Chronic splanchnic ischaemia

Area of Science:

• Vascular Surgery
• Gastroenterology
• Diagnostic Imaging

Background:

• Chronic splanchnic ischemia is a rare condition characterized by pain and weight loss due to stenosis or occlusion of the coeliac and superior mesenteric arteries, often caused by atherosclerosis.
• Collateral circulation can compensate for reduced blood flow, but the exact pathophysiology remains unclear.
• Accurate diagnosis is difficult due to the lack of traditional hemodynamic assessment tools.

Purpose of the Study:

• To review the diagnostic challenges and therapeutic options for chronic splanchnic ischemia.
• To highlight advancements in diagnostic modalities and their role in patient evaluation.
• To discuss the natural history and management strategies for this condition.

Main Methods:

• Review of existing literature on chronic splanchnic ischemia.
• Discussion of diagnostic tools including duplex ultrasound, magnetic resonance angiography, and tonometry.
• Analysis of therapeutic interventions such as surgical reconstruction and angioplasty.

Main Results:

• Duplex ultrasound and MRI have improved diagnostic accuracy for splanchnic circulation abnormalities.
• Tonometry presents a promising functional test for evaluating pathophysiology and clinical status.
• Surgical revascularization offers excellent short- and long-term outcomes.
• Angioplasty with stenting shows potential for symptom relief in high-risk patients.

Conclusions:

• Chronic splanchnic ischemia diagnosis and management have advanced with improved imaging and functional tests.
• Surgical reconstruction remains the gold standard, while endovascular procedures offer an alternative for select patients.
• Further research into tonometry may enhance understanding and clinical evaluation of this syndrome.