Most common arterial involvement causing ischemia of intestine is:
Ans: A (Superior mesenteric artery thrombosis) Ref: Schwartz Textbook of Surgery, 10th edition, pg: 860; Mastery of Vascular and Endovascular Surgery - Gerald B. Zelenock - 2006, pg: 294 and Essentials of General Surgery, Peter F. Lawrence, 2006, pg: 459Explanation:"The SMA is the most commonly involved vessel in acute mesenteric ischemiaRef: Mastery of Vascular and Endovascular Surgery"Embolization to the superior mesenteric artery accounts for approximately 50% of ail cases of acute mesenteric ischemia Ref: Essentials of General SurgerySuperior Mesenteric Artery EmbolusMost common cause of mesenteric ischemia (40 to 50% of cases).The prognosis is poor (70% mortality).Sudden embolus with no time for collaterals to form.Presents with abdominal pain out of proportion to examination findings.Risk Factors:o Arrhythmias (atrial fibrillation),o Post-myocardial infarction with mural thrombi,o Valvular heart disease.o Structural heart defects.Superior Mesenteric Artery ThrombosisAccounts for 25 to 30% of mesenteric ischemia cases.Has worst prognosis with a mortality of 90%.Occurs near the origin of the SMA.Causes enormous amount of bowel necrosis.Most patients have a history of chronic mesenteric ischemia with vague and insidious symptoms such as:o Weight loss.o Abdominal angina (abdominal pain after meals),o Diarrhea,o Fear of food.Risk Factors:o Systemic atherosclerosis,o Old age.Angiography is the gold standard for mesenteric ischemia allowing for diagnosis and therapy.
Superior mesenteric artery thrombosis
Inferior mesenteric artery thrombosis
Hepatic artery thrombosis
Celiac artery thrombosis
Small Intestine - Mesenteric Ischemia