Superior mesenteric arterial occlusion from a leiomyoma.
Levin S. Catalano E. Alexander JB. Pello M.
Department of Surgery, The Cooper Health System, Robert Wood Johnson Medical School, Camden, NJ, USA.
We report a solitary leiomyoma of the superior mesenteric artery resulting in arterial occlusion and gangrenous bowel. On histologic evaluation the lesion extended into the vessel lumen off its stalk and showed immunostaining for smooth muscle antigen and desmin. Leiomyomas can arise anywhere there is smooth muscle and occur most commonly in the uterus followed by the skin and gastrointestinal tract. We could not identify any previous case in the literature of a leiomyoma arising from within the wall of a mesenteric vessel.
The clinical course of asymptomatic mesenteric arterial stenosis.
Thomas JH. Blake K. Pierce GE. Hermreck AS. Seigel E.
University of Kansas Medical Center, Department of Surgery, Kansas City 66160-7308, USA.
PURPOSE: The incidence of subsequent symptomatic mesenteric vascular disease is unknown for patients who have asymptomatic mesenteric arterial stenosis. The purpose of this study was to determine the risk of developing acute and chronic mesenteric ischemia in patients identified by lateral aortography to have significant mesenteric artery stenosis. METHODS: From 1989 through 1995, 980 consecutive aortograms with anteroposterior and lateral projections were reviewed within 1 week of arteriography to identify patients who had significant mesenteric stenosis but no symptoms of mesenteric ischemia. Eighty-two patients were found to have 50% stenosis of at least one mesenteric artery and were monitored by interview to determine if symptoms of acute or chronic mesenteric ischemia developed. RESULTS: Ten patients were lost to follow-up, and 12 patients were withdrawn from the study because of mild mesenteric arterial disease (1% to 49% stenosis) in combination with more significant disease of other vessels. Follow-up was 1 to 6 years. The overall mortality rate was 40%, and mesenteric ischemia developed in four patients. Each of these four patients had significant (>50%) stenosis or occlusion of the celiac artery, superior mesenteric artery, and inferior mesenteric artery. Eighty-six percent of the 15 patients with significant three-vessel arterial disease had mesenteric ischemia, had other vague abdominal symptoms, or died. CONCLUSIONS: Patients with significant three-vessel mesenteric arterial stenosis should be considered for prophylactic mesenteric arterial reconstruction. Mesenteric arterial reconstruction should be routine when these patients undergo aortic reconstruction for aneurysmal or occlusive disease.
Percutaneous stenting for symptomatic stenosis of aberrant right subclavian artery.
Azakie A. McElhinney DB. Dowd CF. Stoney RJ.
Division of Vascular Surgery, University of California, San Francisco, USA.
Aberrant origin of the right subclavian artery is the most common abnormality of the aortic arch vessels and occurs in approximately 0.5% to 1% of the population. Symptoms can result from compression of the esophagus by the aberrant vessel, aneurysm formation, or atherosclerotic occlusion. Occlusive symptoms are typically relieved by surgical revascularization (i.e., transposition or carotid-subclavian bypass) through a cervical approach. An alternative approach to the management of stenosis of normal subclavian arteries is percutaneous angioplasty and stenting, an approach not previously used for occlusive disease of an aberrant right subclavian artery. We describe a case of focal stenosis of an aberrant right subclavian artery causing dizziness and arm claudication in a patient who underwent successful percutaneous angioplasty and stenting.
Aortic stump closure with a titanium permanent clamp: a useful emergency method.
Kobayashi M. Matsushita M. Nishikimi N. Sakurai T. Miyauchi M. Nimura Y.
First Department of Surgery, Nagoya University School of Medicine, Japan.
Successful aortic stump closure in a patient with Behcet's disease was accomplished with a permanent titanium clamp. In May 1990, a saccular infrarenal abdominal aortic aneurysm was detected in this patient, and prosthetic graft replacement was carried out. One year later, this graft was removed because of perigraft fluid collection; the aortic stump was sutured closed, and a right axillobifemoral bypass was done. In November 1994, the patient was admitted to the hospital because of an aortoenteric fistula. An emergency operation was performed, and the aortic stump was managed successfully with a permanent clamp. In patients with Behcet's disease, use of a permanent clamp may offer an alternative to traditional methods for closing blown-out aortic stumps.