Surgical Intervention for Chronic Mesenteric Ischemia

Abstract

Symptomatic chronic mesenteric ischemia (CMI) is a relatively rare condition, yet there are significant clinical consequences for those affected by the disease. CMI not only reduces quality of life but also increases an individual's risk for life-threatening acute mesenteric ischemia. Surgery is the definitive treatment to reduce the risk for this potentially fatal outcome, and both endovascular and open surgical strategies are currently utilized. This review article discusses the approach to making a diagnosis of CMI, as well as the surgical techniques used to revascularize the mesenteric circulation.

Keywords

mesenteric ischemia - mesenteric bypass - mesenteric artery angioplasty and stenting

• References

• 1 Wilson DB, Mostafavi K, Craven TE, Ayerdi J, Edwards MS, Hansen KJ. Clinical course of mesenteric artery stenosis in elderly Americans. Arch Intern Med 2006; 166 (19) 2095-2100
• 2 Hohenwalter EJ. Chronic mesenteric ischemia: diagnosis and treatment. Semin Intervent Radiol 2009; 26 (04) 345-351
• 3 Blauw JTM, Bulut T, Oderich GS, Geelkerken BR. ; Dutch Mesenteric Ischemia Study Group. Mesenteric vascular treatment 2016: from open surgical repair to endovascular revascularization. Best Pract Res Clin Gastroenterol 2017; 31 (01) 75-84
• 4 Kolkman JJ, Geelkerken RH. Diagnosis and treatment of chronic mesenteric ischemia: An update. Best Pract Res Clin Gastroenterol 2017; 31 (01) 49-57
• 5 Bornak A, Milner R. Endovascular treatment of occlusive superior mesenteric artery disease. In: Chaikof E, Cambria R. , eds. Atlas of Vascular Surgery and Endovascular Therapy: Anatomy and Technique. Philadelphia, PA: Elsevier Saunders; 2014: 491-499
• 6 Moneta GL, Yeager RA, Dalman R, Antonovic R, Hall LD, Porter JM. Duplex ultrasound criteria for diagnosis of splanchnic artery stenosis or occlusion. J Vasc Surg 1991; 14 (04) 511-518 , discussion 518–520
• 7 Bowersox JC, Zwolak RM, Walsh DB. , et al. Duplex ultrasonography in the diagnosis of celiac and mesenteric artery occlusive disease. J Vasc Surg 1991; 14 (06) 780-786 , discussion 786–788
• 8 Perko MJ, Just S, Schroeder TV. Importance of diastolic velocities in the detection of celiac and mesenteric artery disease by duplex ultrasound. J Vasc Surg 1997; 26 (02) 288-293
• 9 Pellerito JS, Revzin MV, Tsang JC, Greben CR, Naidich JB. Doppler sonographic criteria for the diagnosis of inferior mesenteric artery stenosis. J Ultrasound Med 2009; 28 (05) 641-650
• 10 Clair DG, Beach JM. Mesenteric ischemia. N Engl J Med 2016; 374 (10) 959-968
• 11 Shih M-CP, Hagspiel KD. CTA and MRA in mesenteric ischemia: part 1, role in diagnosis and differential diagnosis. AJR Am J Roentgenol 2007; 188 (02) 452-461
• 12 van Noord D, Kolkman JJ. Functional testing in the diagnosis of chronic mesenteric ischemia. Best Pract Res Clin Gastroenterol 2017; 31 (01) 59-68
• 13 Thomas JH, Blake K, Pierce GE, Hermreck AS, Seigel E. The clinical course of asymptomatic mesenteric arterial stenosis. J Vasc Surg 1998; 27 (05) 840-844
• 14 Morris Jr GC, Debakey ME. Abdominal angina--diagnosis and surgical treatment. JAMA 1961; 176: 89-92
• 15 Schermerhorn ML, Giles KA, Hamdan AD, Wyers MC, Pomposelli FB. Mesenteric revascularization: management and outcomes in the United States, 1988-2006. J Vasc Surg 2009; 50 (02) 341-348.e1
• 16 Alahdab F, Arwani R, Pasha AK. , et al. A systematic review and meta-analysis of endovascular versus open surgical revascularization for chronic mesenteric ischemia. J Vasc Surg 2018; 67 (05) 1598-1605
• 17 Erben Y, Jean RA, Protack CD. , et al. Improved mortality in treatment of patients with endovascular interventions for chronic mesenteric ischemia. J Vasc Surg 2018; 67 (06) 1805-1812
• 18 Malgor RD, Oderich GS, McKusick MA. , et al. Results of single- and two-vessel mesenteric artery stents for chronic mesenteric ischemia. Ann Vasc Surg 2010; 24 (08) 1094-1101
• 19 Kirkwood ML, Arbique GM, Guild JB. , et al. Surgeon education decreases radiation dose in complex endovascular procedures and improves patient safety. J Vasc Surg 2013; 58 (03) 715-721
• 20 Blauw JT, Meerwaldt R, Brusse-Keizer M, Kolkman JJ, Gerrits D, Geelkerken RH. ; Multidisciplinary Study Group of Mesenteric Ischemia. Retrograde open mesenteric stenting for acute mesenteric ischemia. J Vasc Surg 2014; 60 (03) 726-734
• 21 Peck MA, Conrad MF, Kwolek CJ, LaMuraglia GM, Paruchuri V, Cambria RP. Intermediate-term outcomes of endovascular treatment for symptomatic chronic mesenteric ischemia. J Vasc Surg 2010; 51 (01) 140-7.e1 , 2
• 22 Shirasu T, Hosaka A, Okamoto H. , et al. Bowel necrosis following endovascular revascularization for chronic mesenteric ischemia: a case report and review of the literature. BMC Gastroenterol 2013; 13: 118
• 23 Schaefer PJ, Schaefer FK, Mueller-Huelsbeck S, Jahnke T. Chronic mesenteric ischemia: stenting of mesenteric arteries. Abdom Imaging 2007; 32 (03) 304-309
• 24 Indes JE, Giacovelli JK, Muhs BE, Sosa JA, Dardik A. Outcomes of endovascular and open treatment for chronic mesenteric ischemia. J Endovasc Ther 2009; 16 (05) 624-630
• 25 Sharafuddin MJ, Nicholson RM, Kresowik TF, Amin PB, Hoballah JJ, Sharp WJ. Endovascular recanalization of total occlusions of the mesenteric and celiac arteries. J Vasc Surg 2012; 55 (06) 1674-1681
• 26 Oderich GS. Current concepts in the management of chronic mesenteric ischemia. Curr Treat Options Cardiovasc Med 2010; 12 (02) 117-130
• 27 Oderich GS, Gloviczki P, Bower TC. Open surgical treatment for chronic mesenteric ischemia in the endovascular era: when it is necessary and what is the preferred technique?. Semin Vasc Surg 2010; 23 (01) 36-46
• 28 Zacharias N, Eghbalieh SD, Chang BB. , et al. Chronic mesenteric ischemia outcome analysis and predictors of endovascular failure. J Vasc Surg 2016; 63 (06) 1582-1587
• 29 Farber MA, Carlin RE, Marston WA, Owens LV, Burnham SJ, Keagy BA. Distal thoracic aorta as inflow for the treatment of chronic mesenteric ischemia. J Vasc Surg 2001; 33 (02) 281-287 , discussion 287–288
• 30 Kruger AJ, Walker PJ, Foster WJ, Jenkins JS, Boyne NS, Jenkins J. Open surgery for atherosclerotic chronic mesenteric ischemia. J Vasc Surg 2007; 46 (05) 941-945
• 31 Jimenez JG, Huber TS, Ozaki CK. , et al. Durability of antegrade synthetic aortomesenteric bypass for chronic mesenteric ischemia. J Vasc Surg 2002; 35 (06) 1078-1084
• 32 Rapp JH, Reilly LM, Qvarfordt PG, Goldstone J, Ehrenfeld WK, Stoney RJ. Durability of endarterectomy and antegrade grafts in the treatment of chronic visceral ischemia. J Vasc Surg 1986; 3 (05) 799-806
• 33 Kansal N, LoGerfo FW, Belfield AK. , et al. A comparison of antegrade and retrograde mesenteric bypass. Ann Vasc Surg 2002; 16 (05) 591-596
• 34 Cho JS, Carr JA, Jacobsen G, Shepard AD, Nypaver TJ, Reddy DJ. Long-term outcome after mesenteric artery reconstruction: a 37-year experience. J Vasc Surg 2002; 35 (03) 453-460
• 35 Park WM, Cherry Jr KJ, Chua HK. , et al. Current results of open revascularization for chronic mesenteric ischemia: a standard for comparison. J Vasc Surg 2002; 35 (05) 853-859
• 36 Gentile AT, Moneta GL, Taylor Jr LM, Park TC, McConnell DB, Porter JM. Isolated bypass to the superior mesenteric artery for intestinal ischemia. Arch Surg 1994; 129 (09) 926-931 , discussion 931–932
• 37 Foley MI, Moneta GL, Abou-Zamzam Jr AM. , et al. Revascularization of the superior mesenteric artery alone for treatment of intestinal ischemia. J Vasc Surg 2000; 32 (01) 37-47
• 38 Cormier JM, Fichelle JM, Vennin J, Laurian C, Gigou F. Atherosclerotic occlusive disease of the superior mesenteric artery: late results of reconstructive surgery. Ann Vasc Surg 1991; 5 (06) 510-518
• 39 Hollier LH, Bernatz PE, Pairolero PC, Payne WS, Osmundson PJ. Surgical management of chronic intestinal ischemia: a reappraisal. Surgery 1981; 90 (06) 940-946
• 40 McMillan WD, McCarthy WJ, Bresticker MR. , et al. Mesenteric artery bypass: objective patency determination. J Vasc Surg 1995; 21 (05) 729-740 , discussion 740–741
• 41 Modrall JG, Sadjadi J, Joiner DR. , et al. Comparison of superficial femoral vein and saphenous vein as conduits for mesenteric arterial bypass. J Vasc Surg 2003; 37 (02) 362-366
• 42 Arya S, Kingman S, Knepper JP, Eliason JL, Henke PK, Rectenwald JE. Open mesenteric interventions are equally safe as endovascular interventions and offer better midterm patency for chronic mesenteric ischemia. Ann Vasc Surg 2016; 30: 219-226
• 43 Mell MW, Acher CW, Hoch JR, Tefera G, Turnipseed WD. Outcomes after endarterectomy for chronic mesenteric ischemia. J Vasc Surg 2008; 48 (05) 1132-1138
• 44 Armstrong PA. Visceral duplex scanning: evaluation before and after artery intervention for chronic mesenteric ischemia. Perspect Vasc Surg Endovasc Ther 2007; 19 (04) 386-392 , discussion 393–394
• 45 Pecoraro F, Rancic Z, Lachat M. , et al. Chronic mesenteric ischemia: critical review and guidelines for management. Ann Vasc Surg 2013; 27 (01) 113-122
• 46 Tallarita T, Oderich GS, Gloviczki P. , et al. Patient survival after open and endovascular mesenteric revascularization for chronic mesenteric ischemia. J Vasc Surg 2013; 57 (03) 747-755 , discussion 754–755
• 47 Gupta PK, Horan SM, Turaga KK, Miller WJ, Pipinos II. Chronic mesenteric ischemia: endovascular versus open revascularization. J Endovasc Ther 2010; 17 (04) 540-549
• 48 Kougias P, Huynh TT, Lin PH. Clinical outcomes of mesenteric artery stenting versus surgical revascularization in chronic mesenteric ischemia. Int Angiol 2009; 28 (02) 132-137
• 49 Ryer EJ, Oderich GS, Bower TC. , et al. Differences in anatomy and outcomes in patients treated with open mesenteric revascularization before and after the endovascular era. J Vasc Surg 2011; 53 (06) 1611-8.e2
• 50 Oderich GS, Bower TC, Sullivan TM, Bjarnason H, Cha S, Gloviczki P. Open versus endovascular revascularization for chronic mesenteric ischemia: risk-stratified outcomes. J Vasc Surg 2009; 49 (06) 1472-9.e3