Splanchnic Artery Stenosis and Occlusion

Abstract

The observations and information available on stenosis and occlusion of the splanchnic arteries are primarily derived from surgical (1–4) and autopsy (5–7) studies. The clinical problem of splanchnic artery obstruction, however, extends beyond those patients who are either severely symptomatic or those with a fatal course. Undetermined from these studies is the incidence of asymptomatic or atypically symptomatic patients with splanchnic vessel lesions, since these vessels are not routinely palpated during exploratory laparotomy nor routinely described in autopsy reports (8). Knowledge of this incidence is necessary in evaluating the significance of the type and number of splanchnic vessel obstructions and the influence of collateral vessels in relation to the symptoms of intestinal angina. Abdominal arteriography, in contrast to autopsy and surgical studies, offers a unique opportunity to investigate these lesions in an in vivo population and thus to study their potential natural incidence and history. It provides the possibility of correlating vessel abnormalities with clinical symptoms and a means of evaluating the results of therapy. The purpose of this study was to investigate the problem of splanchnic artery obstruction in a series of patients who had undergone abdominal arteriography for a variety of indications and in whom this finding was noted incidentally. The cases were analyzed for the incidence of each type of lesion, the association and also the lack of abdominal symptoms with specific vessel obstruction, the unique types of celiac artery stenoses, and the arteriographic features of the various vessel lesions and their collateral circulation. The possible etiologies of these lesions are considered. Methods and Materials For the purposes of this investigation the reports of all the abdominal angiographies performed at the University of Pittsburgh Medical Center over a two-year period, from March 1964 through March 1966, were reviewed. Only cases with stenosis or occlusion of the origin or in the proximal third of the celiac, the superior, and the inferior mesenteric arteries were included in this study. A total of 739 cases were reviewed: 11 cases of dissecting aneurysm and 15 with technically poor films were excluded. Thus, 713 cases were considered suitable for further analysis. If the angiographic report indicated no stenosis or occlusion of the vessels under consideration, either by description of the lesion or by discussion of collateral channels, the case was considered normal for the purposes of this study. The films in these cases were then not reviewed; but the presenting complaint, the presence of abdominal pain, the reason for angiography, the patient's age, and the type of study were abstracted from the chart.