Chapter 15: Chronic Mesenteric Ischaemia

The following sections are included:

• Chronic mesenteric ischaemia (CMI) is a rare condition, accounting for less than 5% of all intestinal ischaemic events.

• More than 90% of the cases are due to atherosclerotic occlusion or severe stenosis.

• Classic symptoms include post-prandial abdominal pain, sitophobia, and weight loss.

• At least two of the three main splanchnic arteries must be significantly compromised to result in CMI.

• Duplex ultrasonography is non-invasive and expedient, but may miss up to 20% of vascular lesions in celiac artery.

• Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are equally excellent non-invasive modalities with highly accurate diagnosis.

• Digital Subtraction angiography should be reserved for the diagnosis of CMI only when other modalities have been unhelpful or if intervention such as percutaneous transluminal angioplasty (PTA) is planned.

• Surgical vascular bypass is the definitive therapy for CMI with an overall 5-year graft patency of 78%. It is preferred in younger patients with less comorbidities.

• Endovascular therapy is optimal in short segment atherosclerotic lesions <2 cm from the ostia of coeliac and superior mesenteric artery. Angioplasty and stenting have a significantly lower rate of complications although the intervention rate is higher.