Surgical management and outcomes of chronic mesenteric ischemia
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20243316Keywords:
Chronic mesenteric ischemia, Atherosclerosis, Revascularization, Endovascular therapy, Surgical outcomesAbstract
Chronic mesenteric ischemia (CMI) is a vascular condition resulting from atherosclerotic blockage of the mesenteric arteries, which reduces blood flow to the intestines. Though rare, CMI is critical to diagnose due to the risk of progression to acute mesenteric ischemia, which can be life-threatening. This review discusses the pathophysiology, clinical presentation, and diagnostic challenges of CMI, emphasizing the need for timely revascularization to improve patient outcomes. Both endovascular and open-surgical techniques are examined, with a focus on patient selection and procedural outcomes. Endovascular interventions, preferred for their lower morbidity, have shown promising results despite a higher risk of restenosis. Comprehensive management, including aggressive medical therapy and lifestyle modifications, remains essential to address the underlying atherosclerosis. Given the complexity of CMI, a multidisciplinary approach is recommended to ensure accurate diagnosis and optimal treatment. This review emphasizes the significance of early diagnosis and customized treatments to improve the quality of life and survival rates in patients with CMI.
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Sardar P, White CJ. Chronic mesenteric ischemia: Diagnosis and management. Prog Cardiovasc Dis. 2021;65:71-5.
Zelenock GB, Graham LM, Whitehouse WM Jr, Erlandson EE, Kraft RO, Lindenauer SM, et al. Splanchnic arteriosclerotic disease and intestinal angina. Arch Surg. 1980;115(4):497-501.
Huber TS, Björck M, Chandra A, Clouse WD, Dalsing MC, Oderich GS, et al. Chronic mesenteric ischemia: Clinical practice guidelines from the Society for Vascular Surgery. J Vasc Surg. 2021;73(1S):87S-115S.
Thomas JH, Blake K, Pierce GE, Hermreck AS, Seigel E. The clinical course of asymptomatic mesenteric arterial stenosis. J Vasc Surg. 1998;27(5):840-4.
Kolkman JJ, Geelkerken RH. Diagnosis and treatment of chronic mesenteric ischemia: An update. Best Pract Res Clin Gastroenterol. 2017;31(1):49-57.
Wilson DB, Mostafavi K, Craven TE, Ayerdi J, Edwards MS, Hansen KJ. Clinical Course of Mesenteric Artery Stenosis in Elderly Americans. Arch Int Med. 2006;166(19):2095-100.
Loffroy R, Guiu B, Cercueil J-P, Krausé D. Chronic mesenteric ischemia: efficacy and outcome of endovascular therapy. Abdomin Imag. 2010;35(3):306-14.
Dua A, Lee CJ. Epidemiology of Peripheral Arterial Disease and Critical Limb Ischemia. Tech Vasc Interv Radiol. 2016;19(2):91-5.
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(6):1472-9.
Harki J, Vergouwe Y, Spoor JA, Mensink PB, Bruno MJ, van Noord D, et al. Diagnostic Accuracy of the Combination of Clinical Symptoms and CT or MR Angiography in Patients With Chronic Gastrointestinal Ischemia. J Clin Gastroenterol. 2017;51(6):e39-47.
Ter Steege R, Sloterdijk H, Geelkerken R, Huisman A, van der Palen J, Kolkman J. Splanchnic artery stenosis and abdominal complaints: clinical history is of limited value in detection of gastrointestinal ischemia. World J Surg. 2012;36:793-9.
van Noord D, Sana A, Moons LM, Pattynama PM, Verhagen HJ, Kuipers EJ, et al. Combining radiological imaging and gastrointestinal tonometry: a minimal invasive and useful approach for the workup of chronic gastrointestinal ischemia. Eur J Gastroenterol Hepatol. 2013;25(6):719-25.
van Petersen AS, Kolkman JJ, Gerrits DG, van der Palen J, Zeebregts CJ, Geelkerken RH. Clinical significance of mesenteric arterial collateral circulation in patients with celiac artery compression syndrome. J Vasc Surg. 2017;65(5):1366-74.
Hall JE. Pocket Companion to Guyton & Hall Textbook of Medical Physiology E-Book: Pocket Companion to Guyton & Hall Textbook of Medical Physiology E-Book. Elsevier Health Sciences. 2015.
Meaney JF, Prince MR, Nostrant TT, Stanley JC. Gadolinium‐enhanced MR angiography of visceral arteries in patients with suspected chronic mesenteric ischemia. J Magnetic Resonance Imag. 1997;7(1):171-6.
Laissy J, Trillaud H, Douek P. MR angiography: noninvasive vascular imaging of the abdomen. Abdomin Imag. 2002;27:488-506.
Schaefer PJ, Pfarr J, Trentmann J, Wulff AM, Langer C, Siggelkow M, et al. Comparison of noninvasive imaging modalities for stenosis grading in mesenteric arteries. Rofo. 2013;185(7):628-34.
van Petersen AS, Vriens BH, Huisman AB, Kolkman JJ, Geelkerken RH. Retroperitoneal endoscopic release in the management of celiac artery compression syndrome. J Vasc Surg. 2009;50(1):140-7.
Mensink PB, Hol L, Borghuis-Koertshuis N, Geelkerken RH, Huisman AB, Doelman CJ, et al. Transient postprandial ischemia is associated with increased intestinal fatty acid binding protein in patients with chronic gastrointestinal ischemia. Eur J Gastroenterol Hepatol. 2009;21(3):278-82.
Pillai AK, Kalva SP, Hsu SL, Walker TG, Silberzweig JE, Annamalai G, et al; Society of Interventional Radiology Standards of Practice Committee. Quality Improvement Guidelines for Mesenteric Angioplasty and Stent Placement for the Treatment of Chronic Mesenteric Ischemia. J Vasc Interv Radiol. 2018;29(5):642-7.
Resch T, Lindh M, Dias N, Sonesson B, Uher P, Malina M, et al. Endovascular recanalisation in occlusive mesenteric ischemia--feasibility and early results. Eur J Vasc Endovasc Surg. 2005;29(2):199-203.
Alahdab F, Arwani R, Pasha AK, Razouki ZA, Prokop LJ, Huber TS, et al. A systematic review and meta-analysis of endovascular versus open surgical revascularization for chronic mesenteric ischemia. J Vasc Surg. 2018;67(5):1598-605.
Lima FV, Kolte D, Kennedy KF, Louis DW, Abott JD, Soukas PA, et al. Endovascular Versus Surgical Revascularization for Chronic Mesenteric Ischemia: Insights From the National Inpatient Sample Database. JACC: Cardiovasc Interv. 2017;10(23):2440-7.
Oderich GS, Tallarita T, Gloviczki P, Duncan AA, Kalra M, Misra S, et al. Mesenteric artery complications during angioplasty and stent placement for atherosclerotic chronic mesenteric ischemia. J Vasc Surg. 2012;55(4):1063-71.
Kasirajan K, O'Hara PJ, Gray BH, Hertzer NR, Clair DG, Greenberg RK, et al. Chronic mesenteric ischemia: open surgery versus percutaneous angioplasty and stenting. J Vasc Surg. 2001;33(1):63-71.
van Dijk LJ, van Noord D, de Vries AC, Kolkman JJ, Geelkerken RH, Verhagen HJ, et al. Clinical management of chronic mesenteric ischemia. United European Gastroenterol J. 2019;7(2):179-188.
Clair DG, Beach JM. Mesenteric Ischemia. N Engl J Med. 2016;374(10):959-68.
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(1):36-46.
Saedon M, Saratzis A, Karim A, Goodyear S. Endovascular Versus Surgical Revascularization for the Management of Chronic Mesenteric Ischemia. Vasc Endovasc Surg. 2015;49(1-2):37-44.
Erben Y, Jean RA, Protack CD, Chiu AS, Liu S, Sumpio BJ, et al. Improved mortality in treatment of patients with endovascular interventions for chronic mesenteric ischemia. J Vasc Surg. 2018;67(6):1805-12.
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