Chronic mesenteric ischemia and therapeutic paradigm of mesenteric revascularization

Abstract

Chronic mesenteric ischemia is a life-threatening clinical problem resulting in death from inanition and/or bowel infarction, if left untreated, albeit low disease prevalence. Typical presentation is postprandial abdominal pain, severe weight loss, and altered bowel habit. Surgical revascularization of the superior mesenteric artery provides effective long-term treatment for chronic intestinal ischemia. Eleven patients underwent superior mesenteric artery revascularization, nine of them with open retrograde superior mesenteric artery bypass and two with angioplasty and stenting. All patients except one made a satisfactory recovery in this cohort. Major complication included one graft thrombosis leading to bowel ischemia and death. The rest all recovered weight in 3-6 months with a follow up period of 6 to 28 months. Two patients had recurrence of symptoms due to failing bypass requiring stenting for assisted primary patency. Superior mesenteric artery revascularization can be performed with minimal morbidity and mortality, providing excellent symptom relief and quality of life.

Radiology and mesenteric ischaemia

“…Traditional descriptions require occlusion or high-grade stenosis of two of the three visceral arteries. 53 This is because of the protection provided by presence of a number of collateral pathways within the mesenteric circulation including the pancreatico-duodenal arcade, marginal artery of Drummond, arc of Barkow, arc of Riolan and the arc of Buhler. In CMI, the SMA is the most frequently involved vessel.…”

“…Retrograde bypass from the iliac vessels provides a more direct surgical approach and less haemodynamic instability. 53 Angioplasty of the SMA was first reported in 1980. 70 Subsequently, there has been a significant shift towards endovascular procedures (Fig 4c).…”

Recurrent Mesenteric Ischemia from Celiomesenteric Trunk Stenosis

“…Stenosis of two of the three vessels is often required to manifest symptoms of chronic mesenteric ischemia [ 5 ]. Failure to treat could lead to serious complications including bowel infarction and death [ 6 , 7 ].…”