Chronic Mesenteric Ischemia: Diagnosis and Treatment

 

 Buy Article Permissions and Reprints

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.

REFERENCES

• 1 Goodman G H. Angina abdominus.  Am J Med Sci. 1918;  155 524-528
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 3 Sreenarasimhaiah J. Chronic mesenteric ischemia.  Best Pract Res Clin Gastroenterol. 2005;  19 283-295
  CrossrefPubMedGoogle Scholar
• 4 Chang R W, Chang J B, Longo W E. Update in management of mesenteric ischemia.  World J Gastroenterol. 2006;  12 3243-3247
  PubMedGoogle Scholar
• 5 Cleveland T J, Nawaz S, Gaines P A. Mesenteric arterial ischaemia: diagnosis and therapeutic options.  Vasc Med. 2002;  7 311-321
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 7 Ujiki M, Kibbe M R. Mesenteric ischemia.  Perspect Vasc Surg Endovasc Ther. 2005;  17 309-318
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 9 Mitchell E L, Moneta G L. Mesenteric duplex scanning.  Perspect Vasc Surg Endovasc Ther. 2006;  18 175-183
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 18 Yazdi H R, Youness F, Laroia S et al.. Mesenteric artery stenting for chronic mesenteric ischemia.  Vasc Dis Manage. 2007;  4 180-184
  PubMedGoogle Scholar

Eric J HohenwalterM.D. 

Assistant Professor of Radiology and Surgery, Department of Radiology, Medical College of Wisconsin

9200 W. Wisconsin Avenue, Milwaukee, WI 53226

Email: eho@mcw.edu