The Superior Mesenteric Artery: From Syndrome in the Young to Vascular Atherosclerosis in the Old

Abstract

: This review is directed at increasing awareness of two diverse rare upper gastrointestinal problems that occur at opposite ends of the age spectrum and are difficult to diagnose and treat. The Superior Mesenteric Artery Syndrome (SMAS) likely involves a young patient, especially female, and is especially associated with rapid weight loss, resulting in relative strangulation of the duodenum by a narrowing of the angle between the Superior Mesenteric Artery (SMA) and the aorta. On the other hand, atherosclerosis of the SMA is associated most likely with postprandial upper intestinal ischemia and abdominal pain occurs in the elderly at high risk for cardiovascular (CV) disease. : Medical management of the SMAS in the young involves good alimentation and weight gain to overall increase the intestinal fat pad. Medical management of SMA atherosclerotic ischemia in the elderly is directed at marked lipid lowering with atherosclerotic plaque stabilization or even regression. : If needed, surgery for SMAS can be attempted laparoscopically with duodenojejunoscopy which is the most popular procedure but there are also more conservative possibilities that avoid division of the duodenum. In addition, sometimes direct vision is needed to successfully operate on SMAS. If surgery is needed for SMA atherosclerotic ischemia, it is usually attempted endoscopically with angioplasty and stent placement. : Most important, in the case of these two rare clinical entities, is that the clinician have a suspicion of their presence when indicated so that the young or old patient can be spared unnecessary suffering and return to good health in a timely fashion.

A systematic review and meta-analysis on the efficacy of statins in the treatment of atherosclerosis

“…Lowering blood lipids mainly involves reducing cholesterol in serum, liver, and aorta, and lowering very low-density lipoprotein cholesterol (VLDL-C) and LDL-C, which can effectively prevent coronary heart disease and delay atherosclerosis (7)(8)(9). However, as few meta-analyses have been conducted on the effects of statins in the treatment of atherosclerosis, and there have been limitations in the existing studies such as small sample size and different research focuses, it is impossible to effectively judge the actual treatment effects of statins on atherosclerosis (10). In the study, RCTs involving statins and atherosclerosis were recruited to investigate the efficacy of statins, and meta-analysis was conducted for a systematic analysis.…”

Dynamic ultrasonography for optimizing treatment position in superior mesenteric artery syndrome: Two case reports and review of literature

“…Case 1 had multiple histories of abdominal surgery, suggesting surgical adhesion pulled on the mesentery or restricted the SMA mobility[ 1 ]. Furthermore, the presence of atherosclerosis affecting both the SMA and the Ao, as observed in both cases, might further impede SMA mobility[ 25 , 26 ]. Given these restrictions of the SMA mobility, confirming the SMA mobility by dynamic US should be helpful; or, the absence of SMA mobility could suggest early surgical intervention.…”

miRNAs from Plasma Extracellular Vesicles Are Signatory Noninvasive Prognostic Biomarkers against Atherosclerosis in LDLr-/-Mice

“…Atherosclerosis is characterized by increased oxidative stress associated with endothelial dysfunction, infiltration of leukocytes, and deposition of modified lipoproteins [ 10 ]. The harmful consequence of oxidized LDL further accumulates the cytokine secretions, growth factors, and leukocytes that collectively accelerate the lesion and inflammation that ultimately end up to atherosclerosis [ 5 ].…”

“…One miRNA can control no less than one target gene, and multiple miRNAs can regulate the target genes. The modulations in miRNAs are associated with the development and progression of several diseases, such as atherosclerosis (AS), nasopharyngeal carcinoma (NPC), obesity, and diabetes [5][6][7]. Therefore, the miR-NAs might be used as biomarkers in these diseases.…”