Understanding Patho-physiology of the Superior Mesenteric Artery Endarterectomy

The interesting paper by Xu et al. 1 C. Tolaymat B. Taylor M. Distal superior mesenteric artery endarterectomy remains an excellent option for revascularization in the endovascular era. Ann Vasc Surg. 2020; https://doi.org/10.1016/j.avsg.2020.06.065 Abstract Full Text PDF Scopus (1) Google Scholar underlines place of (SMA) surgery. About this, we consider some patho-physiological observations. At first remark SMA characteristic “feeding,” rather than “conduit” artery. This agrees with its large network ileal branches, consisting numerous vascular arcades originating straight terminal vessels, and important role celiac–mesenteric arteries system, as proved efficient collaterals pancreato-duodenal arcades. Differently, distal connections corresponding colonic vessels develop mainly, sometimes only, through ileocolic branch, itself one middle collaterals. Of note, acute angle branching from abdominal aorta is hemodynamically favorable normal conditions, deriving blood supply aortic stream, minimally changed vector direction; however, case arteriosclerotic parietal stiffening this anatomy can transform physiological laminar flow into a turbulent less one, result high Reynolds number. Furthermore, course tachyarrhythmias, loses pulsating waveform, becoming continuous weaker, agreement augmented Womersley number; gets worse sudden drop splanchnic supply, because increased resistances induced peripheral vasospasm. 2 Terlouw L.G. Moelker A. Abrahamsen J. Mesenteric Ischemia Study group clinical guidelines on diagnosis treatment patients chronic ischaemia. United Eur Gastroenterol 8: 371-395 Crossref PubMed (22) ,3 Gnanapandithan K. Feuerstadt P. Review article: ischemia. Curr Rep. 22: 17 (14)