Chronic mesenteric ischemia: imaging and percutaneous treatment

Area of Science:

• Vascular Surgery
• Gastroenterology
• Interventional Radiology

Background:

• Chronic mesenteric ischemia (CMI) is a rare condition with delayed diagnosis, leading to severe complications.
• Current diagnostic methods rely on medical history and ruling out other conditions, lacking sensitive and specific tests.
• Noninvasive imaging like CT angiography and MR angiography can suggest CMI when visceral artery occlusion is present.

Purpose of the Study:

• To review the diagnosis and treatment of chronic mesenteric ischemia (CMI).
• To highlight the shift in treatment paradigms from open surgery to minimally invasive endovascular procedures.
• To discuss emerging treatment strategies and future research directions for CMI.

Main Methods:

• Review of historical and current diagnostic approaches for CMI.
• Analysis of treatment outcomes comparing open surgery and percutaneous transluminal angioplasty (PTA) with stenting.
• Discussion of advancements in endovascular techniques and potential future therapies.

Main Results:

• Open surgery, once the primary treatment, carries significant morbidity and mortality risks.
• Percutaneous transluminal angioplasty (PTA) with stent placement is increasingly favored as a minimally invasive option.
• PTA with stenting demonstrates good long-term results and acceptable recurrence rates for CMI.

Conclusions:

• Minimally invasive PTA with stent placement is emerging as the primary treatment for CMI.
• Further research is needed to validate new treatments like fibrinolytic agents and routine revascularization.
• Improved data on patient selection will refine the optimal approach for CMI management.