This protocol applies to patients with chronic mesenteric ischemia in whom initial endovascular revascularization — using balloon-expandable covered intraluminal stents targeting the mesenteric arteries — did not achieve the intended therapeutic goals.
Endovascular revascularization with balloon-expandable covered intraluminal stents (superior mesenteric artery as primary target; celiac axis and inferior mesenteric artery as secondary targets) failed to achieve reversal of presenting symptoms — postprandial abdominal pain, food fear, and diarrhea — or adequate weight gain. This protocol describes the next management step.
Reversal of presenting symptoms — postprandial abdominal pain, food fear, and diarrhea — and restoration of weight gain.
When endovascular therapy is not feasible or has been exhausted, open surgical revascularization becomes the relevant management pathway. Multiple surgical techniques exist; the appropriate choice depends on patient anatomy, comorbidities, and prior interventions. The full algorithm and surgical options are in the structured protocol.
DOI: 10.3390/jcm13051217
We recommend reserving open surgical revascularization for patients with CMI who have lesions that are not amenable to endovascular therapy, endovascular failures, and a select group of younger, healthier patients for whom the long-term benefits may offset the increased perioperative risks.
The choice of open surgical revascularization for CMI should be determined by anatomy, comorbidities, prior interventions, and provider preference.
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.
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