Chronic mesenteric ischemia: diagnosis and management

Area of Science:

• Vascular Surgery
• Gastroenterology
• Diagnostic Imaging

Background:

• Chronic mesenteric ischemia (CMI) is the most common vascular intestinal disorder, yet infrequently diagnosed.
• The visceral circulation's extensive redundancy between the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) contributes to its rarity.
• Atherosclerosis is the predominant etiology of CMI.

Purpose of the Study:

• To review the clinical presentation, diagnosis, and management of chronic mesenteric ischemia.
• To highlight the increasing recognition of atherosclerotic mesenteric stenoses due to advanced imaging.
• To discuss the shift in treatment paradigms from open surgery to endovascular interventions.

Main Methods:

• Review of clinical presentation and diagnostic criteria for CMI.
• Analysis of the role of cross-sectional imaging in identifying mesenteric stenoses.
• Evaluation of treatment outcomes for endovascular therapy versus open surgery.

Main Results:

• CMI diagnosis is based on characteristic symptoms and anatomical findings.
• Post-prandial abdominal discomfort and weight loss are classic symptoms, particularly in female patients.
• Endovascular stenting is now the most common revascularization method, superseding open surgery due to lower morbidity and mortality.

Conclusions:

• Atherosclerotic CMI is increasingly recognized due to improved imaging techniques.
• Endovascular therapy offers a safer and more effective revascularization option for CMI.
• Understanding the clinical and anatomical features is crucial for timely diagnosis and management of CMI.