1. To learn about incidence and aetiology of visceral arteries diseases.
2. To become familiar with clinical symptoms and evaluation in visceral arteries diseases.
3. To indicate the role of radiology in diagnosis and treatment of the visceral arteries.
The visceral vessels are the superior and inferior mesenteric artery, coeliac trunc, hepatic artery and splenic artery and the renal arteries. There is a wide variety of pathology including both stenotic disease and dilating vessel disease. There is also a wide variety of interventional treatment options to treat these problems.
1. To become familiar with abdominal arterial and venous compression syndromes.
2. To learn about functional imaging techniques in assessment of vascular compression syndromes.
3. To become familiar with the typical imaging findings in abdominal compression syndromes and their clinical relevance.
Vascular compression syndromes are clinical entities caused by the entrapment of veins or arteries between rigid or semirigid anatomic structures or compression of hollow viscera by vascular structures. Although they occur infrequently (less than 1% of the general population are affected), they may cause significant disease, including median arcuate ligament syndrome, May-Thurner syndrome, nutcracker syndrome, superior mesenteric artery syndrome, and ureteropelvic junction obstruction. These syndromes are usually seen in otherwise healthy young patients, among whom underdiagnosis is common. Most occurrences of vascular compression are associated with an underlying anatomic abnormality. The diagnosis must be based on both clinical and radiologic findings. Digital subtraction angiography, venography or Doppler ultrasonography can provide hemodynamic information in cases of vascular compression. However, computed tomographic angiography and magnetic resonance angiography are particularly useful in that it allows comprehensive, fast evaluation of the anatomy and resultant morphologic changes. Symptomatic patients may require treatment, which is generally surgical due to the need for the relief of external compression. However, endovascular techniques are also increasingly being used to treat venous compressions.
1. To become familiar with occlusive and non-occlusive, mesenteric ischaemia.
2. To understand the differences between acute and chronic ischaemia.
3. To learn about the importance of fast and correct diagnosis in acute mesenteric ischaemia.
Acute mesenteric ischemia (AMI) corresponds to the inadequate blood supply to the gastrointestinal tract resulting in an ischemic and inflammatory injury that may progress to necrosis of the bowel wall. Prognosis is poor with a mortality rate superior to 95 % without treatment, dropping to around 70% when surgical treatment is performed. Contrast-enhanced computed tomography (CT) has become the cornerstone of the diagnosis by showing features of vascular disorder (occlusion and/or low blood flow) and features of intestinal ischemic injury. Imaging-based patient management is required, and multimodal and multidisciplinary management should be introduced. The treatment involves gastroenterologists, vascular and digestive surgeons, cardiologists, intensivists, and diagnostic and interventional radiologists. This lecture will give an overview of pathophysiology, diagnosis proves, and treatment of Acute and Chronic Mesenteric Ischemia. The goal is to improve the understanding and management of this life-threatening condition.
1. To review indications for endovascular treatment of mesenteric ischaemia.
2. To become familiar with the technical possibilities of endovascular repair of visceral arteries.
3. To learn about risks and complications of endovascular treatment of mesenteric ischaemia.
Mesenteric ischaemia is divided into acute and chronic mesenteric ischaemia. The main imaging modalities of mesenteric ischaemia are CT angiography and duplex ultrasound. Acute mesenteric ischaemia (AMI) is an abdominal emergency and is usually due to acute thrombotic or embolic occlusion of one or more of the arteries supplying the gastrointestinal tract. In practice, this is often the superior mesenteric artery (SMA). In some patients, acute mesenteric ischaemia is caused by acute mesenteric venous thrombosis, although such cases are unusual. Standard therapy is by surgical thrombectomy, embolectomy or bypass. In cases where there are no signs of irreversible intestinal ischaemia, patients may be suitable for endovascular treatment, either transcatheter thrombolysis or thrombectomy. Chronic mesenteric ischaemia (CMI) causes postprandial abdominal pain, “food-fear” and weight loss. CMI is usually due to severe stenosis or occlusion of two or three of the coeliac trunk, SMA or inferior mesenteric artery. Endovascular treatment is the primary first method used to treat CMI. Stenting is usually performed in preference to angioplasty. There are insufficient data to decide which endovascular method is best and there are no data on the use of drug-eluting technology.