Treatment of Chronic Mesenteric Ischemia: Endovascular Revascularization
Clinical Scenario
Chronic mesenteric ischemia (CMI) presents with postprandial abdominal pain, food fear, diarrhoea, and progressive weight loss due to occlusive disease of the mesenteric arteries. Selecting the appropriate revascularization target is central to management.
Treatment Goals
The primary objectives are reversal of presenting symptoms — postprandial pain, food fear, and diarrhoea — and restoration of weight gain, alongside prevention of progression to acute mesenteric ischemia and improvement in overall quality of life.
Approach Partial overview
The initial treatment strategy involves an endovascular revascularization approach, with specific priority assigned to one mesenteric vessel over others based on suitability. The full protocol — including which vessel is the primary target, alternative targets, device selection, and the decision algorithm — is available in the complete regimen.
References
- We recommend endovascular revascularization as the initial treatment for patients with CMI and suitable lesions.
- We suggest using balloon-expandable covered intraluminal stents for the treatment of the MAOD in patients with CMI.
- We suggest that the SMA is the primary target for revascularization.
- We suggest that the celiac axis and inferior mesenteric artery are secondary targets for revascularization and that revascularization may aid in symptom relief if the SMA is not suitable for intervention or the technical result is not acceptable.
- We recommend revascularization in patients with CMI to reverse their presenting symptoms (ie, weight loss, food fear, diarrhea, postprandial pain) and improve their overall quality of life.
- Treatment goals for patients with CMI are to reverse the symptoms, facilitate weight gain, prevent the development of AMI, and improve the patient's overall quality of life.
DOI: 10.3390/jcm13051217
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