Asunto(s)
Aneurisma Infectado , Arteria Gastroepiploica , Humanos , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/cirugía , Arteria Mesentérica Superior/diagnóstico por imagen , Arteria Mesentérica Superior/cirugía , Arteria Gastroepiploica/diagnóstico por imagen , Arteria Gastroepiploica/cirugía , Arteria HepáticaRESUMEN
BACKGROUND: Grafting the right gastroepiploic artery (GEA) to the right coronary artery (RCA) is effective, but preoperative evaluation of arterial conduit availability has not been established. By comparing the midterm graft results, we aimed to assess the efficacy of preoperative evaluation of the GEA using computed tomography (CT).MethodsâandâResults: We retrospectively examined patients who underwent isolated coronary artery bypass grafting surgery between April 2010 and December 2020, and those whose GEA was grafted to the RCA were selected: 55 patients were included in the study analysis. Postoperative evaluations were performed during the early phase, 1 year postoperatively, and at follow-up evaluations. The outer diameter of the proximal GEA was compared with the midterm graft patency grade on CT and patients were classified as Functional (Grade A) or Dysfunctional (Grades O or B). The proximal GEA outer diameters were significantly different between the Functional and Dysfunctional groups (P<0.001). Furthermore, multivariate Cox regression analysis revealed that this diameter was an independent predictor of graft functionality (P<0.001). Patients with outer proximal diameters larger than the cutoff value had superior graft results at 3 years postoperatively. The rate of freedom from a dysfunctional graft at 3 years postoperatively was 95.5% and 45.5% for the Larger and Smaller diameter subgroups, respectively (P<0.001). CONCLUSIONS: Preoperative evaluation of the outer diameter of the proximal GEA, excluding calcified GEA, using CT is a minimally invasive and useful method, and may improve midterm results of in-situ GEA grafting, even in severe stenotic lesions.
Asunto(s)
Arteria Gastroepiploica , Humanos , Arteria Gastroepiploica/diagnóstico por imagen , Estudios Retrospectivos , Puente de Arteria Coronaria/métodos , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/cirugía , Tomografía Computarizada por Rayos X , Grado de Desobstrucción VascularRESUMEN
PURPOSE: When added to the internal thoracic artery (ITA), the right gastroepiploic artery (GEA) has been used as an in-situ graft or an I-composite right ITA-right GEA graft in coronary artery bypass grafting (CABG). We aimed to verify its potential. METHODS: We evaluated 104 patients who underwent first isolated CABG with this I-composite graft. The number of distal anastomoses, graft flow (GF) and pulsatility index (PI) during surgery, and graft patency in the early term regarding this I-composite graft were evaluated. RESULTS: The number of total distal anastomoses and distal anastomoses with arterial grafts were 4.17 ± 0.81 and 3.63 ± 0.81, respectively. This I-composite graft achieved 2.38 ± 0.69 distal anastomoses. GF tended to increase according to the increased number of distal anastomoses (p = 0.241), and the PI maintained a low score regardless of the number of distal anastomoses (p = 0.834). Graft patency was 95.5%; moreover, the number of distal anastomoses with this I-composite graft did not affect early-term graft patency. CONCLUSION: Right GEA utility was expanded as this I-composite graft in addition to in-situ graft. This I-composite graft has an adequate flow capacity for revascularization in non-left anterior descending coronary artery lesions.
Asunto(s)
Arteria Gastroepiploica , Arterias Mamarias , Humanos , Arterias Mamarias/diagnóstico por imagen , Arterias Mamarias/cirugía , Arteria Gastroepiploica/diagnóstico por imagen , Arteria Gastroepiploica/trasplante , Grado de Desobstrucción Vascular , Resultado del Tratamiento , Puente de Arteria Coronaria/efectos adversos , Angiografía CoronariaRESUMEN
An 86-year-old man, with a medical history of coronary artery bypass grafting with the right gastroepiploic artery 20 years prior, was admitted to our hospital for right-sided heart failure. Computed tomography findings revealed an intrapericardial diaphragmatic hernia of the transverse colon compressing the right ventricle. The hernia was successfully repaired, and the patient recovered without any complications. Diaphragmatic hernia is rare but may be a lethal complication following coronary artery bypass grafting. We should be aware of the possibility of this condition.
Asunto(s)
Arteria Gastroepiploica , Hernia Hiatal , Hernias Diafragmáticas Congénitas , Anciano de 80 o más Años , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Arteria Gastroepiploica/diagnóstico por imagen , Arteria Gastroepiploica/trasplante , Humanos , Masculino , Resultado del TratamientoRESUMEN
Endoscopic ultrasonography has become a routine procedure in clinical practice and is widely accepted as a safe procedure. Previous studies have reported that severe bleeding rarely occurs even when performing fine-needle aspiration biopsy. Severe hemorrhage following non-interventional endoscopic ultrasonography has never been reported. We herein report a case of hemorrhagic shock due to hemoperitoneum caused by a ruptured right gastroepiploic artery consequent to a diagnostic endoscopic ultrasonography. The patient was administered two antithrombotic agents. An extensive diagnostic workup contributed to the correct diagnosis, which led to a successful treatment by transcatheter arterial embolization. Endoscopists should be aware of this rare, but potentially fatal, adverse event of endoscopic ultrasonography.
Asunto(s)
Arteria Gastroepiploica , Hemoperitoneo , Endosonografía , Arteria Gastroepiploica/diagnóstico por imagen , Hemoperitoneo/diagnóstico por imagen , Hemoperitoneo/etiología , Arteria Hepática , Humanos , UltrasonografíaRESUMEN
A 63-year-old male presented to the Emergency Department with weakness and hematochezia. He was found to have a massive gastroepiploic artery pseudoaneurysm that had eroded into the transverse colon. He underwent open en bloc resection of the aneurysm, a portion of the stomach, and a portion of the transverse colon. The case and a brief review of gastroepiploic aneurysms is presented.
Asunto(s)
Aneurisma Falso/complicaciones , Enfermedades del Colon/etiología , Arteria Gastroepiploica , Fístula Intestinal/etiología , Fístula Vascular/etiología , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Enfermedades del Colon/diagnóstico por imagen , Enfermedades del Colon/cirugía , Arteria Gastroepiploica/diagnóstico por imagen , Arteria Gastroepiploica/cirugía , Hemorragia Gastrointestinal/etiología , Humanos , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/cirugía , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/cirugíaRESUMEN
BACKGROUND Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is a well-established treatment option, improving health status and angina in selected patients with angina and/or a large area of documented ischemia and suitable anatomy. It has been used in patients with a history of coronary artery bypass grafting (CABG) but remains controversial in unusual bypass constructions. This report is of a 63-year-old man with angina due to right coronary CTO, 6 years following CABG, successfully treated using the reverse controlled antegrade and retrograde subintimal tracking technique (reverse CART technique) via the gastroepiploic (GE) artery. CASE REPORT A 63-year-old man with a history of extensive coronary artery disease, including a CTO of the right coronary artery (RCA), previously treated with a right GE artery bypass graft, presented with unacceptable angina despite optimal medical treatment. A vascular CT scan suggested severe stenosis at the level of the anastomosis between the GE artery graft and the posterior descending (PD) artery. A PCI of the native RCA CTO was successfully performed using the GE artery bypass graft as a retrograde conduit, with good angiographical and clinical outcomes. CONCLUSIONS PCI of a CTO via the GE artery has been described only occasionally before, and remains a rare treatment. This report shows that retrograde coronary artery recanalization of CTO using the reverse CART technique, via the GE artery bypass graft, was safe and effective in this case, and that it can and should be considered in selected patients.
Asunto(s)
Oclusión Coronaria , Arteria Gastroepiploica , Intervención Coronaria Percutánea , Enfermedad Crónica , Angiografía Coronaria , Oclusión Coronaria/diagnóstico por imagen , Oclusión Coronaria/cirugía , Vasos Coronarios , Arteria Gastroepiploica/diagnóstico por imagen , Arteria Gastroepiploica/cirugía , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
PURPOSE: Surgical resection is the only curative treatment for pancreatic cancer. Arterial resection and reconstruction during pancreaticoduodenectomy for advanced pancreatic cancer remain controversial due to a high rate of complications. METHODS: We report two cases of pancreatic cancer with hepatic artery resection and reconstruction using the right gastroepiploic artery during pancreaticoduodenectomy after neoadjuvant therapy. RESULTS: The patients underwent pancreaticoduodenectomy with resection of the right hepatic and common hepatic arteries. Achieving direct anastomosis was difficult; therefore, we planned hepatic artery reconstruction using the right gastroepiploic artery. We performed the reconstruction using an interrupted suture with end-to-end anastomosis. The first patient developed a postoperative pancreatic fistula, while the postoperative course of the second patient was uneventful. However, there were no adverse events related to the arterial reconstruction. R0 resection was achieved, and postoperative computed tomography revealed good patency of the reconstructed artery. CONCLUSION: Hepatic artery reconstruction using the right gastroepiploic artery in pancreatic cancer might be technically safe and might become one of the alternative options.
Asunto(s)
Arteria Gastroepiploica , Neoplasias Pancreáticas , Anastomosis Quirúrgica , Arteria Gastroepiploica/diagnóstico por imagen , Arteria Gastroepiploica/cirugía , Arteria Hepática/diagnóstico por imagen , Arteria Hepática/cirugía , Humanos , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/cirugía , PancreaticoduodenectomíaRESUMEN
Gastroepiploic aneurysms are rare. We report the case of a 74-year-old man who presented with temporary loss of consciousness and abdominal pain. Computed tomography revealed a ruptured right gastroepiploic artery aneurysm. His vital signs improved after extracellular fluid infusion; hence, we performed transcatheter arterial embolization. There were no postoperative complications, and the patient was discharged on the 15th day of hospitalization. Ruptured abdominal aneurysms are often fatal and should be considered in patients with symptoms of anemia and abdominal pain. Currently, minimally invasive transcatheter arterial embolization had been designated as the preferred treatment option because of effectiveness in both diagnosis and treatment. Thus, we report a case of ruptured right gastroepiploic artery aneurysm treated by transcatheter arterial embolization, thereby preventing an emergency surgery.
Asunto(s)
Aneurisma Roto , Embolización Terapéutica , Arteria Gastroepiploica , Dolor Abdominal/etiología , Anciano , Aneurisma Roto/diagnóstico por imagen , Aneurisma Roto/cirugía , Arteria Gastroepiploica/diagnóstico por imagen , Arteria Hepática , Humanos , MasculinoRESUMEN
BACKGROUND: Leakage of the esophago-gastrostomy after esophagectomy with gastric tube reconstruction is a serious complication. Anastomotic leakage occurs in up to 20% of patients and a compromised perfusion of the gastric tube is thought to play an important role. This meta-analysis aimed to investigate whether arterial calcification is a risk factor for anastomotic leakage in esophageal surgery. METHOD: Embase, Medline, PubMed, Cochrane databases and Google scholar databases were systematically searched for studies that assessed arterial calcification of the thoracic aorta, celiac axis including its branches, or the superior mesenteric artery in patients that underwent esophagectomy with gastric tube reconstruction. The degree of calcification was classified as absent, minor or major. A "random-effects model" was used to calculate pooled Odds Ratios (OR) and 95% confidence intervals (CI). Heterogeneity was assessed using the Q-test and I2-test. RESULTS: From the 456 articles retrieved, seven studies were selected including 1.860 patients. The median (range) of anastomotic leakage was 17.2% (12.7-24.8). Meta-analysis showed a statistically significant association between increased calcium score and anastomotic leakage for the thoracic aorta (OR 2.18(CI 1.42-3.34)), celiac axis (OR 1.62(CI 1.15-2.29)) and right post-celiac axis (common hepatic, gastroduodenal and right gastroepiploic arteries) (OR 2.69(CI 1.27-5.72)). Heterogeneity was observed for analysis on calcification of the thoracic aorta and celiac axis (I2 = 71% and 59%, respectively) but not for the right branches of the celiac axis (I2 = 0%). CONCLUSION: This meta-analysis, including good quality studies, showed a statistically significant association between arterial calcification and anastomotic leakage in patients who underwent esophagectomy with gastric tube reconstruction.
Asunto(s)
Fuga Anastomótica/epidemiología , Esofagectomía , Procedimientos de Cirugía Plástica , Estómago/cirugía , Calcificación Vascular/epidemiología , Anastomosis Quirúrgica , Aorta Torácica/diagnóstico por imagen , Arteria Celíaca/diagnóstico por imagen , Arteria Gastroepiploica/diagnóstico por imagen , Humanos , Estómago/irrigación sanguínea , Estructuras Creadas Quirúrgicamente/irrigación sanguínea , Tomografía Computarizada por Rayos X , Calcificación Vascular/diagnóstico por imagenRESUMEN
Rupture of abdominal aneurysms associated with median arcuate ligament syndrome (MALS) is a serious condition and requires accurate diagnosis in a clinical setting. We examined three patients with this condition: two women aged 45 and 71 years, and a 61-year-old man. They complained of abdominal pain and had fluid collection around the duodenum. Plain computed tomography (CT) of the fluid collection revealed hyper density, which suggests the presence of blood. Moreover, contrast-enhanced CT revealed aneurysms in the pancreatic head area. Angiography revealed aneurysms of the branches of the gastroepiploic artery, which were treated by endovascular embolization in all patients. Thus, patients with abdominal pain and high-density fluid collection around the duodenum on plain CT may suffer from hemorrhage following rupture of MALS-associated aneurysms.
Asunto(s)
Aneurisma Roto/diagnóstico por imagen , Hemorragia/diagnóstico por imagen , Síndrome del Ligamento Arcuato Medio/diagnóstico por imagen , Dolor Abdominal/diagnóstico por imagen , Dolor Abdominal/etiología , Dolor Abdominal/terapia , Anciano , Aneurisma Roto/etiología , Aneurisma Roto/terapia , Angiografía por Tomografía Computarizada , Embolización Terapéutica/métodos , Femenino , Arteria Gastroepiploica/diagnóstico por imagen , Hemorragia/etiología , Hemorragia/terapia , Humanos , Masculino , Síndrome del Ligamento Arcuato Medio/complicaciones , Persona de Mediana Edad , Páncreas/irrigación sanguínea , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To analyze the detection rate of the inferior pyloric artery (IPA) in patients with gastric cancer by computed tomography arteriography (CTA). MATERIALS AND METHODS: Fifty-four patients (48 males and 6 females; mean age, 59.0 ± 1.5 years) who had undergone radical gastrectomy for gastric cancer from September 2016 to July 2017 at our institution were recruited prospectively. Patients underwent abdominal contrast-enhanced CT scans and CTA imaging reconstruction before the operation. The origin of the IPA in all cases was determined by a radiologist based on CTA images and verified by the surgeon. The accuracy of CTA in diagnosing the origin of the IPA was calculated. Dominant vessels of the origin were analyzed. RESULTS: IPAs were detected by CTA in 51 patients (94.4%). Among these, IPAs originated from the right gastroepiploic artery (RGEA) (24 cases), the gastroduodenal artery (GDA) (4 cases), and the anterior superior pancreaticoduodenal artery (ASPDA) (20 cases). In the remaining 3 cases, the IPAs contained two branches originating from the RGEA and ASPDA, respectively. During surgery, in 2 (3.7%) of the 54 cases of gastric cancer, IPAs could not be detected; the IPAs originated from the RGEA (22 cases), GDA (5 cases), and ASPDA (24 cases). One case had an IPA originating from both the RGEA and the GDA. Finally, the accuracy of CTA in diagnosing the origin artery of the IPA was 85.2% (46/54). CONCLUSION: CTA can detect the origin of the IPA accurately, which can aid surgeons while performing pylorus-preserving operations.
Asunto(s)
Angiografía , Arteria Gastroepiploica/diagnóstico por imagen , Neoplasias Gástricas/diagnóstico , Angiografía/métodos , Femenino , Gastrectomía , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Neoplasias Gástricas/cirugía , Tomografía Computarizada por Rayos XAsunto(s)
Pérdida de Sangre Quirúrgica/prevención & control , Embolización Terapéutica/instrumentación , Endoscopía , Artería Gástrica , Arteria Gastroepiploica , Pancreatitis Aguda Necrotizante/terapia , Arteria Esplénica , Anciano , Angiografía por Tomografía Computarizada , Artería Gástrica/diagnóstico por imagen , Arteria Gastroepiploica/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Pancreatitis Aguda Necrotizante/diagnóstico por imagen , Arteria Esplénica/diagnóstico por imagen , Resultado del TratamientoRESUMEN
Omental artery aneurysms are a unique subset of splanchnic artery aneurysms that are associated with intraperitoneal hemorrhage and high mortality rates. Detecting omental artery aneurysms prior to rupture is especially challenging; as such there are limited data surrounding unruptured aneurysms. Various methods of treating ruptured omental artery aneurysms have been previously described including omentectomy and transcatheter arterial embolization. Because of the mortality rate associated with ruptures, elective intervention in unruptured splanchnic artery aneurysms is recommended regardless of their size. This report details the successful embolization of an unruptured omental artery aneurysm utilizing a percutaneous approach.
Asunto(s)
Aneurisma/terapia , Embolización Terapéutica/métodos , Arteria Gastroepiploica/diagnóstico por imagen , Aneurisma Ilíaco/terapia , Epiplón/irrigación sanguínea , Anciano , Aneurisma/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Cianoacrilatos , Fluoroscopía , Humanos , Aneurisma Ilíaco/diagnóstico por imagen , Arteria Ilíaca/diagnóstico por imagen , Masculino , PuncionesRESUMEN
ABSTRACT CONTEXT: Aneurysms of the gastroepiploic arteries are seen only rarely. They are usually diagnosed during autopsy or laparotomy in patients with hemodynamic instability. Although the operation to treat this condition is relatively easy, delay in making the diagnosis affects the course of the disease. Case Report: A 57-year-old woman was admitted to the emergency department with abdominal pain and unconsciousness. A computed tomography scan showed extravasation of contrast agent at the headcorpus junction of the pancreas, and the patient underwent exploratory laparotomy under general anesthesia. During laparotomy, aneurysmatic rupture of the right gastroepiploic artery was detected. Control over bleeding was achieved by ligating the right gastroepiploic artery at its origin. The aneurysm was also resected and sent for pathological examination. CONCLUSION: Especially in cases of unidentified shock, splanchnic artery aneurysms should be kept in mind. Moreover, in the light of the data in the literature, the possibility of death should be taken into account seriously and, if feasible, prophylactic aneurysmectomy should be performed.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Choque Hemorrágico/etiología , Aneurisma Roto/complicaciones , Arteria Gastroepiploica/cirugía , Arteria Gastroepiploica/diagnóstico por imagen , Rotura Espontánea/cirugía , Rotura Espontánea/complicaciones , Rotura Espontánea/diagnóstico por imagen , Choque Hemorrágico/cirugía , Tomografía Computarizada por Rayos X/métodos , Dolor Abdominal/etiología , Aneurisma Roto/cirugía , Aneurisma Roto/diagnóstico por imagen , Laparotomía/métodosRESUMEN
Although the aneurysm of the splenic artery represents the third most common abdominal arterial aneurysm next to the aortic and iliac aneurysms, the aneurysm of the gastroepiploic artery is extremely rare occurring at a frequency of 3-4% of all visceral arteries' aneurysms; only 17 cases have been reported in the English literature. We present the case of a 65-year-old woman with an asymptomatic visceral artery aneurysm, which was an incidental ultrasonography finding. Magnetic resonance imaging showed an arterial aneurysm close to the peripheral splenic artery with intense tortuosity of the celiac and splenic artery. Abdominal computed tomography angiography confirmed the existence of an arterial aneurysm with a diameter of 2.3 cm near the splenic hilus without identifying the involved vessel. Endoluminal treatment was considered cumbersome due to anticipated anatomic obstacles; the patient underwent an elective open surgery in which the tortuosity of the celiac and splenic arteries and the aneurysm of the left gastroepiploic artery were revealed. The aneurysm was resected after proximal and distal ligation of the gastroepiploic artery; the flow of the splenic artery was intact. Histologically, it was a true aneurysm. The patient left the hospital on the fourth postoperative day without any complication. Historically, most aneurysms of the gastroepiploic arteries have been observed in men in the sixth decade of their life and after rupture; in modern times, their early incidental apocalypse is frequent due to the widespread use of imaging studies. Diagnostic approach and preoperative planning is of paramount importance to avoid complications. Current therapeutic modalities include catheter-based techniques or laparoscopic surgery.
Asunto(s)
Aneurisma , Arteria Gastroepiploica , Anciano , Aneurisma/diagnóstico por imagen , Aneurisma/fisiopatología , Aneurisma/cirugía , Angiografía por Tomografía Computarizada , Femenino , Arteria Gastroepiploica/diagnóstico por imagen , Arteria Gastroepiploica/fisiopatología , Arteria Gastroepiploica/cirugía , Humanos , Hallazgos Incidentales , Ligadura , Angiografía por Resonancia Magnética , Resultado del Tratamiento , Procedimientos Quirúrgicos VascularesRESUMEN
CONTEXT: Aneurysms of the gastroepiploic arteries are seen only rarely. They are usually diagnosed during autopsy or laparotomy in patients with hemodynamic instability. Although the operation to treat this condition is relatively easy, delay in making the diagnosis affects the course of the disease. CASE REPORT: A 57-year-old woman was admitted to the emergency department with abdominal pain and unconsciousness. A computed tomography scan showed extravasation of contrast agent at the headcorpus junction of the pancreas, and the patient underwent exploratory laparotomy under general anesthesia. During laparotomy, aneurysmatic rupture of the right gastroepiploic artery was detected. Control over bleeding was achieved by ligating the right gastroepiploic artery at its origin. The aneurysm was also resected and sent for pathological examination. CONCLUSION: Especially in cases of unidentified shock, splanchnic artery aneurysms should be kept in mind. Moreover, in the light of the data in the literature, the possibility of death should be taken into account seriously and, if feasible, prophylactic aneurysmectomy should be performed.