Clinical significance of mesenteric arterial collateral circulation in patients with celiac artery compression syndrome

Andre S. van Petersen; Jeroen J. Kolkman; Dick G. Gerrits; Job van der Palen; Clark J. Zeebregts; Robert H. Geelkerken; Dutch Mesenteric Ischemia Study Gr

doi:10.1016/j.jvs.2016.11.052

Clinical significance of mesenteric arterial collateral circulation in patients with celiac artery compression syndrome

Andre S. van Petersen^*, Jeroen J. Kolkman, Dick G. Gerrits, Job van der Palen, Clark J. Zeebregts, Robert H. Geelkerken, Dutch Mesenteric Ischemia Study Gr

^*Corresponding author for this work

Man, Biomaterials and Microbes (MBM)

Research output: Contribution to journal › Article › Academic › peer-review

22 Citations (Scopus)

Abstract

Objective: Although extensive collateral arterial circulation will prevent ischemia in most patients with stenosis of a single mesenteric artery, mesenteric ischemia may occur in these patients, for example, in patients with celiac artery compression syndrome (CACS). Variation in the extent of collateral circulation may explain the difference in clinical symptoms and variability in response to therapy; however, evidence is lacking. The objective of the study was to classify the presence of mesenteric arterial collateral circulation in patients with CACS and to evaluate the relation with clinical improvement after treatment.

Methods: Collateral mesenteric circulation was classified on the basis of angiographic findings. Collaterals were categorized in three groups: no visible collaterals (grade 0), collaterals seen on selective angiography only (grade 1), and collaterals visible on nonselective angiography (grade 2). Surgical release of the celiac artery in patients with suspected CACS was performed by arcuate ligament release. Clinical success after surgical revascularization was defined as an improvement in abdominal pain.

Results: Between 2002 and 2013, there were 135 consecutive patients with suspected CACS who were operated on. In 129 patients, preoperative angiograms allowed classification of collateral circulation. Primary assisted anatomic success was 93% (120/129). In patients with grade 0 collaterals, clinical success was 81% (39 of 48 patients); with grade 1 collaterals, 89% (25 of 28 patients); and with grade 2 collaterals, 52% (23 of 44 patients; P <.001).

Conclusions: Patients with CACS and with extensive collateral mesenteric arterial circulation are less likely to benefit from arcuate ligament release than are patients without this type of collateral circulation. The classification of the extent of mesenteric collateral circulation may predict and guide shared decision-making in patients with CACS.

Original language	English
Pages (from-to)	1366-1374
Number of pages	9
Journal	Journal of Vascular Surgery
Volume	65
Issue number	5
DOIs	https://doi.org/10.1016/j.jvs.2016.11.052
Publication status	Published - May-2017

Keywords

GASTRIC EXERCISE TONOMETRY
RAT
MANAGEMENT
ADAPTATIONS
OCCLUSION
ISCHEMIA
CRITERIA
STENOSIS

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@article{e939b442a23c40fd9c17beea78fa9fc1,

title = "Clinical significance of mesenteric arterial collateral circulation in patients with celiac artery compression syndrome",

abstract = "Objective: Although extensive collateral arterial circulation will prevent ischemia in most patients with stenosis of a single mesenteric artery, mesenteric ischemia may occur in these patients, for example, in patients with celiac artery compression syndrome (CACS). Variation in the extent of collateral circulation may explain the difference in clinical symptoms and variability in response to therapy; however, evidence is lacking. The objective of the study was to classify the presence of mesenteric arterial collateral circulation in patients with CACS and to evaluate the relation with clinical improvement after treatment.Methods: Collateral mesenteric circulation was classified on the basis of angiographic findings. Collaterals were categorized in three groups: no visible collaterals (grade 0), collaterals seen on selective angiography only (grade 1), and collaterals visible on nonselective angiography (grade 2). Surgical release of the celiac artery in patients with suspected CACS was performed by arcuate ligament release. Clinical success after surgical revascularization was defined as an improvement in abdominal pain.Results: Between 2002 and 2013, there were 135 consecutive patients with suspected CACS who were operated on. In 129 patients, preoperative angiograms allowed classification of collateral circulation. Primary assisted anatomic success was 93% (120/129). In patients with grade 0 collaterals, clinical success was 81% (39 of 48 patients); with grade 1 collaterals, 89% (25 of 28 patients); and with grade 2 collaterals, 52% (23 of 44 patients; P <.001).Conclusions: Patients with CACS and with extensive collateral mesenteric arterial circulation are less likely to benefit from arcuate ligament release than are patients without this type of collateral circulation. The classification of the extent of mesenteric collateral circulation may predict and guide shared decision-making in patients with CACS.",

keywords = "GASTRIC EXERCISE TONOMETRY, RAT, MANAGEMENT, ADAPTATIONS, OCCLUSION, ISCHEMIA, CRITERIA, STENOSIS",

author = "{van Petersen}, {Andre S.} and Kolkman, {Jeroen J.} and Gerrits, {Dick G.} and {van der Palen}, Job and Zeebregts, {Clark J.} and Geelkerken, {Robert H.} and {Dutch Mesenteric Ischemia Study Gr}",

year = "2017",

month = may,

doi = "10.1016/j.jvs.2016.11.052",

language = "English",

volume = "65",

pages = "1366--1374",

journal = "Journal of Vascular Surgery",

issn = "0741-5214",

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number = "5",

}

TY - JOUR

T1 - Clinical significance of mesenteric arterial collateral circulation in patients with celiac artery compression syndrome

AU - van Petersen, Andre S.

AU - Kolkman, Jeroen J.

AU - Gerrits, Dick G.

AU - van der Palen, Job

AU - Zeebregts, Clark J.

AU - Geelkerken, Robert H.

AU - Dutch Mesenteric Ischemia Study Gr

PY - 2017/5

Y1 - 2017/5

N2 - Objective: Although extensive collateral arterial circulation will prevent ischemia in most patients with stenosis of a single mesenteric artery, mesenteric ischemia may occur in these patients, for example, in patients with celiac artery compression syndrome (CACS). Variation in the extent of collateral circulation may explain the difference in clinical symptoms and variability in response to therapy; however, evidence is lacking. The objective of the study was to classify the presence of mesenteric arterial collateral circulation in patients with CACS and to evaluate the relation with clinical improvement after treatment.Methods: Collateral mesenteric circulation was classified on the basis of angiographic findings. Collaterals were categorized in three groups: no visible collaterals (grade 0), collaterals seen on selective angiography only (grade 1), and collaterals visible on nonselective angiography (grade 2). Surgical release of the celiac artery in patients with suspected CACS was performed by arcuate ligament release. Clinical success after surgical revascularization was defined as an improvement in abdominal pain.Results: Between 2002 and 2013, there were 135 consecutive patients with suspected CACS who were operated on. In 129 patients, preoperative angiograms allowed classification of collateral circulation. Primary assisted anatomic success was 93% (120/129). In patients with grade 0 collaterals, clinical success was 81% (39 of 48 patients); with grade 1 collaterals, 89% (25 of 28 patients); and with grade 2 collaterals, 52% (23 of 44 patients; P <.001).Conclusions: Patients with CACS and with extensive collateral mesenteric arterial circulation are less likely to benefit from arcuate ligament release than are patients without this type of collateral circulation. The classification of the extent of mesenteric collateral circulation may predict and guide shared decision-making in patients with CACS.

AB - Objective: Although extensive collateral arterial circulation will prevent ischemia in most patients with stenosis of a single mesenteric artery, mesenteric ischemia may occur in these patients, for example, in patients with celiac artery compression syndrome (CACS). Variation in the extent of collateral circulation may explain the difference in clinical symptoms and variability in response to therapy; however, evidence is lacking. The objective of the study was to classify the presence of mesenteric arterial collateral circulation in patients with CACS and to evaluate the relation with clinical improvement after treatment.Methods: Collateral mesenteric circulation was classified on the basis of angiographic findings. Collaterals were categorized in three groups: no visible collaterals (grade 0), collaterals seen on selective angiography only (grade 1), and collaterals visible on nonselective angiography (grade 2). Surgical release of the celiac artery in patients with suspected CACS was performed by arcuate ligament release. Clinical success after surgical revascularization was defined as an improvement in abdominal pain.Results: Between 2002 and 2013, there were 135 consecutive patients with suspected CACS who were operated on. In 129 patients, preoperative angiograms allowed classification of collateral circulation. Primary assisted anatomic success was 93% (120/129). In patients with grade 0 collaterals, clinical success was 81% (39 of 48 patients); with grade 1 collaterals, 89% (25 of 28 patients); and with grade 2 collaterals, 52% (23 of 44 patients; P <.001).Conclusions: Patients with CACS and with extensive collateral mesenteric arterial circulation are less likely to benefit from arcuate ligament release than are patients without this type of collateral circulation. The classification of the extent of mesenteric collateral circulation may predict and guide shared decision-making in patients with CACS.

KW - GASTRIC EXERCISE TONOMETRY

KW - RAT

KW - MANAGEMENT

KW - ADAPTATIONS

KW - OCCLUSION

KW - ISCHEMIA

KW - CRITERIA

KW - STENOSIS

U2 - 10.1016/j.jvs.2016.11.052

DO - 10.1016/j.jvs.2016.11.052

M3 - Article

SN - 0741-5214

VL - 65

SP - 1366

EP - 1374

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

IS - 5

ER -

Clinical significance of mesenteric arterial collateral circulation in patients with celiac artery compression syndrome

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