Mesenteric Ischemia

ABSTRACT

Mesenteric ischemia is classified as either acute or chronic. The former is a life-threatening emergency in which a sudden reduction in intestinal blood flow may ultimately result in bowel infarction. The most common causes are arterial embolism, arterial thrombosis, nonocclusive mesenteric ischemia, and mesenteric venous thrombosis. A high index of suspicion, early diagnosis and rapid intervention are necessary so that normal mesenteric perfusion is restored before fatal bowel infarction can occur. Chronic mesenteric ischemia is usually caused by stenotic or occlusive disease involving the proximal segments of the mesenteric arterial supply to the bowel, usually as a result of atherosclerosis. Intestinal angina is the classic presentation, defined as recurrent postprandial abdominal pain that subsides in 1 to 2 hours, with associated weight loss and aversion to food. When combined with the clinical presentation, physical examination, and laboratory data, imaging plays a key role in the diagnosis of either acute or chronic mesenteric ischemia. Recognition of pertinent imaging findings and various treatment options may aid in preventing the serious and possibly fatal sequelae that may occur in cases of mesenteric ischemia.

KEYWORDS

Acute mesenteric ischemia - chronic mesenteric ischemia - nonocclusive mesenteric ischemia - intestinal angina

REFERENCES

• 1 Schneider T A, Longo W E, Ure T, Vernava III A M. Mesenteric ischemia. Acute arterial syndromes.  Dis Colon Rectum. 1994;  37(11) 1163-1174
• 2 Schoenberg M H, Beger H G. Reperfusion injury after intestinal ischemia.  Crit Care Med. 1993;  21(9) 1376-1386
• 3 Kim A Y, Ha H K. Evaluation of suspected mesenteric ischemia: efficacy of radiologic studies.  Radiol Clin North Am. 2003;  41(2) 327-342
• 4 Cognet F, Ben Salem D, Dranssart M et al.. Chronic mesenteric ischemia: imaging and percutaneous treatment.  Radiographics. 2002;  22(4) 863-879 discussion 879-880
• 5 Valentine R J, Martin J D, Myers S I, Rossi M B, Clagett G P. Asymptomatic celiac and superior mesenteric artery stenoses are more prevalent among patients with unsuspected renal artery stenoses.  J Vasc Surg. 1991;  14(2) 195-199
• 6 Thomas J H, Blake K, Pierce G E, Hermreck A S, Seigel E. The clinical course of asymptomatic mesenteric arterial stenosis.  J Vasc Surg. 1998;  27(5) 840-844
• 7 Oldenburg W A, Lau L L, Rodenberg T J, Edmonds H J, Burger C D. Acute mesenteric ischemia: a clinical review.  Arch Intern Med. 2004;  164(10) 1054-1062
• 8 Sebastià C, Quiroga S, Espin E, Boyé R, Alvarez-Castells A, Armengol M. Portomesenteric vein gas: pathologic mechanisms, CT findings, and prognosis.  Radiographics. 2000;  20(5) 1213-1224 discussion 1224-1226
• 9 Bradbury M S, Kavanagh P V, Bechtold R E et al.. Mesenteric venous thrombosis: diagnosis and noninvasive imaging.  Radiographics. 2002;  22(3) 527-541
• 10 Chow L C, Chan F P, Li K CP. A comprehensive approach to MR imaging of mesenteric ischemia.  Abdom Imaging. 2002;  27(5) 507-516
• 11 Martinez J P, Hogan G J. Mesenteric ischemia.  Emerg Med Clin North Am. 2004;  22(4) 909-928
• 12 Demirpolat G, Oran I, Tamsel S, Parildar M, Memis A. Acute mesenteric ischemia: endovascular therapy.  Abdom Imaging. 2007;  32(3) 299-303
• 13 Schoots I G, Levi M M, Reekers J A, Lameris J S, van Gulik T M. Thrombolytic therapy for acute superior mesenteric artery occlusion.  J Vasc Interv Radiol. 2005;  16(3) 317-329 , Review
• 14 Mitsuyoshi A, Obama K, Shinkura N, Ito T, Zaima M. Survival in nonocclusive mesenteric ischemia: early diagnosis by multidetector row computed tomography and early treatment with continuous intravenous high-dose prostaglandin E(1).  Ann Surg. 2007;  246(2) 229-235
• 15 Schaefer P J, Schaefer F KW, Mueller-Huelsbeck S, Jahnke T. Chronic mesenteric ischemia: stenting of mesenteric arteries.  Abdom Imaging. 2007;  32(3) 304-309
• 16 Atkins M D, Kwolek C J, LaMuraglia G M, Brewster D C, Chung T K, Cambria R P. Surgical revascularization versus endovascular therapy for chronic mesenteric ischemia: a comparative experience.  J Vasc Surg. 2007;  45(6) 1162-1171
• 17 Sharafuddin M J, Olson C H, Sun S, Kresowik T F, Corson J D. Endovascular treatment of celiac and mesenteric arteries stenoses: applications and results.  J Vasc Surg. 2003;  38(4) 692-698
• 18 Matsumoto A H, Angle J F, Spinosa D J et al.. Percutaneous transluminal angioplasty and stenting in the treatment of chronic mesenteric ischemia: results and longterm followup.  J Am Coll Surg. 2002;  194(1, Suppl) S22-S31
• 19 Sarac T P, Altinel O, Kashyap V et al.. Endovascular treatment of stenotic and occluded visceral arteries for chronic mesenteric ischemia.  J Vasc Surg. 2008;  47(3) 485-491