Chronic Mesenteric Ischemia: Diagnosis and Treatment

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.

Ischemia - mesenteric - atherosclerosis

REFERENCES

• 1 Goodman G H. Angina abdominus.  Am J Med Sci. 1918;  155 524-528
• 2 Shaw R S, Maynard III E P. Acute and chronic thrombosis of the mesenteric arteries associated with malabsorption; a report of two cases successfully treated by thromboendarterectomy.  N Engl J Med. 1958;  258 874-878
• 3 Sreenarasimhaiah J. Chronic mesenteric ischemia.  Best Pract Res Clin Gastroenterol. 2005;  19 283-295
• 4 Chang R W, Chang J B, Longo W E. Update in management of mesenteric ischemia.  World J Gastroenterol. 2006;  12 3243-3247
• 5 Cleveland T J, Nawaz S, Gaines P A. Mesenteric arterial ischaemia: diagnosis and therapeutic options.  Vasc Med. 2002;  7 311-321
• 6 Biebl M, Oldenburg W A, Paz-Fumagalli R, McKinney J M, Hakaim A G. Surgical and interventional visceral revascularization for the treatment of chronic mesenteric ischemia—when to prefer which?.  World J Surg. 2007;  31 562-568
• 7 Ujiki M, Kibbe M R. Mesenteric ischemia.  Perspect Vasc Surg Endovasc Ther. 2005;  17 309-318
• 8 Kougias P, El Sayed H F, Zhou W, Lin P H. Management of chronic mesenteric ischemia. The role of endovascular therapy.  J Endovasc Ther. 2007;  14 395-405
• 9 Mitchell E L, Moneta G L. Mesenteric duplex scanning.  Perspect Vasc Surg Endovasc Ther. 2006;  18 175-183
• 10 Atkins M D, Kwolek C J, LaMuraglia G M, Brewster D C, Chung T K, Cambria R P. Surgical revascularization versus endovascular therapy for chronic mesenteric ischemia: a comparative experience.  J Vasc Surg. 2007;  45 1162-1171
• 11 Kihara T K, Blebea J, Anderson K M, Friedman D, Atnip R G. Risk factors and outcomes following revascularization for chronic mesenteric ischemia.  Ann Vasc Surg. 1999;  13 37-44
• 12 Jimenez J G, Huber T S, Ozaki C K et al.. Durability of antegrade synthetic aortomesenteric bypass for chronic mesenteric ischemia.  J Vasc Surg. 2002;  35 1078-1084
• 13 Park W M, Cherry Jr K J, Chua H K et al.. Current results of open revascularization for chronic mesenteric ischemia: a standard for comparison.  J Vasc Surg. 2002;  35 853-859
• 14 Cho J S, Carr J A, Jacobsen G, Shepard A D, Nypaver T J, Reddy D J. Long-term outcome after mesenteric artery reconstruction: a 37-year experience.  J Vasc Surg. 2002;  35 453-460
• 15 Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri S F. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study.  Arch Surg. 1999;  134 36-42
• 16 Furrer J, Grüntzig A, Kugelmeier J, Goebel N. Treatment of abdominal angina with percutaneous dilatation of an arteria mesenterica superior stenosis. Preliminary communication.  Cardiovasc Intervent Radiol. 1980;  3 43-44
• 17 Landis M S, Rajan D K, Simons M E, Hayeems E B, Kachura J R, Sniderman K W. Percutaneous management of chronic mesenteric ischemia: outcomes after intervention.  J Vasc Interv Radiol. 2005;  16 1319-1325
• 18 Yazdi H R, Youness F, Laroia S et al.. Mesenteric artery stenting for chronic mesenteric ischemia.  Vasc Dis Manage. 2007;  4 180-184