Semin intervent Radiol 2009; 26(4): 345-351
DOI: 10.1055/s-0029-1242198
© Thieme Medical Publishers

Chronic Mesenteric Ischemia: Diagnosis and Treatment

Eric J. Hohenwalter1
  • 1Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Publication History

Publication Date:
17 November 2009 (online)

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ABSTRACT

Chronic mesenteric ischemia is a rare condition, generally characterized by postprandial abdominal pain. Although chronic mesenteric ischemia accounts for only a small percentage of all mesenteric ischemic events, it can have significant clinical consequences. There are multiple etiologies; however, the most common cause is atherosclerosis. The diagnosis of chronic mesenteric ischemia requires a high clinical index of suspicion. An imaging study can confirm the presence of a stenosis or occlusion involving the mesenteric vessels in patients who are suspected of having chronic mesenteric ischemia. The diagnosis is usually late in its course due to the slow progression of disease and the abundance of mesenteric collaterals. Because of the extensive collateral network, usually at least two of the three visceral vessels need to be affected before patients develop symptoms. Treatment is necessary to avoid progression to bowel ischemia and infarction. Once a diagnosis of chronic mesenteric ischemia is made, treatment options include open surgical revascularization and endovascular revascularization.