- Celiac and SMA Dissection: Facts
-Usually isolated finding but both vessels can be involved in up to 10% of cases
-Clinical presentation is persistent abdominal pain but most cases are incidental findings
-Treatment may be conservative (anticoagulation, analgesics and beta blockade)
-Intervention may be necessary with persistent symptoms, expansion of the false lumen or true lumen compromise - Splenic Artery Aneurysms: Etiologies
-Atherosclerosis
-Portal hypertension
-Hepatic transplant
-Pregnancy
-Collagen vascular disease
-Cirrhosis - Mesenteric Artery Aneurysms: Facts
-Most common artery is splenic artery (60%)
-Hepatic artery, SMA, celiac are the other common location in sequential order
- SMA Thrombosis: Facts
-SMA occlusion results in acute intestinal ischemia and infarction
-May be a result of thrombus from cardiac thrombus (50%), atrial fibrillation (40%)
-When acute thrombus usually in more distal portion of the SMA than proximal
- Celiac and SMA Stenosis: Etiology
-Atherosclerosis (older patients)
-Median arcuate ligament syndrome (younger patients)
-Tumor encasement (pancreatic cancer)
-Pancreatitis
- CT Angiography: Mesenteric Artery Evaluation: Protocols
-Phases required depend on the application with two phases usually necessary
-Contrast injection rate is 4-5 cc/sec with contrast volumes in the 80-120 cc volume range
-Contrast used is Omnipaque-350 or Visipaque-320 depending on the patients creatinine or GFR levels
-Arterial phase imaging is usually with a 25-30 second delay and nephrographic phase is at 55-60 seconds
- CT Angiography: Mesenteric Artery Evaluation
-Stenosis
-Median arcuate ligament syndrome
-Thrombus
-Aneurysm
-Pseudoaneurysm
-Dissection
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