[Operative treatment of chronic mesenteric ischemia]

Area of Science:

• Vascular Surgery
• Gastroenterology
• Radiology

Context:

• Chronic ischemic lesions of splanchnic organs are frequently underestimated and underdiagnosed.
• Increasing prevalence of chronic mesenteric ischemia is linked to atherosclerosis progression and an aging population's polymorbidity.
• Splanchnic artery occlusions are diagnosed more often, with diffuse stenotic processes potentially remaining asymptomatic due to collateralization.

Purpose:

• To distinguish the etiology, therapy, and prognosis of acute mesenteric ischemia from chronic splanchnic ischemia.
• To discuss the operative treatment of chronic intestinal ischemia.
• To propose a classification for treatment stratification in chronic intestinal ischemia.

Summary:

• Computed tomography angiography with 3D reconstruction is the preferred diagnostic tool for chronic mesenteric ischemia.
• Diagnostic angiography is often combined with endovascular treatments like angioplasty and stenting.
• Duplex sonography offers hemodynamic insights but can be limited by bowel gas and operator dependency.

Impact:

• Highlights the importance of recognizing and diagnosing chronic splanchnic organ ischemia.
• Provides a framework for stratifying treatment options for chronic intestinal ischemia.
• Emphasizes the role of advanced imaging and endovascular interventions in managing splanchnic artery disease.