Current Results of Surgical Therapy for Chronic Mesenteric Ischemia

Moawad, John; McKinsey, James F.; Wyble, Charles W.; Bassiouny, Hisham S.; Schwartz, Lewis B.; Gewertz, Bruce L.

doi:10.1001/archsurg.1997.01430300055012

Cited by 120 publications

(65 citation statements)

References 29 publications

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“…Although the expected increase in intestinal arterial flow that results from food ingestion can be detected and quantified by duplex scanning, this information has not added to the diagnostic accuracy of the test for establishing whether abdominal symptoms that are present are the result of intestinal ischemia (840). Surgical treatment of chronic intestinal ischemia is accomplished by endarterectomy or bypass grafting, with the majority of surgeons preferring the latter approach (836,(851)(852)(853)(854)(855)(856)(857)(858). The overall operative mortality and durability of revascularization in chronic cases described by multiple contemporary reports are listed in Table 42.…”

Section: Duplex Scanningmentioning

confidence: 99%

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

Hirsch

Haskal²,

Hertzer³

et al. 2006

Circulation

2,934

1,102

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Section: Duplex Scanningmentioning

confidence: 99%

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

Hirsch

Haskal²,

Hertzer³

et al. 2006

Circulation

2,934

1,102

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“…Physical examination may reveal an epigastric bruit in 48% to 63% of patients [18,21], indicative of turbulent flow through an area of vascular narrowing. A history of smoking, peripheral vascular disease, and hypertension is also frequently present [14,22]. In addition, patients may demonstrate evidence of gallbladder dysmotility, gastroparesis, or gastric ulcers as a reflection of disease in the CA [14].…”

Section: Nonocclusive Ischemiamentioning

confidence: 99%

Acute and Chronic Mesenteric Ischemia

Herbert¹,

Steele²

2007

Surgical Clinics of North America

124

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“…In 1997, the section on vascular surgery from the department of Surgery of the University of Chicago [4] reported the results of 24 consecutive patients treated in the decade before 1996 with successful outcome of mesenteric bypass with minimal mortality and symptom-free survival rate of 70%, indicating to the presenters that revascularization is the treatment of choice for chronic mesenteric ischemia. In 2002, Pietura et al [5] from the University of Lubin, in Poland described experiences between 1996 and 2011 with 6 patients with abdominal angina.…”

Section: Treatmentmentioning

confidence: 99%

10.4172/2329-6925.1000106

Angina¹

2013

J Vasc Med Surg

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Currently specialization in medicine leaves a gap between the special interests of several specialties: internist, gastroenterologist, cardiologist, general abdominal surgeon, and vascular surgeon, into which the problems of the patient with abdominal angina are likely to fall. Although abdominal angina from intestinal ischaemia is an infrequent event, it is lethal unless recognized and corrected by vascular procedures that have been developing. The syndrome deserves more special attention by the practicing physician than it has received during the past half century since I first drew attention to the syndrome [1].Abdominal angina results from the accumulation of metabolites when inadequate volumes of blood flow through the muscle of the bowel wall to clear them and shares a similar mechanism to that of angina pectoris [2] (Myocardium) and intermittent claudication (leg muscles).Blood flowing through the 3 main vessels supplying the bowel becomes sufficiently impeded to produce the ischemic pain of abdominal angina; but yet is adequate to prevent necrosis. Available collateral circulation is small, particularly in the distribution of the superior mesenteric artery. The superior mesenteric artery communicates above and around the head of the pancreas, with the celiac axis through the pancreaticoduodenal arteries, and below in the mesentery of the colon in Riolan's arch, where the middle colic branch of the superior mesenteric artery communicates with the left colic branch of the inferior mesenteric artery.The mesenteric vessels respond to neurogenic, hormonal, and pharmacologic influences, and this response influences the volume of available collateral circulation. Characteristic Features of the Pain of Abdominal AnginaThe 7 characteristics of the patient's pain provide the most valuable clues for recognition of abdominal angina. These are the same characteristics appropriate for recognizing angina pectoris, but have substantially different features for abdominal angina.1. Location of the pain is poorly localized around the umbilicus or in the epigastrium.2. Radiation may occur at back but radiation is frequently absent.3. Quality of the pain varies from a dull ache in some patients to a colicky pain in others. Lack of associated tenderness is characteristic but is present in most other painful conditions. 4.Intensity is usually sufficient severe to discourage eating and to lead to severe loss of weight. It is greater than one might expect with the limited physical findings.5. Duration varies from few minutes to an hour or more and correlates with intestinal function. It gradually increases, reaches a plateau, and then decreases several hours after eating.6. Fluctuation and periodicity are characteristic and pain-free intervals separate the attacks that are ordinarily correlated with eating and lead to food avoidance behavior and weight loss.

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Current Results of Surgical Therapy for Chronic Mesenteric Ischemia

Cited by 120 publications

References 29 publications

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

Acute and Chronic Mesenteric Ischemia

10.4172/2329-6925.1000106

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