superior mesenteric artery aneurysm, transit-time doppler blood flow meter, internal iliac artery graft
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1 Key words: superior mesenteric artery aneurysm, transit-time doppler blood flow meter, internal iliac artery graft
2 Table 1 Laboratory data on admission superior mesenteric aneurysm (l0mm in diameter and 15mm in length) is visible 2.bcm from the base of this artery. Fig. 2 Relationship between aneurysm and each arterial branch I nferior pancreaticoduodenal Middle colic arterv I Preoperative abdominal angiogram. A Fig. I leocolic artery jejunal Second branch of jejunal artery Fig. 3 Operative findings. The upper picture shows the fine external appearance of the operated site after orthotopic reconstruction with an internal iliac artery autograft. The lower picture shows determination of blood flow through the ileocolic artery with a transit time blood flow meter. Table 2 Change in blood flow following revas. culatization (ml/min) operalton lleocolic lst jojunal an ry branch Beiore
3 r99r+ 4 F Fig. 4 Surgical procedure outlined. Great saphenous vein grafts were used for wedge-formed dilatation of proximal and distal ends of the internal iliac artery graft. 113 (1063) Fig. 6 Postoperative abdominal angiogram (magnified pictures). The left picture shows a preoperative superior mesenteric aneurysm (arrow). The right picture shows the internal iliac artery graft (arrow). Flow of contrast material is excellent. Great saphenous vein graft Patch Internal iliac artery graft First branch of jejunal artery branch of artery I leocolic artery Fig. 5 Histological specimens. The true lumen had a diameter of 2mm. while the false lumen as filled with organized thrombi. The lower picture shows a pecimen stained for elastic fibers. Broken elastic fibers of the vascular intima are visible.
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5 Revascularization by Internal Iliac Artery Graft in a Case of Superior Mesenteric Aneurysm Junichi Shimada, Hideyuki Kawachi, Kenji Tsukamoto, Shuji Shirakata, Koichi Oga and Takahiro Oka The Second Department of Surgery, Kyoto Prefectural University of Medicine Superior mesenteric aneurysm is a rare condition and its diagnosis is frequently difficult. We recently encountered a patient with this condition who could be surgically treated on the basis of the preoperative diagnosis. The patient was a sl-year-old man who was admitted to our hospital because of repeated attacks of hypogastric pain for 3 months. Abdominal angiography revealed an aneurysm at the base of the superior mesenteric artery (SMA). Orthotopic revascularization was attempted by aneurysmectomy and internal iliac artery grafting. During and after the operation, blood flow through each SMA branch was monitored with an ultrasound blood flow meter. The excised aneurysm was histologically found to be an arteriosclerotic lesion (10 X 15 mm). In this case, an ultrasound blood flow meter was very useful in assessing run-off on the side distal from the obstructed point and in judging the viability of the intestinal tract. Arterial grafting was selected, with the expectation of long'term patency of the gaft. The effectiveness of this technique will be assessed in the future. Reprint requests: Junichi Shimada The Second Department of Surgery, Kyoto Prefectural University of Medicine KawaramachiHirokoji, Kamigyo-ku, Kyoto, 602 JAPAN
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