Management of chronic visceral ischemia

The triad of postprandial pain, weight loss, and diarrhea are the hallmarks of abdominal angina. An anastomotic meandering mesenteric artery noted on frontal arteriogram is valuable in signaling significant disease, but lateral views are the sine qua non for diagnosis. Early surgical correction either by local endarterectomy or bypass of a stenotic or occluded segment and accurate selection of cases results in long-term correction of the intestinal ischemia. When advanced occlusive disease of the mesenteric arteries is noted on the preoperative arteriogram of patients selected for aortoiliofemoral, renal artery, or aortic aneurysm reconstructive surgery, concomitant reconstitution of the mesenteric vascular circulation is advisable. It is our opinion that such an approach can be a significant deterrent to subsequent catastrophic bowel infarction from mesenteric arterial occlusive disease.