Thoracoabdominal aortic aneurysms. A review and current status.
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Surgical management of the thoracoabdominal aortic aneurysm is a formidable undertaking. Presently two fairly distinct operative methods are available. The conventional technique, pioneered by Etheredge, involves replacement of the aneurysm with a synthetic graft and then, step by step, revascularization of the abdominal organs with prosthetic side limbs taken from the primary graft. Individual organ ischemic time is limited to that time required for the performance of each distal side limb anastomosis. The second operative method, first described by Crawford, consists of proximal and distal control of the aneurysm, followed by its incision to simultaneously expose the origin of all four major intra-abdominal arteries. Replacement is then rapidly performed with a tubular Dacron graft including anastomosis of these major intra-abdominal arteries to four elliptical graft incisions, from within the aneurysm. Total operating time is reduced at the expense of prolonged organ ischemia. The conventional method allows for step-by-step intraoperative planning and action, and this technique is accordingly recommended to most surgeons, who have had little experience with this unusual lesion. Our recent successful experience with two cases of extensive thoracoabdominal aortic aneurysms is described as well as a discussion of additional measures which may become useful in certain cases to favor a successful outcome. Finally the problem of potential resultant paraplegia is discussed. (+info)
Ferulic acid is quickly absorbed from rat stomach as the free form and then conjugated mainly in liver.
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Ferulic acid (FA) is one of the most abundant phenolic antioxidants in the human diet. Many studies have documented its beneficial properties. It is therefore essential to understand the absorption and metabolism of FA in detail. The purpose of this study was to confirm the hypothesis that FA is absorbed in rat stomach and metabolized mainly in the liver. We determined the recovery of FA and its metabolites (FA sulfate/glucuronides) in rat gastric contents, gastric mucosa, portal vein plasma, celiac arterial plasma, bile, and urine after 2.25 micromol FA was administered in 0.5 mL physiological saline and incubated for 25 min in situ in the stomach of rats. Within 25 min, 74 +/- 11% of the administered FA disappeared from the stomach; later, FA was recovered in both free and conjugated forms in plasma, bile, and urine. On the other hand, only free FA was detected in the gastric contents and mucosa; it was also detected in the portal vein plasma as 49 +/- 5% of the total FA (all forms of FA). However, the proportion of free FA in the celiac arterial plasma, bile, and urine decreased to 5-8%. These results indicate that FA can be quickly absorbed from the rat stomach, and then is likely metabolized mainly in the liver. Such novel information would be helpful in the use of FA as a nutrient supplement. For example, oral administration of FA in capsule form or in a form bonded with sugar esters may provide a more appropriate concentration of FA in the circulation, which may improve its proposed efficacy in preventing chronic disease. (+info)
Common celiacomesenteric trunk: aneurysmal and occlusive disease.
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Eighteen patients (14 men, 4 women), ages 24 to 77 years, with a common celiacomesenteric trunk (CMT) were treated between 1965 and 2004 at the University of Michigan. Four patients had CMT aneurysmal or occlusive disease that led to operative treatment. Pertinent arteriographic findings in these 4 patients included a CMT aneurysm (n = 2), an occluded proximal CMT (n = 1), and a type III aortic dissection that was compressing the CMT (n = 1). Therapy in these 4 patients included placement of a polytetrafluoroethylene bypass graft from the supraceliac aorta to the CMT (n = 2) or a Dacron bypass graft from a thoracoabdominal bypass to the CMT (n = 1), and endovascular fenestration of the septum between the true and false lumens of an aortic dissection at the level of the CMT (n = 1). (+info)
Retroperitoneal ganglioneuroma encasing the celiac and superior mesenteric arteries.
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Ganglioneuroma is a rare neoplasm arising from the sympathoadrenal neuroendocrine system and has anatomic distribution paralleling the sympathetic chain ganglia and the adrenal medulla. In some cases, ganglioneuroma is the end stage maturation of less-differentiated neoplasms such as neuroblastoma or ganglioneuroblastoma, but based on age at diagnosis (over 10 years of age) and anatomic location, many of these tumors appear to arise de novo. It must be included in the differential diagnosis of posterior mediastinal and retroperitoneal mass. We report a case of retroperitoneal ganglioneuroma involving the celiac axis and superior mesenteric arteries in a 40-year-old female. (+info)
Mitral valve prolapse associated with celiac artery stenosis: a new ultrasonographic syndrome?
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BACKGROUND: Celiac artery stenosis (CAS) may be caused by atherosclerotic degeneration or compression exerted by the arched ligament of the diaphragm. Mitral valve prolapse (MVP) is the most common valvular disorder. There are no reports on an association between CAS and MVP. METHODS: 1560 (41%) out of 3780 consecutive patients undergoing echocardiographic assessment of MVP, had Doppler sonography of the celiac tract to detect CAS. RESULTS: CAS was found in 57 (3.7%) subjects (23 males and 34 females) none of whom complained of symptoms related to visceral ischemia. MVP was observed in 47 (82.4%) subjects with and 118 (7.9%) without CAS (p < 0.001). The agreement between MVP and CAS was 39% (95% CI 32-49%). PSV (Peak Systolic Velocity) was the only predictor of CAS in MPV patients (OR 0.24, 95% CI 0.08-0.69) as selected in a multivariate logistic model. CONCLUSION: CAS and MVP seem to be significantly associated in patients undergoing consecutive ultrasonographic screening. (+info)
Treatment of three pancreaticoduodenal artery aneurysms associated with coeliac artery occlusion and splenic artery aneurysm: a case report and review of the literature.
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A case of three pancreaticoduodenal artery (PDA) aneurysms associated with coeliac artery occlusion and a concomitant splenic arterial aneurysm is described. Surgical treatment was used because it was anticipated that the hepatic blood supply would be obstructed completely if percutaneous transluminal embolization for three PDA aneurysms were performed. Splenectomy in continuity with the splenic artery aneurysm and PDA aneurysmectomies were performed, and infrarenal abdominal aorto-splenic artery bypass was accomplished using a 6mm ringed expanded polytetrafluoroethylene graft. The postoperative course was uneventful. Graft patency and successful aneurysm ablation were confirmed using MRA and intravenous DSA. Arterial histology revealed segmental arterial mediolysis. At 2-year follow-up, the patient was well and asymptomatic. A literature review of PDA aneurysms is presented. (+info)
Selective visceral perfusion during thoracoabdominal aortic aneurysm repair.
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PURPOSE: To evaluate the effectiveness of selective visceral perfusion during repair of an thoracoabdominal aortic aneurysm (TAAA), we compared the postoperative renal and hepatic functions (blood urea nitrogen, serum creatinine, total bilirubin, glutamate pyruvate transaminase) between the two groups with and without perfusion. PATIENTS AND METHODS: We operated on 52 patients with TAAA. Among them, the visceral vessels were reconstructed in 22 patients with selective visceral perfusion and in 12 patients without perfusion. The average selective perfusion time was 49.5+/-25.5 min. in the celiac and superior mesenteric arteries and 32.8+/-18.8 min. in the renal arteries. The average perfusion flow rate per each visceral vessel was 155.4+/-97.4 ml/min. RESULTS: There were five hospital deaths. There was no significant difference between the groups in the postoperative value of four factors. The selective perfusion time for vessel reconstruction in the selective visceral perfusion group was significantly longer than the arterial clamp time for vessel reconstruction in the non-perfusion group (49.5+/-25.5 min. vs. 25.6+/-13.4 min.). CONCLUSION: Our selective visceral perfusion method is not only beneficial for organ protection, but also provides us with the necessary time to reimplant the visceral as well as intercostal or lumbar arteries. (+info)
Thoracoabdominal aortic replacement for abdominal aortic aneurysm with atypical coarctation of thoracoabdominal aorta following mitral valve plasty.
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We successfully treated a case of a 65-year-old female with an abdominal aortic aneurysm coexisting with an atypical coarctation of thoracoabdominal aorta and celiac axis and superior mesenteric artery occlusion. A dilated inferior mesenteric artery was supplying the celiac artery and superior mesenteric artery regions. The patient also had mitral regurgitation. After a mitral valve plasty, we repaired the abdominal aortic aneurysm and the atypical coarctation of the thoracoabdominal aorta using partial extracorporeal circulation, segmental clamping, and a selective perfusion of both the bilateral renal artery and dilated inferior mesenteric artery. The patient had an uneventful hospital course and remains well. (+info)