Chronic occlusion of visceral arteries
Introduction
Introduction to chronic occlusion of visceral arteries The nutritional artery of the gastrointestinal tract is mainly the celiac artery, the superior mesenteric artery and the inferior mesenteric artery. When it is chronically occluded, there are three possible consequences: establishing adequate collateral circulation; developing intestinal infarction; developing intestinal ischemia without infarction; the latter is due to collateral circulation sufficient to maintain intestinal motility, but insufficient to maintain feeding The physiological function is required, so there is a postprandial intestinal pain, which is called intestinalcolic because its clinical condition is similar to angina and intermittent claudication. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: acute superior mesenteric artery infarction
Cause
Cause of chronic occlusion of visceral artery
Nutritional blood vessels in the gastrointestinal tract (25%):
The celiac artery, superior mesenteric artery, and inferior mesenteric artery are the vascular vessels of the gastrointestinal tract. The collateral circulation between them provides a blood supply sufficient to maintain the vitality and function of the affected bowel. Therefore, most of the separate superior mesenteric artery occlusion is Asymptomatic, however, when there is a lack of blood supply to the second blood vessel, the relatively ischemic intestinal can not meet the increased blood supply requirements for feeding, which is the cause of the typical "feeding pain" of intestinal colic.
Atherosclerosis (15%):
The main cause of visceral arterial occlusion is atherosclerosis. Arterial angiography and autopsy found that the incidence of chronic mesenteric ischemia caused by arteriosclerotic occlusion in the elderly population is on the rise. Hypertension and smoking are arteriosclerotic occlusive disease. The main risk factor.
Celiac ganglion compression (5%):
Less common lesions are celiac ganglion compression celiac artery, expanded aortic pseudoaneurysm or isolated aneurysm, thromboangiitis obliterans or nodular arteritis and celiac artery, etc., a rare The medial arcuate ligament syndrome is caused by the high position of the celiac artery or the normal starting point of the celiac artery but the position of the ligament is low, thereby compressing the celiac artery and partially occluding it.
Pathogenesis
When chronic atherosclerotic lesions involve more than 2 of the three main visceral arteries, there is a rich collateral circulation between the mesenteric vessels. Under normal circumstances, the gastrointestinal tract is in the asymptomatic chronic ischemic state of the mesentery, but eats. After the increase of gastrointestinal motility and metabolic activity, more blood supply is needed to ensure its normal physiological function, but due to occlusion of the nutritional artery, blood flow can not increase and visceral ischemia occurs, producing anaerobic metabolites to stimulate the body. Pain, the severity of abdominal pain is related to the amount of food consumed and the amount of fat in the food.
Prevention
Visceral artery chronic occlusion prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Visceral complication of chronic occlusion Complications Acute superior mesenteric artery infarction
Mesenteric infarction is a common complication of this disease. In the case of intestinal colic symptoms for several months or years, mesenteric infarction can occur due to severe reduction of visceral circulation. It is estimated that about one-third of patients with mesenteric infarction have colic. Prodromal symptoms.
Symptom
Visceral arterial chronic occlusion symptoms common symptoms diarrhea dull pain nausea bloating constipation upper abdominal pain abdominal pain
The patients are mostly 40 to 59 years old, and women are more common.
1. Postprandial pain Postprandial or mid-abdominal pain after meals is the main clinical manifestation of chronic mesenteric ischemia, usually within 30 to 45 minutes after a meal, abdominal cramps or dull pain, lasting for several hours, the patient is reduced due to fear of pain Eating, pain can be manifested as pain or severe abdominal pain, radiating to the back, a small number of patients with persistent pain, similar to persistent rest pain caused by lower limb ischemia, in addition to the severity of abdominal pain and the amount of food and fat content in food .
2. Gastrointestinal activity disorder About 1/3 of patients with abdominal pain are accompanied by nausea, vomiting and bowel movement abnormalities, starting with constipation, followed by diarrhea, increasing frequency and duration. These symptoms are not characteristic, and the affected blood vessels and It is related to the ischemic site of the digestive tract. When the celiac artery is involved, there are many nausea, vomiting and bloating. The superior mesenteric artery is manifested as postprandial abdominal pain and weight loss. The inferior mesenteric artery involvement is constipation, fecal occult blood and ischemic colitis. Wait.
3. Weight loss eating-pain linkages quickly lead to anorexia in patients, followed by rapid and severe weight loss is a characteristic of this disease, with the progress of intestinal ischemia, can produce intestinal malabsorption syndrome and lead to further weight loss, A large amount of feces with foam appears, indicating that the feces are rich in fat and protein.
4. Signs of patients can have significant weight loss, the upper abdomen can be heard and murmurs, which is caused by the aorta or other narrow visceral arteries.
Examine
Examination of chronic occlusion of visceral artery
Red blood cell ratio, hypoproteinemia, hypocholesterolemia and low immunity, some cases of jejunal or colon biopsy, can be found in chronic ischemic manifestations, including intestinal mucosal atrophy, epithelial cells flat and chronic swelling.
Selective visceral angiography
(1) Abdominal angiography orthotopic radiograph: The catheter was inserted through the femoral artery to the top of the celiac artery. After a small test dose was confirmed to confirm the position of the catheter, 50% of sodium diatrizoate was injected into 30-40 ml, and then continued. Rapid multiple-shots can show the presence or absence of stenosis or occlusion in one or two of the celiac and superior mesenteric arteries.
(2) superior mesenteric artery angiography: after abdominal angiography, the catheter is inserted into the superior mesenteric artery starting point for angiography, such as the obvious expansion and extension of the inferior mesenteric artery and filling the superior mesenteric artery through the collateral circulation. , indicating superior mesenteric artery occlusion.
(3) Arterial angiography lateral position: For the medial arc ligament syndrome, lateral angiography may show that the upper edge of the celiac artery is compressed and the artery is displaced to the caudal side, while the superior and inferior mesenteric arteries usually show normal. .
2. Doppler ultrasonography to detect the proximal end of the obstruction site, can be expressed as high-speed jet blood flow or blood flow disorder spectrum, if there is hepatic artery blood backflow, it suggests celiac artery obstruction or severe stenosis, in addition to the determination of mesenteric vascular flow, A typical intestinal vascular flow rate is 500 to 1200 ml/min, which is 10% to 20% of cardiac output.
3. In the normal magnetic resonance group and the patient within 30 minutes after the meal, the blood flow of the superior mesenteric artery was significantly different. At the same time, the blood flow of the superior mesenteric artery and the upper venous vein was measured. The more severe the superior mesenteric artery was occluded, the superior mesenteric artery and the superior mesenteric vein. The difference between the blood flow ratio and the postprandial increase is less obvious.
Diagnosis
Diagnosis and diagnosis of visceral arterial chronic occlusion
Diagnostic criteria
History
Patients may have generalized atherosclerosis, thromboangiitis obliterans, nodular arteritis or abdominal tumors.
2. Clinical manifestations
Chronic mesenteric artery occlusion has a typical "triple syndrome", that is, upper abdominal pain, weight loss and vascular murmurs stimulated after a long meal, but not every case has three major symptoms, and not all three major symptoms can be diagnosed Some patients have no weight loss and vascular murmur.
3. Auxiliary inspection
Various results suggest chronic mesenteric ischemia, celiac artery, superior mesenteric artery, stenosis or occlusion of the inferior mesenteric artery.
Differential diagnosis
1. Need to be differentiated from peptic ulcer, cholecystitis, pancreatitis and abdominal mass.
2. Need to be differentiated from mesenteric artery embolization and thrombosis.
