Multi-modal imaging for the diagnosis of spontaneous visceral artery dissection:A case report

BACKGROUND Spontaneous visceral artery dissection(SVAD)is a rare condition that affects the visceral arteries,such as the celiac,superior mesenteric,and inferior mesenteric arteries,without involving the aorta.Organ ischemia or hemorrhage from vessel rupture can occur in SVAD;therefore,prompt detection and management is essential.Contrast-enhanced computed tomography(CECT)has been used to diagnose most of the previous cases,but few studies have explored the potential of contrast-enhanced ultrasound(CEUS)for early detection of this disease.CASE SUMMARY A 53-year-old male presented with complaints of poor appetite and abnormal liver function for the past 6 months.He had previously undergone transabdominal splenectomy,esophagogastric devascularization,and cholecystectomy for gallstones and severe portal hypertension.Liver ultrasound was performed in our department to assess liver status.An abnormal hepatic artery spectrum was observed,and dissection involving both the celiac artery and the common hepatic artery was observed.A CEUS was then performed and clearly showed the entry site of the intimal tear and the false lumen,and dissection was subsequently confirmed by CECT.The patient was asymptomatic;therefore,treatment to control the blood pressure was provided,and follow-up was recommended.After 6 months of follow-up,the celiac artery was found to be dilated with an adherent thrombus visible in the wall,and the common hepatic artery was occluded with the presence of collateralization.Despite these findings,no significant changes in liver function were observed.CONCLUSION Multi-modal imaging is effective in diagnosing SVAD,and conservative treatment is a choice for asymptomatic patients.

Nonclassical Cause of Obstructive Jaundice: A Case Report of Multiple Visceral Arterial Aneurysms in a Young Patient

Multiple visceral artery aneurysms are relatively rare;the rarest are superior mesenteric artery and gastroduodenal artery aneurysms. The clinical presentation depends on the size and site of the aneurysm. We report the case of a 33-year-old man with recurrent episodes of obstructive jaundice and weight loss. Computed tomography with contrast revealed scattered hepatic arterial aneurysms with two other aneurysms along the course of the left gastro-duodenal and superior mesenteric artery. Investigations to determine the etiology were negative, but the patient had a history of smoking and substance abuse. Angiography revealed an occluded feeding artery. The patient developed multiorgan failure, leading to cardiac arrest and died. Diagnosing multiple visceral artery aneurysms needs a high index of suspicion;early diagnosis enables early intervention, which can reduce the high mortality of this condition.

Visceral and renal arteries stenosis associated with Takayasu arteritis

Takayasu arteritis （TA） is a nonspecific granulomatous inflammatory arteriopathy of unknown cause that results in occlusive obliteration or less commonly aneurysm degeneration of large and medium-sized elastic arteries. Most descriptions of this disease have emphasized the ＂pulseless＂ syndrome, however, less attention has been paid to involvement of other segments of the aorta, renal arteries, and in particular the visceral arteries. We reported a case of type Ⅱ TA, in which both the visceral and the bilateral renal arteries were involved.

A mussel-inspired supramolecular hydrogel with robust tissue anchor for rapid hemostasis of arterial and visceral bleedings

In recent years,the developed hemostatic technologies are still difficult to be applied to the hemostasis of massive arterial and visceral hemorrhage,owing to their weak hemostatic function,inferior wet tissue adhesion,and low mechanical properties.Herein,a mussel-inspired supramolecular interaction-cross-linked hydrogel with robust mechanical property(308.47±29.20 kPa)and excellent hemostatic efficiency(96.5%±2.1%)was constructed as a hemostatic sealant.Typically,we combined chitosan(CS)with silk fibroin(SF)by cross-linking them through tannic acid(TA)to maintain the structural stability of the hydrogel,especially for wet tissue adhesion ability(shear adhesive strength=29.66±0.36 kPa).Compared with other materials reported previously,the obtained CS/TA/SF hydrogel yielded a lower amount of blood loss and shorter time to hemostasis in various arterial and visceral bleeding models,which could be ascribed to the synergistic effect of wound closure under wet state as well as intrinsic hemostatic activity of CS.As a superior hemostatic sealant,the unique hydrogel proposed in this work can be exploited to offer significant advantages in the acute wound and massive hemorrhage with the restrictive access of therapeutic moieties.