How to manage chronic mesenteric ischemia? A deliberated strategy

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Gastroenterology

Background:

• Chronic mesenteric ischemia (CMI) is a rare condition, often affecting elderly patients with widespread atherosclerosis.
• Symptomatic occlusive disease of the superior mesenteric artery or celiac trunk presents diagnostic and therapeutic challenges.
• Limited surgeon experience with mesenteric revascularization exists due to the condition's rarity.

Purpose of the Study:

• To review the literature on chronic mesenteric ischemia management.
• To guide decision-making regarding the optimal revascularization modality.
• To address patient heterogeneity in choosing between endovascular and open surgical repair.

Main Methods:

• Extensive literature review.
• Analysis of endovascular vs. open surgical revascularization outcomes.
• Consideration of patient factors influencing treatment choice.

Main Results:

• An endovascular-first strategy is prevalent due to lower peri-procedural risks and faster recovery.
• Mesenteric artery stenting volumes have increased significantly.
• Long-term results of percutaneous mesenteric angioplasty and stenting are inferior to open surgery.

Conclusions:

• Open surgical repair remains a viable option, often reserved for cases where percutaneous transluminal angioplasty (PTA) fails.
• The choice of revascularization modality requires careful consideration of individual patient characteristics.
• Further research may be needed to optimize long-term outcomes for CMI patients.