Endovascular treatment of chronic mesenteric ischemia

Mesenteric angina successfully treated by percutaneous angioplasty

A female patient of 47 years was sent to our radiology department for abdominal CT. She had severe epigastric pain very marked to left hypochondrium in postprandial period for a month. The pain was increasingly progressive with critical attacks at night. That forced her into fear and food restriction with an estimated weight loss of 4kg. Drug treatments did not improve symptoms. Abdominal CT highlighted thrombosis of superior mesenteric artery of 90%. Other arterial trunks and intestines were normal. Percutaneous angiography confirmed mesenteric thrombosis. A percutaneous transluminal angioplasty (PTA) was performed with success. Antiplatelets were prescribed. A good clinical evolution was observed within one year.

Reimplantation of a Stenotic Inferior Mesenteric Artery for Chronic Visceral Artery Occlusion after Failed Bypass to the Superior Mesenteric Artery

The patient was a 71-year-old man complaining of postprandial abdominal pain and weight loss. Computed tomography angiography showed occlusion of the superior mesenteric artery and the celiac axis. The inferior mesenteric artery, supplying the mesenteric circulation, was stenotic at its origin. The patient had portal vein thrombosis and was diagnosed as having antiphospholipid antibody syndrome. The reimplantation of the inferior mesenteric artery was successfully performed after failed bypass grafting to the superior mesenteric artery from the abdominal aorta.

Mesenteric ischemia: Pathogenesis and challenging diagnostic and therapeutic modalities

Mesenteric ischemia (MI) is an uncommon medical condition with high mortality rates. ΜΙ includes inadequate blood supply, inflammatory injury and eventually necrosis of the bowel wall. The disease can be divided into acute and chronic MI (CMI), with the first being subdivided into four categories. Therefore, acute MI (AMI) can occur as a result of arterial embolism, arterial thrombosis, mesenteric venous thrombosis and non-occlusive causes. Bowel damage is in proportion to the mesenteric blood flow decrease and may vary from minimum lesions, due to reversible ischemia, to transmural injury, with subsequent necrosis and perforation. CMI is associated to diffuse atherosclerotic disease in more than 95% of cases, with all major mesenteric arteries presenting stenosis or occlusion. Because of a lack of specific signs or due to its sometime quiet presentation, this condition is frequently diagnosed only at an advanced stage. Computed tomography (CT) imaging and CT angiography contribute to differential diagnosis and management of AMI. Angiography is also the criterion standard for CMI, with mesenteric duplex ultrasonography and magnetic resonance angiography also being of great importance. Therapeutic approach of MI includes both medical and surgical treatment. Surgical procedures include restoration of the blood flow with arteriotomy, endarterectomy or anterograde bypass, while resection of necrotic bowel is always implemented. The aim of this review was to evaluate the results of surgical treatment for MI and to present the recent literature in order to provide an update on the current concepts of surgical management of the disease. Mesh words selected include MI, diagnostic approach and therapeutic management.