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Updated: Dec 2, 2025

Multimodality Diagnosis of Mesenteric Ischemia
05:07

Multimodality Diagnosis of Mesenteric Ischemia

Published on: July 21, 2023

984

[The Mesenteric Malperfusion with Aortic Dissection and Perioperative Management of Mesenteric Malperfusion]

Hideo Kanamitsu1, Kenji Minatoya

  • 1Department of Cardiovascular Surgery, Kyoto University, Kyoto, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|November 1, 2020
PubMed

Insights

Mesenteric malperfusion, a complication of acute aortic dissection (AAD), significantly increases mortality. Early diagnosis and tailored treatment, including surgical repair and mesenteric reperfusion, are crucial for improving patient outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Gastroenterology
  • Radiology

Background:

  • Mesenteric malperfusion complicates 3-5% of acute aortic dissections (AAD), posing a significant risk to patient survival.
  • Mortality rates are substantially higher in AAD patients with mesenteric malperfusion compared to those without.
  • Effective management of mesenteric malperfusion is critical for improving clinical outcomes in AAD.

Purpose of the Study:

  • To highlight the diagnostic challenges and optimal management strategies for mesenteric malperfusion in the context of AAD.
  • To emphasize the importance of early diagnosis and timely intervention to improve survival rates.

Main Methods:

  • Review of diagnostic modalities, including computed tomography (CT) angiography as the gold standard.
  • Discussion of treatment algorithms based on the presence and severity of organ ischemia.
  • Emphasis on a tailored approach considering individual patient factors and risks.

Main Results:

  • Abdominal pain is a common but nonspecific symptom of acute mesenteric ischemia.
  • Computed tomography (CT) with angiography is the definitive diagnostic tool for both AAD and associated mesenteric malperfusion.
  • Serum markers like lactate lack reliability for diagnosing mesenteric ischemia.

Conclusions:

  • Immediate surgical repair is indicated for malperfusion without significant organ ischemia.
  • Mesenteric reperfusion followed by surgical repair is recommended for hemodynamically stable patients with significant organ ischemia.
  • A personalized management strategy is essential for optimizing outcomes in AAD patients with mesenteric malperfusion.

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