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Evolution of the management of mesenteric occlusive disease
1Division of Vascular Surgery, University of California at San Francisco, USA. sarkarR@surgery.ucsf.edu
Abstract:
Current approaches to the diagnosis and management of occlusive disease of the mesenteric arteries have developed over a relatively short period. Five decades ago chronic mesenteric ischemia was almost exclusively a post-mortem diagnosis with the causative link between proximal occlusive lesions of the mesenteric arteries and bowel infarction still in dispute. Successful management of mesenteric occlusive disease has evolved to overcome numerous associated complicating factors, including the relatively inaccessible anatomic location, the cardiovascular co-morbidity present in these patients, the extensive associated atherosclerotic lesions of the paravisceral aorta and the catastrophic consequences of failed revascularization. Although a wide range of surgical strategies are currently used to treat these lesions, many of the most widely used and most successful approaches were developed at the University of California at San Francisco (UCSF). This review will cover the history of treatment of mesenteric occlusive disease, significant contributions made by vascular surgeons at UCSF, and our current approach to this challenging clinical problem.
Insights
Mesenteric artery occlusive disease diagnosis and management have advanced significantly. This review details the historical evolution and current surgical strategies for treating mesenteric ischemia, highlighting UCSF contributions.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Cardiovascular Medicine
Background:
- Chronic mesenteric ischemia was historically a post-mortem diagnosis, with its link to bowel infarction debated.
- Management challenges include anatomical inaccessibility, patient comorbidities, and severe consequences of treatment failure.
Purpose of the Study:
- To review the historical treatment of mesenteric occlusive disease.
- To highlight significant contributions from University of California at San Francisco (UCSF) vascular surgeons.
- To present current approaches to managing mesenteric ischemia.
Main Methods:
- Historical review of mesenteric occlusive disease treatment.
- Analysis of surgical strategies developed at UCSF.
- Discussion of contemporary management protocols.
Main Results:
- Significant advancements in diagnosis and management over the past five decades.
- Development of successful surgical strategies, many originating from UCSF.
- Improved outcomes in treating complex mesenteric occlusive disease.
Conclusions:
- Current management of mesenteric occlusive disease represents a major evolution from historical practices.
- UCSF vascular surgeons have made pivotal contributions to treatment advancements.
- A comprehensive understanding of historical and current approaches is crucial for effective patient care.