endarterectomy Remains an Excellent Option for Mesenteric Revascularization in the Endovascular Era.
Ann Vasc Surg. 2020 Jul 04 [Online ahead of print]AV

Abstract

BACKGROUND

Endovascular treatment of mesenteric lesions has become increasingly prevalent. Mesenteric bypass, however, remains the optimal treatment in the cases of chronic mesenteric ischemia (CMI) in young, medically fit patients given its durability. Endarterectomy has gone by the wayside, but in certain situations, this technique remains surgically relevant and should still be used. Herein, we present 2 cases of distal superior mesenteric artery (SMA) endarterectomy for mesenteric revascularization.

METHODS/RESULTS

Case 1 is a 40-year-old male with history of antithrombin III deficiency, myocardial infarction, bilateral pulmonary embolism, acute aortic thrombus, and mesenteric ischemia status after placement of a proximal SMA stent and was transferred to our institution because of concern for ischemic bowel. Intraoperative angiography showed mid to distal SMA chronic thromboembolism with narrow lumen of recanalization and distal flow. No intervention was performed at that time. He developed worsening abdominal pain and weight loss over several months which required initiation of total parenteral nutrition, complicated by line-associated sepsis. Subsequent distal SMA endarterectomy was performed. He recovered well and had improved enteral intake at 1-month follow-up, and radiographic imaging at 2 months showed patent vessels. Case 2 is a 50-year-old female with extensive smoking history and hyperlipidemia and gastroesophageal reflux who presented with postprandial abdominal pain and a forty-pound weight loss over the past year. Attempted angiographic cannulation with a stent was not successful because of flush occlusion of the SMA approximately 1 centimeter distal to the ostium that was unable to be crossed. Computed tomography angiography confirmed that the SMA origin was free of atherosclerotic disease with a distal focal segment of occlusion. She underwent successful endarterectomy of this occlusion. The postoperative course was uneventful, and at 1-month follow-up, she reported continued improvement in pain and appetite.

CONCLUSIONS

SMA endarterectomy can be successfully performed on mid to distal lesions of the SMA. This operation should remain a viable option in the management of CMI.

Authors+Show Affiliations

Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD. Electronic address: cynthiaxueras@gmail.com.Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32634563

Citation

Xu, Cynthia, et al. "Distal Superior Mesenteric Artery Endarterectomy Remains an Excellent Option for Mesenteric Revascularization in the Endovascular Era." Annals of Vascular Surgery, 2020.
Xu C, Tolaymat B, Taylor M, et al. Distal Superior Mesenteric Artery Endarterectomy Remains an Excellent Option for Mesenteric Revascularization in the Endovascular Era. Ann Vasc Surg. 2020.
Xu, C., Tolaymat, B., Taylor, M., Aicher, B. O., Flentje, A. O., Sahajwani, S., Endicott, K. M., & Nagarsheth, K. H. (2020). Distal Superior Mesenteric Artery Endarterectomy Remains an Excellent Option for Mesenteric Revascularization in the Endovascular Era. Annals of Vascular Surgery. https://doi.org/10.1016/j.avsg.2020.06.065
Xu C, et al. Distal Superior Mesenteric Artery Endarterectomy Remains an Excellent Option for Mesenteric Revascularization in the Endovascular Era. Ann Vasc Surg. 2020 Jul 4; PubMed PMID: 32634563.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Distal Superior Mesenteric Artery Endarterectomy Remains an Excellent Option for Mesenteric Revascularization in the Endovascular Era. AU - Xu,Cynthia, AU - Tolaymat,Besher, AU - Taylor,Maryclare, AU - Aicher,Brittany O, AU - Flentje,Alison O, AU - Sahajwani,Sunny, AU - Endicott,Kendal M, AU - Nagarsheth,Khanjan H, Y1 - 2020/07/04/ PY - 2020/05/05/received PY - 2020/06/27/revised PY - 2020/06/30/accepted PY - 2020/7/8/pubmed PY - 2020/7/8/medline PY - 2020/7/8/entrez JF - Annals of vascular surgery JO - Ann Vasc Surg N2 - BACKGROUND: Endovascular treatment of mesenteric lesions has become increasingly prevalent. Mesenteric bypass, however, remains the optimal treatment in the cases of chronic mesenteric ischemia (CMI) in young, medically fit patients given its durability. Endarterectomy has gone by the wayside, but in certain situations, this technique remains surgically relevant and should still be used. Herein, we present 2 cases of distal superior mesenteric artery (SMA) endarterectomy for mesenteric revascularization. METHODS/RESULTS: Case 1 is a 40-year-old male with history of antithrombin III deficiency, myocardial infarction, bilateral pulmonary embolism, acute aortic thrombus, and mesenteric ischemia status after placement of a proximal SMA stent and was transferred to our institution because of concern for ischemic bowel. Intraoperative angiography showed mid to distal SMA chronic thromboembolism with narrow lumen of recanalization and distal flow. No intervention was performed at that time. He developed worsening abdominal pain and weight loss over several months which required initiation of total parenteral nutrition, complicated by line-associated sepsis. Subsequent distal SMA endarterectomy was performed. He recovered well and had improved enteral intake at 1-month follow-up, and radiographic imaging at 2 months showed patent vessels. Case 2 is a 50-year-old female with extensive smoking history and hyperlipidemia and gastroesophageal reflux who presented with postprandial abdominal pain and a forty-pound weight loss over the past year. Attempted angiographic cannulation with a stent was not successful because of flush occlusion of the SMA approximately 1 centimeter distal to the ostium that was unable to be crossed. Computed tomography angiography confirmed that the SMA origin was free of atherosclerotic disease with a distal focal segment of occlusion. She underwent successful endarterectomy of this occlusion. The postoperative course was uneventful, and at 1-month follow-up, she reported continued improvement in pain and appetite. CONCLUSIONS: SMA endarterectomy can be successfully performed on mid to distal lesions of the SMA. This operation should remain a viable option in the management of CMI. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/32634563/Distal_Superior_Mesenteric_Artery_Endarterectomy_Remains_Excellent_Option_for_Mesenteric_Revascularization_in_the_Endovascular_Era L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(20)30567-7 DB - PRIME DP - Unbound Medicine ER -
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