American journal of roentgenology skip to main page content home current issue archive contact subscribe alerts help search go advanced search â» user name password sign in american roentgen ray society cta and mra in mesenteric ischemia: part 2, normal findings and complications after surgical and endovascular treatment ming-chen paul shih 1 , 2, john f. Angle 3, daniel a. Leung 3 , 4, kenneth j. Cherry 5, nancy l. Harthun 5, alan h. Matsumoto 3 and klaus d. Hagspiel 1 , 3 1division of noninvasive cardiovascular imaging, university of virginia health system, 1215 lee st. , po box 800170, charlottesville, va 22908. 2present address: department of medical imaging, kaohsiung medical university hospital, kaohsiung, taiwan. 3division of interventional radiology, university of virginia health system, charlottesville, va. 4present address: division of interventional radiology, medical college of virginia, richmond, va. 5division of thoracic and cardiovascular surgery, department of surgery, university of virginia health system, charlottesville, va. â next section abstract objective. discount generic viagra india A number of surgical and endovascular options exist for the treatment of acute and chronic mesenteric ischemia. Both surgical and endovascular treatments necessitate close clinical and imaging follow-up because the consequences of acute occlusions can be catastrophic. Mdct angiography (cta) and contrast-enhanced mr angiography (mra) are the preferred imaging techniques in this setting. Conclusion. We review the appearance of the normal and complicated surgical and endovascular treatment on cta and mra. Abdominal imaging angiography, ct angiography, mr gastrointestinal imaging ischemia mesentery stents previous section next section introduction therapeutic treatment of ischemic bowel is based on relief of causes and consequences of arterial obstruction. The type of treatment depends largely on the clinical presentation, with time being the most important factor determining viability before irreversible damage occurs to the bowel [1, 2]. In acute mesenteric ischemia, the viability of the bowel is usually in doubt, which necessitates an open surgical approach to assess for bowel infarction and to urgently revascularize the bowel. Percutaneous endovascular procedures are more appropriate in patients with chronic mesenteric ischemia [3, 4]. generic viagra A number of surgical and endovascular therapeutic options exist for the treatment of patients with acute or chronic mesenteric ischemia [5-7]. generic viagra Although these techniques are valuable in restoring mesenteric blood flow, they all can lead to complications and all may be subject to early or late failure. Therefore, clinical followup is mandatory, and high-quality vascular imaging is essential. Mdct angiography (cta) and, to a lesser extent, contrast-enhanced mr angiography (mra) are the most suitable noninvasive techniques [8-10]. generic viagra release date In this pictorial essay we review the normal appearance of surgical and endovascular treatments of mesenteric ischemia and their complications as seen on cta and contrast-enhanced mra. All scanning was performed on 4-, 8-, or 16-mdct scanners and 1. 5-t high-performance mr scanners. Image reconstruction was performed on carestream pacs (eastman kodak) and aquarius workstations (terarecon). Previous section next section surgical techniques embolectomy and thrombectomy surgical embolectomy or thrombectomy, together with resection of nonviable bowel, is the procedure of choice for emboli and graft thromboses that cause acute mesenteric ischemia. Early postoperative studies may show residual emboli or branch occlusions. Dissections can be also seen associated with embolectomy. Late stenoses can develop at the arteriotomy site or diffusely as a consequence of embolectomy balloon-associated intimal injury. generic viagra Endarterectomy endarterectomy is the surgical removal of plaque from an artery that has become narrowed or blocked, which usually occurs as a consequence of chronic atherosclerosis. The first successful treatment of chronic mesenteric ischemia by superior mesenteric thromboendarterectomy was reported in 1958  (fig. 1a, 1b). It is performed when atherosclerosis of the supra- and infraceliac aorta and the ostia of the visceral arteries would make placement of bypass graft difficult [11, 12]. generic viagra reviews forum Endarterectomy is also performed in cases of bowel perforation and contamination of the surgical field . Bypass placement bypass grafts can be antegrade from the supraceliac abdominal aorta or retrograde from the infraceliac abdominal aorta, the common iliac arteries, or previous grafts. Most vascular surgeons prefer antegrade or retrograde bypass grafts to thrombectomy or endarterectomy , mainly because of the shorter clamping times and greater technical ease. Both vein grafts and synthetic grafts are used, but synthetic grafts are superior because they have better patency [4, 12] (figs. generic viagra soft tabs 100mg 2 and 3a, 3b). Differentiating these bypass materials is not essential, but they have several specific characteristics. Vein grafts appear to be of relatively small caliber. generic viagra Postoperative synthetic grafts should be of a uniform size. A single-vessel bypass to the superior mesenteric artery is generally effective in providing symptomatic relief even in patients with multiple vessel occlusions (fig. buy viagra europe 3a, 3b). However, a higher incidence of graft failure and recurrence of symptoms occurs after single as opposed to multiple-vessel revascularizations . If revascularization of two or more visceral branches is performed, bifurcated grafts (fig. 4a, 4b, 4c) and jump grafts (fig. 5a, 5b) can be used instead of several individual grafts. Reimplantat.