A Case of Chronic Mesenteric Ischemia: Complete Revascularization Using Multiple Procedures

Area of Science:

• Vascular Surgery
• Gastroenterology
• Interventional Radiology

Background:

• Chronic mesenteric ischemia (CMI) is a rare condition characterized by insufficient blood flow to the intestines, often due to occlusion or stenosis of multiple mesenteric arteries.
• Symptoms typically include postprandial abdominal pain, nausea, vomiting, diarrhea, and unintentional weight loss, significantly impacting quality of life.

Purpose of the Study:

• To report a rare case of CMI caused by combined superior mesenteric artery (SMA) occlusion and celiac artery stenosis due to median arcuate ligament syndrome.
• To describe the successful management of this complex case through a combination of surgical and endovascular interventions.

Main Methods:

• A 66-year-old male patient presented with a 3-month history of abdominal pain and vomiting/diarrhea.
• Diagnostic workup revealed SMA occlusion and severe celiac artery stenosis attributed to median arcuate ligament syndrome.
• Treatment involved complete revascularization via iliac artery-SMA bypass grafting and arcuate ligament dissection, supplemented by staged-catheter intervention.

Main Results:

• The combined surgical and endovascular approach successfully restored mesenteric blood flow.
• The patient experienced complete resolution of his abdominal pain and gastrointestinal symptoms.
• Postoperatively, the patient maintained a normal diet for at least 6 months without recurrence of symptoms.

Conclusions:

• CMI due to median arcuate ligament syndrome, though rare, can be effectively treated with a comprehensive revascularization strategy.
• A multidisciplinary approach combining open surgery and endovascular techniques offers a viable solution for complex mesenteric artery disease.
• Successful revascularization can significantly improve patient outcomes and quality of life in cases of chronic mesenteric ischemia.