Year 2018 Vol. 26 No 2




Nizhny Novgorod State Medical Academy 1,
City Clinical Hospital 30, Nizhny Novgorod 2,
The Russian Federation

Objective. To study experimentally the mechanisms of intramural bloodstream dysfunction and small bowel necrosis development in case of the acute mesenteric ischemia.
Methods. Acute complete mesenteric ischemia was modelled in laboratory animals by ligating a. mesenterica cranialis. The OCT-based microangiography technique was used to monitor bowel microcirculation till the visual signs of its non-viability appeared. Then the bowel was resected, the degree of ischemic lesion was histologically evaluated.
Results. In occlusion of mesenteric arteries by the moment when macroscopic nonviability signs appear, the ischemic damage without necrosis spreads out to 22.2% of the bowel length and mucous tunic necrosis and transmural necrosis spread out to 38.1% and 39.7% of the bowel length correspondingly. While comparing the histological preparations and OCT images, the features of OCT-microangiograms were described in different degrees of ischemic lesion and bowel necrosis. According to OCT-microangiography, in 60.3% of the wall of the ischemic intestine the number of functioning vessels remained normal. The decrease in the length of functioning vessels (by 5.6%, p=0.029), the total area of the vascular bed (by 4.5%, p=0.032) and the average vascular density (by 5.1%, p=0.001) occurred only in the intestinal wall with transmural necrosis. The mechanism of the superficial bowel necrosis development was a decrease in the proportion of small diameter vessels (p=0.029) against the background of the preserved microcirculation.
Conclusions. The attempt to recommence hemocirculation in the bowel arteries which are traditionally considered empty is the basis of modern surgical treatment of the mesenteric ischemia. However, the authors came to the conclusion that for 38% of ischemic bowel the blood supply remains at a normal level till necrosis development. This fact seems important for improving results of surgical treatment of acute mesenteric ischemia because it gives the opportunity to save a part of the bowel without thrombectomy. In these cases the OCT-based microangiography method can be an effective noninvasive tool for functioning blood vessels visualization and control of treatment results.

Keywords: acute mesenteric ischemia, intestinal infarction, mesenteric arterial occlusion, microcirculation, optical coherence tomography, OCT-based microangiography, mesenteric revascularization
p. 135-145 of the original issue
  1. Garelik PV, Dubrovshchik OI, Marmysh GG, Dovnar IS, Polynskiy AA, Tsilindz IT, Mogilevets EV, Mileshko MI, Koleshko SV, Pakulnevich YuF, Deshuk AN. Diagnostic and medical problems of acute disorders of mesenteric circulation in emergency surgery. Zhurn GRGMU. 2011;(4):3-7. (in Russ.)
  2. Adaba F, Askari A, Dastur J, Patel A, Gabe SM, Vaizey CJ, Faiz O, Nightingale JM, Warusavitarne J. Mortality after acute primary mesenteric infarction: a systematic review and meta-analysis of observational studies. Colorectal Dis. 2015 Jul;17(7):566-77. doi: 10.1111/codi.12938.
  3. Prozorov SA, Grishin AV. Endovascular treatment for acute disorders of mesenteric circulation. Zhurn im NV Sklifosovskogo Neotlozh Med Pomoshch. 2016;(2):37-42. (in Russ.)
  4. Timerbulatov VM, Urazbakhtin IM, Timerbulatov ShV, Sagitov RB, Smyr RA. Visualization and objectification of diagnosis in abdominal surgery. Med Vestn Bashkortostana. 2015;10(6):26-30. (in Russ.)
  5. Beaulieu RJ, Arnaoutakis KD, Abularrage CJ, Efron DT, Schneider E, Black JH 3rd. Comparison of open and endovascular treatment of acute mesenteric ischemia. J Vasc Surg. 2014 Jan;59(1):159-64. doi: 10.1016/j.jvs.2013.06.084.
  6. Gibbons P, Roberts DE. Endovascular treatment of chronic arterial mesenteric ischemia: a changingperspective? Semin Vasc Surg. 2010 Mar;23(Is 1):47-53. doi: 10.1053/j.semvascsurg.2009.12.006.
  7. Plotnikov GP, Shukevich DL, Grigoryev EV. Abdominal complication in cardiac surgery with cardiopulmonary bypass. Kompleks Problemy Serdech-Sosud Zabolevanii. 2014;(1):75-86. (in Russ.)
  8. Basarab DA, Bagdasarov VV, Bagdasarova EA, Zelenskii AA, Ataian AA. Patofiziologicheskie aspekty problemy ostroi intestinalnoi ishemii. Infektsii v Khirurgii. 2012;10(2):6-13. (in Russ.)
  9. Gordeeva AE, Sharapov MG, Novoselov VI, Fesenko EE, Temnov AA, Khubutiya MSh. The effects of Peroxiredoxin VI on the preservation of the small intestine in rats after ischemia/reperfusion damage. Transplantologiia. 2014;(4):21-27. doi: 10.23873/2074-0506-2014-0-4-21-27. (in Russ.)
  10. Ermolov AS, Lebedev AG, Titova GP, Yartsev PA, Selina IE, Reznitsky PA, Alekseechkina OA, Kaloeva OKh, Shavrina NV, Evdokimova OL, Zhigalkin RG. The difficulties of diagnosis and treatment of non-occlusive mesenteric circulatory disorders. Khirurgiia Zhurn im NI Pirgova. 2015;(12):24-32. doi: 10.17116/hirurgia20151224-32. (in Russ.)
  11. Björck M, Wanhainen A. Nonocclusive mesenteric hypoperfusion syndromes: recognition and treatment. Semin Vasc Surg. 2010 Mar;23(1):54-64. doi: 10.1053/j.semvascsurg.2009.12.009.
  12. Acosta S. Epidemiology of mesenteric vascular disease: clinical implications. Semin Vasc Surg. 2010 Mar;23(1):4-8. doi: 10.1053/j.semvascsurg.2009.12.001.
  13. Sirotkina M, Matveev L, Shirmanova M, Zaytsev V, Buyanova N, Elagin V, Gelikonov GV, Kuznetsov SS, Kiseleva EB, Moiseev AA, Gamayunov SV, Zagaynova EV, Feldchtein FI, Vitkin A, Gladkova ND. Photodynamic therapy monitoring with optical coherence angiography. Sci Rep. 2017; Article number: 41506. doi: 10.1038/srep41506.
  14. Gelikonov VM, Gelikonov GV. New approach to cross-polarized optical coherence tomography based on orthogonal arbitrarily polarized modes. Laser Phys Lett. 2006 Sep;3(Is 9):445-51. doi: 10.1002/lapl.200610030.
  15. Matveev LA, Zaitsev VY, Gelikonov GV, Matveyev AL, Moiseev AA, Ksenofontov SY, Gelikonov VM, Sirotkina MA, Gladkova ND, Demidov V, Vitkin A. Hybrid M-mode-like OCT imaging of three-dimensional microvasculature in vivo using reference-free processing of complex valued B-scans. Opt Lett. 2015 Apr 1;40(7):1472-75. doi: 10.1364/OL.40.001472.
Address for correspondence:
605157, The Russian Federation,
Nizhny Novgorod, Berezovskaya Str., 85,
City Clinical Hospital 30
of Moscow District,
Surgical Unit 2,
Tel.: +7 905 012-21-50,
Ryabkov Maxim G.
Information about the authors:
Ryabkov Maxim G., MD, Associate Professor, Consultant of the Surgical Unit 2, City Clinical Hospital 30 of Moscow District, Nizhny Novgorod, Russian Federation.
Kiseleva Elena B., PhD, Researcher of the Laboratory of Studying the Optical Properties of Tissues of SRI of Biomedical Technologies, Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russian Federation.
Gladkova Natalia D., MD, Professor, Deputy Director of SRI of Biomedical Technologies, Nizhny Novgorod State Medical Academy, Russian Federation.
Baleev Mixail S., Surgeon, the Surgical Unit 2, City Clinical Hospital 30 of Moscow District, Nizhny Novgorod, Russian Federation.
Bedrina Evgenia L., Pathologist, City Clinical Hospital 30 of Moscow District, Nizhny Novgorod, the Chief Out-Of-Staff Specialist (Pathologist) of the Department of Health, Nizhny Novgorod, Russian Federation.
Lukoyanychev Egor E., PhD, Surgeon, City Clinical Hospital 30 of Moscow District, Nizhny Novgorod, Russian Federation.
Mironov Andrey A., PhD, Senior Researcher of the Central Research Laboratory, Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russian Federation.
Dezortsev Ilya L., Surgeon, City Clinical Hospital 30 of Moscow District, Nizhny Novgorod, Russian Federation.
Beschastnov Vladimir V., MD, Associate Professor, Surgical Unit N2, Consultant of the Surgical Unit 2, City Clinical Hospital 30 of Moscow District, Nizhny Novgorod, Russian Federation.
Contacts | ©Vitebsk State Medical University, 2007-2023