Clinical management of chronic mesenteric ischemia

Abstract

This This Dutch Mesenteric Ischemia Study group consists of: Ron Balm, Academic Medical Center, Amsterdam Gert Jan de Borst, University Medical Center Utrecht, Utrecht Juliette T Blauw, Medisch Spectrum Twente, Enschede Marco J Bruno, Erasmus MC University Medical Center, Rotterdam Olaf J Bakker, St Antonius Hospital, Nieuwegein Louisa JD van Dijk, Erasmus MC University Medical Center, Rotterdam Hessel CJL Buscher, Gelre Hospitals, Apeldoorn Bram Fioole, Maasstad Hospital, Rotterdam Robert H Geelkerken, Medisch Spectrum Twente, Enschede Jaap F Hamming, Leiden University Medical Center, Leiden Jihan Harki, Erasmus MC University Medical Center, Rotterdam Daniel AF van den Heuvel, St Antonius Hospital, Nieuwegein Eline S van Hattum, University Medical Center Utrecht, Utrecht Jan Willem Hinnen, Jeroen Bosch Hospital, ‘s-Hertogenbosch Jeroen J Kolkman, Medisch Spectrum Twente, Enschede Maarten J van der Laan, University Medical Center Groningen, Groningen Kaatje Lenaerts, Maastricht University Medical Center, Maastricht Adriaan Moelker, Erasmus MC University Medical Center, Rotterdam Desirée van Noord, Franciscus Gasthuis & Vlietland, Rotterdam Maikel P Peppelenbosch, Erasmus MC University Medical Center, Rotterdam André S van Petersen, Bernhoven Hospital, Uden Pepijn Rijnja, Medisch Spectrum Twente, Enschede Peter J van der Schaar, St Antonius Hospital, Nieuwegein Luke G Terlouw, Erasmus MC University Medical Center, Rotterdam Hence JM Verhagen, Erasmus MC University Medical Center, Rotterdam Jean Paul PM de Vries, University Medical Center Groningen, Groningen Dammis Vroegindeweij, Maasstad Hospital, Rotterdam review provides an overview on the clinical management of chronic mesenteric ischemia (CMI). CMI is defined as insufficient blood supply to the gastrointestinal tract, most often caused by atherosclerotic stenosis of one or more mesenteric arteries. Patients classically present with postprandial abdominal pain and weight loss. However, patients may present with, atypically, symptoms such as abdominal discomfort, nausea, vomiting, diarrhea or constipation. Early consideration and diagnosis of CMI is important to timely treat, to improve quality of life and to prevent acute-on-chronic mesenteric ischemia. The diagnosis of CMI is based on the triad of clinical symptoms, radiological evaluation of the mesenteric vasculature and if available, functional assessment of mucosal ischemia. Multidisciplinary consensus on the diagnosis of CMI is of paramount importance to adequately select patients for treatment. Patients with a consensus diagnosis of single-vessel or multi-vessel atherosclerotic CMI are preferably treated with endovascular revascularization.

Severe Abdominal Pain Eight Years after Renal Transplant: A Case of Renal Transplant Atherosclerosis

“…The differential diagnoses include acute cholecystitis, acute mesenteric ischemia, chronic pancreatitis, chronic mesenteric ischemia, and peptic ulcer disease, among others. 2 As seen in our patient, the only risk factors that she had prior to presentation were age and LAD coronary artery disease. As such, her pretest probability for chronic mesenteric ischemia being the etiology of patient's abdominal pain was low.…”

“…Computer tomography angiography (CTA) is the primary imaging modality in patients whose clinical suspicion of CMI is moderate to high. 2 On CTA, atherosclerotic plaque has a sensitivity of 100% and specificity of 95%. If CTA is unable to be obtained given renal insufficiency or contrast allergy, magnetic resonance angiography (MRA) can be performed.…”

“…Once the diagnosis has been established by CTA, revascularization is indicated in patients to relieve symptoms. 2,4,[10][11][12] Previously, open surgical revascularization was the standard therapy. However, more recently, endovascular revascularization is less invasive and is now favored as the treatment of choice.…”

Chronic mesenteric ischemia: a case report and review of the literature

“…Изначально использовались барометаллические стенты, ретроспективный анализ показал преимущество стентов с лекарственным покрытием. В настоящее время ожидаются результаты многоцентрового рандомизированного датского исследо-вания, которые могут подтвердить это преимущество [41].…”

Selected Disorders of the Digestive System

“…Chronic mesenteric ischemia is an uncommon condition and more than 90% of cases are related to progressive atherosclerotic stenosis of one or more mesenteric arteries [13]. The goals of management are to resolve patient symptoms, improve nutritional status, and prevent possible infarction.…”