Rutherford's 135: Mesenteric Arterial Dissection скачать в хорошем качестве

Rutherford's 135: Mesenteric Arterial Dissection

#CIVAD #SIVAD #MesentericDissection #VascularSurgery #SMAdissection #CTAngiography #AbdominalPain #EndovascularTreatment #MedicalManagement #ArteryRemodeling #DrGregoryWeir #RutherfordChapters This summary is based on excerpts from a YouTube transcript discussing Spontaneous Isolated Visceral Artery Dissection (SIVAD), focusing on the mesenteric arteries (CIVAD), drawing on Rutherford's Vascular and Endovascular Therapy 10th Edition. Unlike aortic dissection or connective tissue disorders, CIVAD involves a tear spontaneously occurring in arteries feeding the intestines. Increased reporting isn't necessarily due to an epidemic, but vastly improved detection with modern imaging like CT scans. The superior mesenteric artery (SMA) is the most common site, followed by the celiac artery. CIVAD is more frequent in men, typically in their 50s or 60s. While hypertension is less linked than in aortic dissection, most cases don't have clear underlying conditions. A leading theory, particularly for SMA, involves mechanical stress at the artery's transition point near the aorta. There's also a noticeable cluster of cases in East Asia, raising questions about genetic predisposition. Clinical presentation varies widely, from incidental findings on scans (up to a third of cases) to severe bowel ischemia or aneurysm rupture. The main symptom is severe abdominal pain, often described as tearing, sometimes disproportionate to physical findings if ischemia is present. Diagnosis relies heavily on imaging, with contrast-enhanced CT or CT angiography (CTA) being the gold standard, showing detailed artery changes. Classification systems exist to describe dissections, but no single one universally guides treatment. Treatment is individualised. Asymptomatic patients are typically managed medically with observation. For symptomatic patients with pain but no severe ischemia, initial steps include bowel rest and close observation. The role of antiplatelets or anticoagulation is controversial. While medical management can be successful, close monitoring is crucial due to the risk of progression. Intervention is needed if medical management fails, or for emergencies like active bleeding or advanced ischemia. Open surgery (bypass, repair) is used for these emergencies. Endovascular treatment, primarily stenting, is increasingly used for ongoing symptoms (pain) not linked to critical ischemia, aiming to stabilize the artery. Follow-up imaging (CTA) is recommended to monitor for changes, especially aneurysm formation. Encouragingly, surveillance often shows artery remodeling or improvement over time. More research is needed to develop clear guidelines and predict outcomes.