Chronic mesenteric ischemia
Updates to Article Attributes
Chronic mesenteric ischaemia is a rare type is an uncommon type of intestinal ischaemia.
Epidemiology
Normally seen in patients older than 60 years of age and is found to be 3three times more oftencommon in women.
Pathology
ItChronic mesenteric ischaemia is often multifactorial in aetiology. The most common cause is atherosclerosis involving the proximal portions of the celiaccoeliac artery, superior mesenteric artery (SMA), or inferior mesenteric artery (IMA). Less common aetiologies include
:
- dissection
- vasculitis
- fibromuscular dysplasia
- radiation
- cocaine abuse.
Chronicity of the symptoms are caused by the gradual decrease in blood flow to the intestines. The normal vascular supply to the bowel is from the celiaccoeliac artery, superior mesentricmesenteric and inferior mesentric arteriesmesenteric arteries. Extensive collateralization can occur between the vascular territories of these vessels. Because of this collateral circulation, patients may experience symptoms not until two or three major mesenteric vessels are involved.
Clinical features
Reported feautresfeatures include:
- postprandial abdominal pain (classically starts 15-30 minutes post meal and typically lasts for 30 minutes)
- significant weight loss
- food fear
- nausea
- vomiting
- diarrhoea
Radiographic assessment
Ultrasound
Useful for diagnosing an underlying stenosisa haemodynamically significant stenosis involving the SMA coeliac artery or coeliac artery SMA.
Fasting duplex criteria for significant mesenteric stenosis suggest that a superior mesenteric artery peak systolic velocity of 275 cm/s or greater and a celiaccoeliac artery peak systolic velocity of 200 cm/s or greater are reliable indicators of a 70% or greater stenosis.
CT
CT may showTypical findings include:
- stenosis of
mesentricmesenteric vessels - bowel wall thickening
- pneumatosis
- peritoneal free fluid
- 3D imaging may help in visualisation of collateral pathways
MRI
Helps in visualising mesentric vessels stenosis; thoughmesenteric vessel stenosis. The inferior mesentric arterymesenteric artery may be poorly depictedvisualized, depending on the sequence.
Angiography/CTA/MRA
Catheter angiography is the gold standard for diagnosing mesenteric vascular vascular disease. It aids in visualisation of the Not only does it directly visualizes the mesenteric vasculature, selective catheterisation and pressure measurements across a stenosis tocan determine the haemodynamic significance of the questionable lesions.
Managment and prognosis
If a diagnosis of chronic mesenteric ischaemia is made, patients should undergo definitive treatment due to risk of continued weight loss, acute infarction, perforation, sepsis, andor death.
Medical treatment is usually reserved for patients who are not healthy enough to be treated, either surgically or endovascularly. The treatment consists of long-term anticoagulation, such as Warfarin.
An open surgical repair includes a trans-aortic endarterectomy, direct reimplantation on the aorta, andor antegrade or retrograde bypass grafting.
Endovascular repair includes angioplasty and/or stent placement of lesions within the mesenteric vasculature.
Differential diagnosis
Possible considerations include:
- acute
mesentricmesenteric ischemia - retroperitoneal or coeliomesenteric
Malignancymalignancy - median arcuate ligament syndrome
- nonocclusive vascular lesions
- e(e.g. aneurysms and dissections)
Etymology
It was first described as “abdominal angina” byG H Goodman.
-<p><strong>Chronic mesenteric ischaemia</strong> is a rare type of <a href="/articles/intestinal-ischaemia" title="Intestinal ischaemia">intestinal ischaemia</a>.</p><h4>Epidemiology</h4><h4></h4><p>Normally seen in patients older than 60 years of age and is found to be 3 times more often in women.</p><h4>Pathology</h4><p>It is often multifactorial in aetiology. The most common cause is atherosclerosis involving the proximal portions of the celiac artery, superior mesenteric artery, or inferior mesenteric artery. Less common aetiologies include </p><p></p><ul>- +<p><strong>Chronic mesenteric ischaemia</strong> is an uncommon type of <a href="/articles/intestinal-ischaemia">intestinal ischaemia</a>.</p><h4>Epidemiology</h4><p>Normally seen in patients older than 60 years of age and is three times more common in women.</p><h4>Pathology</h4><p>Chronic mesenteric ischaemia is often multifactorial in aetiology. The most common cause is atherosclerosis involving the proximal portions of the coeliac artery, superior mesenteric artery (SMA), or inferior mesenteric artery (IMA). Less common aetiologies include:</p><ul>
-</ul><p>Chronicity of the symptoms are caused by the gradual decrease in blood flow to the intestines. The normal vascular supply to the bowel is from the celiac artery, superior mesentric and inferior mesentric arteries. Extensive collateralization can occur between the vascular territories of these vessels. Because of this collateral circulation, patients may experience symptoms not until two or three major mesenteric vessels are involved. </p><h4>Clinical features</h4><p>Reported feautres include</p><ul>-<li>postprandial abdominal pain (classically starts 15-30 minutes post meal and typically lasts for 30 minutes)</li>-<li>significant weight loss</li>-<li>food fear</li>-<li>nausea</li>-<li>vomiting</li>-<li>diarrhoea</li>-</ul><h4>Radiographic assessment</h4><div id="__sec2" style="clear: both; background-color: rgb(255, 255, 255);">-<h6 style="font-family: Georgia, 'Times New Roman', serif; font-size: 15px; line-height: 21px;">Ultrasound</h6>-<p style="font-family: Georgia, 'Times New Roman', serif; font-size: 15px; line-height: 21px;">Useful for diagnosing an underlying stenosis involving the SMA or coeliac artery.</p>-<p style="font-family: Georgia, 'Times New Roman', serif; font-size: 15px; line-height: 21px;">Fasting duplex criteria for mesenteric stenosis suggest that a superior mesenteric artery peak systolic velocity of 275 cm/s or greater and a celiac artery peak systolic velocity of 200 cm/s or greater are reliable indicators of a 70% or greater stenosis</p>-<h6 style="font-family: Georgia, 'Times New Roman', serif; font-size: 15px; line-height: 21px;">CT</h6>-<p>CT may show</p>-<ul>-<li>stenosis of mesentric vessels</li>-<li>bowel wall thickening</li>-<li>pneumatosis</li>-<li>peritoneal fluid</li>-<li>3D imaging may help in visualisation of collateral pathways</li>-</ul>-</div><div id="__sec4" style="clear: both; background-color: rgb(255, 255, 255);"><div id="__sec5" style="clear: both;">-<h6 style="font-family: Georgia, 'Times New Roman', serif; font-size: 15px; line-height: 21px;">MRI</h6>-<p style="font-family: Georgia, 'Times New Roman', serif; font-size: 15px; line-height: 21px;">Helps in visualising mesentric vessels stenosis; though inferior mesentric artery poorly depicted.</p>-<h6 style="font-family: Georgia, 'Times New Roman', serif; font-size: 15px; line-height: 21px;">Angiography/CTA/MRA</h6>-<p id="__p10" style="font-family: Georgia, 'Times New Roman', serif; font-size: 15px; line-height: 21px; margin: 0.6923em 0px;">Catheter angiography is the gold standard for diagnosing mesenteric vascular disease. It aids in visualisation of the mesenteric vasculature, selective catheterisation and pressure measurements across a stenosis to determine the haemodynamic significance of the questionable lesions.</p>-<h4 style="font-family: Georgia, 'Times New Roman', serif; font-size: 15px; line-height: 21px;">Managment and prognosis</h4>-<p id="__p17" style="font-family: Georgia, 'Times New Roman', serif; font-size: 15px; line-height: 21px; margin: 0.6923em 0px;">If a chronic mesenteric ischaemia is made, patients should undergo definitive treatment due to risk of continued weight loss, acute infarction, perforation, sepsis, and death.</p>-<p id="__p18" style="font-family: Georgia, 'Times New Roman', serif; font-size: 15px; line-height: 21px; margin: 0.6923em 0px;">Medical treatment is usually reserved for patients who are not healthy enough to be treated, either surgically or endovascularly. The treatment consists of long-term anticoagulation, such as Warfarin. </p>-<p id="__p18" style="font-family: Georgia, 'Times New Roman', serif; font-size: 15px; line-height: 21px; margin: 0.6923em 0px;">An open surgical repair includes a trans-aortic endarterectomy, direct reimplantation on the aorta, and antegrade or retrograde bypass grafting. </p>-<p id="__p19" style="font-family: Georgia, 'Times New Roman', serif; font-size: 15px; line-height: 21px; margin: 0.6923em 0px;">Endovascular repair includes angioplasty and/or stent placement of lesions within the mesenteric vasculature </p>-<h4 style="font-family: Georgia, 'Times New Roman', serif; font-size: 15px; line-height: 21px;">Differential diagnosis</h4>-<p>Possible considerations include</p>-<ol>-<li><a href="/articles/acute-mesentric-ischemia" title="acute mesentric ischemia">acute mesentric ischemia</a></li>-<li>retroperitoneal or coeliomesenteric Malignancy</li>-<li><a href="/articles/coeliac_artery_compression_syndrome" title="Median arcuate ligament syndrome">median arcuate ligament syndrome</a></li>-<li>nonocclusive vascular lesions - e.g aneurysms and dissections</li>-</ol>-<h4>Etymology</h4>-<p> It was first described as “abdominal angina” by <strong>Goodman</strong>. </p>-</div></div>- +</ul><p>Chronicity of the symptoms are caused by the gradual decrease in blood flow to the intestines. The normal vascular supply to the bowel is from the coeliac artery, superior mesenteric and inferior mesenteric arteries. Extensive collateralization can occur between the vascular territories of these vessels. Because of this collateral circulation, patients may experience symptoms not until two or three major mesenteric vessels are involved. </p><h4>Clinical features</h4><p>Reported features include:</p><ul>
- +<li>postprandial abdominal pain (classically starts 15-30 minutes post meal and typically lasts for 30 minutes)</li>
- +<li>significant weight loss</li>
- +<li>food fear</li>
- +<li>nausea</li>
- +<li>vomiting</li>
- +<li>diarrhoea</li>
- +</ul><h4>Radiographic assessment</h4><h6>Ultrasound</h6><p>Useful for diagnosing a haemodynamically significant stenosis involving the coeliac artery or SMA.</p><p>Fasting duplex criteria for significant mesenteric stenosis suggest that a superior mesenteric artery peak systolic velocity of 275 cm/s or greater and a coeliac artery peak systolic velocity of 200 cm/s or greater are reliable indicators of a 70% or greater stenosis.</p><h6>CT</h6><p>Typical findings include:</p><ul>
- +<li>stenosis of mesenteric vessels</li>
- +<li>bowel wall thickening</li>
- +<li>pneumatosis</li>
- +<li>peritoneal free fluid</li>
- +<li>3D imaging may help in visualisation of collateral pathways</li>
- +</ul><h6>MRI</h6><p>Helps in visualising mesenteric vessel stenosis. The inferior mesenteric artery may be poorly visualized, depending on the sequence.</p><h6>Angiography/CTA/MRA</h6><p>Catheter angiography is the gold standard for diagnosing mesenteric vascular disease. Not only does it directly visualizes the mesenteric vasculature, selective catheterisation and pressure measurements across a stenosis can determine the haemodynamic significance of the questionable lesions.</p><h4>Managment and prognosis</h4><p>If a diagnosis of chronic mesenteric ischaemia is made, patients should undergo definitive treatment due to risk of continued weight loss, acute infarction, perforation, sepsis, or death.</p><p>Medical treatment is usually reserved for patients who are not healthy enough to be treated, either surgically or endovascularly. The treatment consists of long-term anticoagulation, such as Warfarin. </p><p>An open surgical repair includes a trans-aortic endarterectomy, direct reimplantation on the aorta, or antegrade or retrograde bypass grafting. </p><p>Endovascular repair includes angioplasty and/or stent placement of lesions within the mesenteric vasculature.</p><h4>Differential diagnosis</h4><p>Possible considerations include:</p><ul>
- +<li><a href="/articles/acute-mesentric-ischemia">acute mesenteric ischemia</a></li>
- +<li>retroperitoneal or coeliomesenteric malignancy</li>
- +<li><a href="/articles/coeliac-artery-compression-syndrome">median arcuate ligament syndrome</a></li>
- +<li>nonocclusive vascular lesions (e.g. aneurysms and dissections)</li>
- +</ul><h4>Etymology</h4><p> It was first described as “abdominal angina” by <strong>G H </strong><strong>Goodman</strong>. </p>
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