Mesenteric ischemia: nutritional impact and capturing the golden operative moment

Chronic thrombotic mesenteric ischemia is a well-described but infrequently encountered disease in the practice of clinical vascular surgery. Viewing it as a three-stage process and tailoring the management to this concept will help to achieve maximal success in prompt diagnosis, appropriate revascularization, and resection when needed. Aggressive intravenous nutritional support will help bolster these patients against the complications and mortality associated with management for each stage, while helping to restore the deficits engendered preoperatively by the disease itself.