1/12. Idiopathic intimal hyperplasia of small arteries and arterioles affecting intestines and myocardium.We report the case of a 52-year-old woman dying from a noninflammatory, occlusive vasculopathy. histology showed marked intimal hyperplasia of small arteries of the intestines and myocardium with subsequent infarction of myocardium, large intestine and gallbladder. A comprehensive work up including laboratory studies, clinical investigations and postmortem failed to assign this condition to any of the known vascular diseases.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/12. Mesenteric angioplasty for chronic intestinal ischaemia.Mesenteric angina is a difficult diagnosis and surgical treatment carries a significant morbidity and mortality. In patients with stenotic mesenteric vascular disease angioplasty offers an alternative method of treatment. In six patients who underwent mesenteric angioplasty relief of symptoms was achieved in five. recurrence of symptoms associated with recurrent stenosis occurred in two patients and was remedied by re-dilation in one. Mesenteric angioplasty is a safe alternative to surgical revascularisation for mesenteric stenosis causing chronic intestinal ischaemia.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
3/12. Does visceral ischemia play a role in the pathogenesis of acute acalculous cholecystitis?Acute acalculous cholecystitis is a virulent disease of uncertain etiology observed most commonly in critically ill patients. Although the precise mechanism is unknown, the most commonly postulated theories regarding its pathogenesis are bile stasis, sepsis, and ischemia. The role of ischemia in this process, whose etiology is multifactorial, has been difficult to elucidate. Consequently, we report two patients who developed acute acalculous cholecystitis without apparent risk for the disease other than severe visceral atherosclerosis. Both patients had symptomatic mesenteric vascular disease requiring revascularization and developed fulminant acalculous cholecystitis temporally related to exacerbation of their visceral ischemia. These cases suggest that patients with visceral atherosclerosis may be at increased risk for acute acalculous cholecystitis, perhaps due to impaired mucosal resistance when other factors, such as bile statis and sepsis, are also present.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
4/12. Treatment of acute mesenteric ischemia by percutaneous transluminal angioplasty.A 79-yr-old man with previously documented atherosclerotic vascular disease presented with acute abdominal pain, signs of peritoneal irritation, and guaiac-positive stool. A mesenteric arteriogram showed high-grade stenosis of the superior mesenteric artery with a pressure gradient of 70 mmHg and complete occlusion of the inferior mesenteric artery. Percutaneous transluminal angioplasty of the superior mesenteric artery was performed with immediate reduction of the pressure gradient, increase in vessel caliber, and relief of abdominal pain. The patient went on to complete recovery and remains pain-free 6 mo after discharge from the hospital. To our knowledge, this is the first report of percutaneous transluminal angioplasty used to treat acute mesenteric ischemia.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
5/12. Upper gastrointestinal bleeding in acute mesenteric thrombosis.We report an unusual case of upper gastrointestinal bleeding secondary to superior mesenteric vein thrombosis and review the literature to assess the frequency of upper GI bleeding in patients with superior mesenteric vascular disease. Clinical features and laboratory and radiological findings are nonspecific; endoscopy and abdominal angiograms are helpful to rule out the common causes of GI bleeding and to suspect the diagnoses of superior mesenteric vein thrombosis. Without early surgical intervention, mortality is close to 100%.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
6/12. Intimal hyperplasia and thrombosis of the visceral arteries in a young woman: possible relation with oral contraceptives and smoking.This is a report of a 26-year-old woman who died of a massive intestinal infarction caused by occlusion of the celiac axis and the superior and inferior mesenteric arteries. autopsy showed intimal hyperplasia and an overlying thrombus that obstructed the lumen of the vessel. As shown by Irey et al., exogenous or endogenous female reproductive steroids can act on the vascular system as a target organ and induce intimal hyperplasia and thrombus formation. The effects of contraceptive estrogens and progestogens are discussed, but the catalytic effect of heavy cigarette smoking appears to be the factor that induces, in predisposed women with hyperplasia, thrombosis of visceral arteries. In this case report we want to emphasize that the association between smoking and oral contraceptives can cause cardiovascular disease in young women. Failure to recognize this fact could result in delayed diagnosis and worsen the prognosis.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
7/12. Aphthous ulcers in ischemic gastroenterocolitis: a case report.Extensive occlusive mesenteric vascular disease is described in a 41-year-old man, resulting in aphthous ulcers of the stomach, small bowel, and colon. Ischemic disease was confirmed angiographically and ultimately by surgical intervention. No evidence of inflammatory bowel disease was detected. Occlusive vascular disease must be considered in the differential diagnosis of aphthous ulcers of the gastrointestinal tract. The risks of angiography may be warranted in the presence of atypical and unresponsive inflammatory bowel disease, especially when it coexists with vascular disease elsewhere.- - - - - - - - - - ranking = 3keywords = vascular disease (Clic here for more details about this article) |
8/12. Chronic intestinal ischemia. The Lahey Clinic approach to management.Recognizing decreased mesenteric arterial blood supply in symptomatic and asymptomatic patients is essential to successful treatment of the ischemic bowel. The vascular disease can be documented by using standard arteriography, including a lateral projection. We favor revascularization by bypass in the celiac and superior mesenteric systems and by reimplantation or bypass in the inferior mesenteric system. Externally supported ringed PTFE is our conduit of choice. The chances of late recurrence can be lessened by complete revascularization. For the patient with no symptoms of mesenteric insufficiency who undergoes revascularization for other abdominal arteries, it is important to avoid restricting the mesenteric flow when disease is present, and it may be necessary to revascularize the superior mesenteric artery simultaneously as a prophylactic measure. Avoidance of the major problems of bowel infarction can be achieved by these maneuvers.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
9/12. Mesenteric vascular disease.Mesenteric vascular disease continues to be associated with an extremely high mortality. It is not necessarily a disease of old age: 20 of the 75 patients in our series were less than 60 years of age. In retrospect, earlier diagnosis and a more aggressive approach could have improved the survival rate of 17.3 percent. Surgeons have been slower to accept revascularization of the bowel compared with similar procedures in the extremities and other organs. A greater understanding of the disease and the benefits of surgery should yield better results. Early laparotomy with aortomesenteric grafting and planned resection 24 hours later, as used in one patient, is advocated as a useful technique.- - - - - - - - - - ranking = 5keywords = vascular disease (Clic here for more details about this article) |
10/12. Mesenteric ischaemia--a diagnostic triad?An elderly man with ischaemic heart and peripheral vascular disease presented with a 3-month history of increasingly severe postprandial epigastric pain, nausea, vomiting, diarrhoea and weight loss, associated with gastroscopic evidence of superficial antral ulceration and discoloration. The patient died shortly after admission to hospital. autopsy showed evidence of mesenteric vascular disease and ischaemic bowel. The literature on chronic mesenteric ischaemia is briefly reviewed, and the role of arteriography is discussed.- - - - - - - - - - ranking = 2keywords = vascular disease (Clic here for more details about this article) |
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