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Thomas M. Van Gulik - One of the best experts on this subject based on the ideXlab platform.
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Thrombolytic therapy for acute superior Mesenteric Artery Occlusion.
Journal of vascular and interventional radiology : JVIR, 2005Co-Authors: Ivo G. Schoots, Marcel Levi, Jim A. Reekers, Johan S. Laméris, Thomas M. Van GulikAbstract:The aim of this review is to evaluate thrombolytic therapy for acute superior Mesenteric Artery Occlusion as an alternative or adjunctive treatment modality to surgical therapy and to provide current knowledge for timely and informed decisions regarding treatment of acute Mesenteric ischemia. A systematic analysis of the available literature from 1966 to 2003 regarding thrombolytic therapy for superior Mesenteric Artery thromboembolism was performed. A total of 20 case reports and seven small series covered 48 patients with acute superior Mesenteric Artery thromboembolism. In the herein reviewed series, thrombolytic therapy of acute superior Mesenteric Artery thromboembolism resulted in angiographic resolution of the thromboembolism in 43 patients, in clinical success without requiring additional surgical intervention in 30 patients, and in survival in 43 patients, with similar complication rates as in thrombolytic treatment of peripheral vascular Occlusions. Remission of abdominal pain during the first few hours of treatment formed the most important indicator of therapeutic success. Insufficient evidence from reviewed literature is available to determine the relative effectiveness and safety of thrombolytic treatment for acute superior Mesenteric Artery thromboembolism; however, initial results appear to be promising. Thrombolytic therapy can be effective relatively quickly, may obviate surgery, and has the potential to resolve the clot completely. In some cases it can be used as an alternative or neo-adjunctive treatment modality to surgery. A treatment guideline for thrombolysis of acute superior Mesenteric Artery thromboembolism should be developed.
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Local intravascular coagulation and fibrin deposition on intestinal ischemia-reperfusion in rats.
Surgery, 2003Co-Authors: Ivo G. Schoots, Marcel Levi, E. H. Paulina Roossink, P.b. Bijlsma, Thomas M. Van GulikAbstract:Abstract Background. This study investigates intravascular coagulation and thrombotic obstruction in the splanchnic vasculature after intestinal ischemia in relation to epithelial integrity and function. Methods. Intestinal ischemia was induced in rats by superior Mesenteric Artery Occlusion for 20 or 40 minutes. Intestinal injury was assessed by histologic analysis, biochemical markers, and functional studies. During reperfusion, portal and systemic blood samples were collected to analyze activation of coagulation and fibrinolysis. Results. Superior Mesenteric Artery Occlusion resulted in mild to moderate intestinal injury. Twenty and 40 minutes of ischemia and 3 hours of reperfusion resulted in local intestinal thrombin generation and conversion of fibrinogen to fibrin, reflected by 3- and 4-fold increases in thrombin-antithrombin complex levels and a 3-fold elevation of fibrin degradation products (D-dimer), respectively. During reperfusion, after a short-lasting initial activation of local fibrinolysis, plasminogen activator activity was suppressed, as indicated by an approximately 4-fold increase in portal plasma levels of the plasminogen activator inhibitor. D-dimer levels showed that activation of coagulation and depression of fibrinolysis resulted in fibrin formation, which was confirmed to be intravascular fibrin deposition by histologic examination. Conclusions. Intestinal ischemia-reperfusion results in local intravascular coagulation and fibrin deposition. (Surgery 2003;133:411-9.)
S. Acosta - One of the best experts on this subject based on the ideXlab platform.
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Surgical management of peritonitis secondary to acute superior Mesenteric Artery Occlusion
World journal of gastroenterology, 2014Co-Authors: S. AcostaAbstract:Diagnosis of acute arterial Mesenteric ischemia in the early stages is now possible using modern computed tomography with intravenous contrast enhancement and imaging in the arterial and/or portal phase. Most patients have acute superior Mesenteric Artery (SMA) Occlusion, and a large proportion of these patients will develop peritonitis prior to Mesenteric revascularization, and explorative laparotomy will therefore be necessary to evaluate the extent and severity of intestinal ischemia, and to perform bowel resections. The establishment of a hybrid operating room in vascular units in hospitals is most important to be able to perform successful intestinal revascularization. This review outlines current frontline surgical strategies to improve survival and minimize bowel morbidity in patients with peritonitis secondary to acute SMA Occlusion. Explorative laparotomy needs to be performed first. Curative treatment is based upon intestinal revascularization followed by bowel resection. If no vascular imaging has been carried out, SMA angiography is performed. In case of embolic Occlusion of the SMA, open embolectomy is performed followed by angiography. In case of thrombotic Occlusion, the occlusive lesion can be recanalized retrograde from an exposed SMA, the guidewire snared from either the femoral or brachial Artery, and stented with standard devices from these access sites. Bowel resections and sometimes gall bladder removal due to transmural infarctions are performed at initial laparotomy, leaving definitive bowel reconstructions to a planned second look laparotomy, according to the principles of damage control surgery. Patients with peritonitis secondary to acute SMA Occlusion should be managed by both the general and vascular surgeon, and a hybrid revascularization approach is of utmost importance to improve outcomes.
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Epidemiology and Prognostic Factors in Acute Superior Mesenteric Artery Occlusion
Journal of Gastrointestinal Surgery, 2010Co-Authors: S. Acosta, Maria Wadman, Ingvar Syk, Sölve Elmståhl, Olle EkbergAbstract:Background Reports on trends in incidence and mortality of acute superior Mesenteric Artery (SMA) Occlusion and evaluation of prognostic factors in recent years are lacking. Methods Patients with acute SMA Occlusion were identified through the in-patient and autopsy registry between 1970 and 1982 ( n = 270), 1987 to 1996 ( n = 135), and 2000 and 2006 ( n = 100) in Malmö, Sweden. Results The overall incidence rate decreased from 8.6 to 5.4/100,000 person years and the autopsy rate from 87% to 25% over time. A higher serum creatinine level was associated with a lower probability of undergoing multi-detector row computed tomography with intravenous contrast (MDCTiv) ( p = 0.006). Not performing a MDCTiv (odds ratio 4.0; 95% confidence interval [1.0–16.0]) remained as independent prognostic factor for in-hospital mortality. General and vascular surgeons collaborated in 25 out of 61 patients that underwent an intervention, of which 21 (84%) ( p
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Epidemiology and Prognostic Factors in Acute Superior Mesenteric Artery Occlusion.
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2010Co-Authors: S. Acosta, Maria Wadman, Ingvar Syk, Sölve Elmståhl, Olle EkbergAbstract:Background Reports on trends in incidence and mortality of acute superior Mesenteric Artery (SMA) Occlusion and evaluation of prognostic factors in recent years are lacking.
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Endovascular Therapeutic Approaches for Acute Superior Mesenteric Artery Occlusion
CardioVascular and Interventional Radiology, 2009Co-Authors: S. Acosta, B. Sonesson, T. ReschAbstract:The purpose of this study was to characterize the outcome of attempted endovascular intervention in patients with acute embolic or thrombotic superior Mesenteric Artery (SMA) Occlusion. The records of 21 patients during a 3-year period between 2005 and 2008 were retrieved from the in-hospital registry. The first group included 10 patients (6 women and 4 men; median age 78 years) with acute embolic Occlusion of the SMA. The median duration of symptoms from symptom onset to angiography was 30 hours (range 6 to 120). Synchronous emboli (n = 12) occurred in 6 patients. Embolus aspiration was performed in 9 patients, and 7 of these had satisfactory results. Complementary local thrombolysis was successful in 2 of 3 patients. Residual emboli were present at completion angiography in all 7 patients who underwent successful aspiration embolectomy, and bowel resection was necessary in only 1 of these patients. One serious complication occurred because of a long SMA dissection. The in-hospital survival rate was 90% (9 of 10 patients). The second group included 11 patients (10 women and 1 man; median age 68 years) with atherosclerotic acute SMA Occlusions. The median time of symptom duration before intervention was 97 hours (range 17 to 384). The brachial, femoral, and SMA routes were used in 6, 7, and 5 patients, respectively. SMA stenting was performed through an antegrade (n = 7) or retrograde (n = 3) approach. Bowel resection was necessary in 4 patients. No major complications occurred. The in-hospital survival rate was 82% (9 of 11 patients). Endovascular therapy of acute SMA Occlusion provides a good alternative to open surgery.
Ivo G. Schoots - One of the best experts on this subject based on the ideXlab platform.
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Thrombolytic therapy for acute superior Mesenteric Artery Occlusion.
Journal of vascular and interventional radiology : JVIR, 2005Co-Authors: Ivo G. Schoots, Marcel Levi, Jim A. Reekers, Johan S. Laméris, Thomas M. Van GulikAbstract:The aim of this review is to evaluate thrombolytic therapy for acute superior Mesenteric Artery Occlusion as an alternative or adjunctive treatment modality to surgical therapy and to provide current knowledge for timely and informed decisions regarding treatment of acute Mesenteric ischemia. A systematic analysis of the available literature from 1966 to 2003 regarding thrombolytic therapy for superior Mesenteric Artery thromboembolism was performed. A total of 20 case reports and seven small series covered 48 patients with acute superior Mesenteric Artery thromboembolism. In the herein reviewed series, thrombolytic therapy of acute superior Mesenteric Artery thromboembolism resulted in angiographic resolution of the thromboembolism in 43 patients, in clinical success without requiring additional surgical intervention in 30 patients, and in survival in 43 patients, with similar complication rates as in thrombolytic treatment of peripheral vascular Occlusions. Remission of abdominal pain during the first few hours of treatment formed the most important indicator of therapeutic success. Insufficient evidence from reviewed literature is available to determine the relative effectiveness and safety of thrombolytic treatment for acute superior Mesenteric Artery thromboembolism; however, initial results appear to be promising. Thrombolytic therapy can be effective relatively quickly, may obviate surgery, and has the potential to resolve the clot completely. In some cases it can be used as an alternative or neo-adjunctive treatment modality to surgery. A treatment guideline for thrombolysis of acute superior Mesenteric Artery thromboembolism should be developed.
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Local intravascular coagulation and fibrin deposition on intestinal ischemia-reperfusion in rats.
Surgery, 2003Co-Authors: Ivo G. Schoots, Marcel Levi, E. H. Paulina Roossink, P.b. Bijlsma, Thomas M. Van GulikAbstract:Abstract Background. This study investigates intravascular coagulation and thrombotic obstruction in the splanchnic vasculature after intestinal ischemia in relation to epithelial integrity and function. Methods. Intestinal ischemia was induced in rats by superior Mesenteric Artery Occlusion for 20 or 40 minutes. Intestinal injury was assessed by histologic analysis, biochemical markers, and functional studies. During reperfusion, portal and systemic blood samples were collected to analyze activation of coagulation and fibrinolysis. Results. Superior Mesenteric Artery Occlusion resulted in mild to moderate intestinal injury. Twenty and 40 minutes of ischemia and 3 hours of reperfusion resulted in local intestinal thrombin generation and conversion of fibrinogen to fibrin, reflected by 3- and 4-fold increases in thrombin-antithrombin complex levels and a 3-fold elevation of fibrin degradation products (D-dimer), respectively. During reperfusion, after a short-lasting initial activation of local fibrinolysis, plasminogen activator activity was suppressed, as indicated by an approximately 4-fold increase in portal plasma levels of the plasminogen activator inhibitor. D-dimer levels showed that activation of coagulation and depression of fibrinolysis resulted in fibrin formation, which was confirmed to be intravascular fibrin deposition by histologic examination. Conclusions. Intestinal ischemia-reperfusion results in local intravascular coagulation and fibrin deposition. (Surgery 2003;133:411-9.)
Thomas J Miner - One of the best experts on this subject based on the ideXlab platform.
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ischemia reperfusion protects the rat small intestine against subsequent injury
Journal of Surgical Research, 1999Co-Authors: Thomas J Miner, Houman Tavafmotamen, Alexander Stojadinovic, Terez SheadonohueAbstract:Background.It has been suggested that multiple sublethal insults are commonly associated with the development of multiple organ failure (MOF). The gut is considered to be pivotal in the pathogenesis of MOF. This study investigated the effects of repeated ischemia–reperfusion of the rat small intestine. Methods.Groups of rats underwent 30 min of superior Mesenteric Artery Occlusion or sham operation followed by 24 h of reperfusion. They then received an additional 30 min of superior Mesenteric Artery Occlusion and 2 h of reperfusion or sham operation. Small intestine was examined for mucosal injury, neutrophil infiltration, goblet cell number, and generation of the eicosanoids, prostaglandin E2, and leukotriene B4. Activation of neutrophils was assessed in systemic venous blood. Results.Animals subjected to two insults of ischemia–reperfusion demonstrated significantly less mucosal injury than animals undergoing one episode of ischemia and 2 h of reperfusion, despite increased neutrophil infiltration, leukotriene B4, and activated systemic neutrophils. Goblet cell number was elevated in animals 24 h after the first ischemia–reperfusion insult and remained enhanced after the second episode of ischemia–reperfusion. Conclusions.The initial episode of ischemia–reperfusion caused an adaptive response associated with cytoarchitectural preservation following the subsequent insult. Increased mucus production was associated with mucosal protection. Nevertheless, repeated ischemia–reperfusion potentiated the local inflammatory response and the systemic activation of neutrophils.
Marcel Levi - One of the best experts on this subject based on the ideXlab platform.
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Thrombolytic therapy for acute superior Mesenteric Artery Occlusion.
Journal of vascular and interventional radiology : JVIR, 2005Co-Authors: Ivo G. Schoots, Marcel Levi, Jim A. Reekers, Johan S. Laméris, Thomas M. Van GulikAbstract:The aim of this review is to evaluate thrombolytic therapy for acute superior Mesenteric Artery Occlusion as an alternative or adjunctive treatment modality to surgical therapy and to provide current knowledge for timely and informed decisions regarding treatment of acute Mesenteric ischemia. A systematic analysis of the available literature from 1966 to 2003 regarding thrombolytic therapy for superior Mesenteric Artery thromboembolism was performed. A total of 20 case reports and seven small series covered 48 patients with acute superior Mesenteric Artery thromboembolism. In the herein reviewed series, thrombolytic therapy of acute superior Mesenteric Artery thromboembolism resulted in angiographic resolution of the thromboembolism in 43 patients, in clinical success without requiring additional surgical intervention in 30 patients, and in survival in 43 patients, with similar complication rates as in thrombolytic treatment of peripheral vascular Occlusions. Remission of abdominal pain during the first few hours of treatment formed the most important indicator of therapeutic success. Insufficient evidence from reviewed literature is available to determine the relative effectiveness and safety of thrombolytic treatment for acute superior Mesenteric Artery thromboembolism; however, initial results appear to be promising. Thrombolytic therapy can be effective relatively quickly, may obviate surgery, and has the potential to resolve the clot completely. In some cases it can be used as an alternative or neo-adjunctive treatment modality to surgery. A treatment guideline for thrombolysis of acute superior Mesenteric Artery thromboembolism should be developed.
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Local intravascular coagulation and fibrin deposition on intestinal ischemia-reperfusion in rats.
Surgery, 2003Co-Authors: Ivo G. Schoots, Marcel Levi, E. H. Paulina Roossink, P.b. Bijlsma, Thomas M. Van GulikAbstract:Abstract Background. This study investigates intravascular coagulation and thrombotic obstruction in the splanchnic vasculature after intestinal ischemia in relation to epithelial integrity and function. Methods. Intestinal ischemia was induced in rats by superior Mesenteric Artery Occlusion for 20 or 40 minutes. Intestinal injury was assessed by histologic analysis, biochemical markers, and functional studies. During reperfusion, portal and systemic blood samples were collected to analyze activation of coagulation and fibrinolysis. Results. Superior Mesenteric Artery Occlusion resulted in mild to moderate intestinal injury. Twenty and 40 minutes of ischemia and 3 hours of reperfusion resulted in local intestinal thrombin generation and conversion of fibrinogen to fibrin, reflected by 3- and 4-fold increases in thrombin-antithrombin complex levels and a 3-fold elevation of fibrin degradation products (D-dimer), respectively. During reperfusion, after a short-lasting initial activation of local fibrinolysis, plasminogen activator activity was suppressed, as indicated by an approximately 4-fold increase in portal plasma levels of the plasminogen activator inhibitor. D-dimer levels showed that activation of coagulation and depression of fibrinolysis resulted in fibrin formation, which was confirmed to be intravascular fibrin deposition by histologic examination. Conclusions. Intestinal ischemia-reperfusion results in local intravascular coagulation and fibrin deposition. (Surgery 2003;133:411-9.)