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Selective Minimally Invasive Strategy for Acute Superior Mesenteric Artery Obstruction.

J Vasc Surg

January 2025

Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University. Electronic address:

Objective: Acute mesenteric artery obstruction is a severe cause of acute mesenteric ischemia, associated with significant morbidity and mortality. However, there is limited guidance on choosing between traditional and minimally invasive techniques comprehensively. This study introduces a selective, minimally invasive strategy designed to improve the survival and prognosis of patients with acute superior mesenteric artery obstruction.

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Background: Prepancreatic postduodenal portal vein (PPPV) is a rare anatomic variant where the portal vein (PV) runs anterior to the pancreas and posterior to the duodenum. Only 20 cases of PPPV, all in adults, have been reported in literature. We report the first case of PPPV in a pediatric patient discovered intraoperatively during total pancreatectomy with islet autotransplantation (TPIAT) and the third known case in which the PPPV could be isolated intraoperatively.

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Plasminogen activator inhibitor-1 (PAI-1) is central to fibrinolysis regulation, and genetic variants such as the 4G/4G genotype predispose individuals to hypercoagulability. This case highlights a 46-year-old female patient presenting with acute mesenteric venous thrombosis, where genetic evaluation revealed homozygosity for the PAI-1 4G/4G polymorphism. Management with unfractionated heparin followed by a transition to direct oral anticoagulants led to clinical resolution.

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We present a case of an 86-year-old female with chronic mesenteric ischemia secondary to long-segment flush occlusion of the superior mesenteric artery and near-total occlusion of the celiac artery. The superior mesenteric artery was unable to be revascularized by conventional antegrade approaches. Successful transcollateral crossing of the occluded superior mesenteric artery and body-flossing, followed by antegrade balloon angioplasty, shockwave lithotripsy, and stent implantation were performed.

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Intra-mesenteric steroids for steroid-refractory graft-versus-host disease in pediatric patients: A safe option.

Biomedica

December 2024

Servicio de Cardiología Pediátrica, Departamento Materno-Infantil, Fundación Valle del Lili, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia.

Introduction: Graft-versus-host disease is a serious complication after hematopoietic stem cell transplantation and is a major cause of death post-transplantation. Approximately 50% of acute graft-versus-host disease patients do not respond to systemic steroids and their prognosis is poor regardless of the treatment. This study describes our experience with pediatric patients diagnosed with steroid-refractory graft-versus-host disease who received intra-mesenteric steroid treatment.

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