Chronic Mesenteric Ischemia with Recurrent Stenosis After Prior Mesenteric Revascularization
Patients with a history of mesenteric revascularization may develop recurrent arterial stenosis and return of ischemic symptoms, representing a specific and clinically important scenario that requires a targeted remedial approach.
Clinical Scenario
This protocol addresses patients with prior mesenteric revascularization who present with recurrent stenosis and recurrent symptoms of chronic mesenteric ischemia. Restenosis can occur after both endovascular and open revascularization procedures, reproducing the original symptom burden.
Treatment Goals
The primary objective is reversal of the recurrent symptoms — postprandial abdominal pain, food fear, and diarrhea — and restoration of quality of life.
Treatment Approach
Remedial revascularization is indicated. An endovascular-first strategy is recommended, with the specific technique guided by lesion extent, the presence of thrombus, and the details of the prior procedure. The full protocol — including the specific endovascular decision criteria and options — is available below.
References
DOI: 10.3390/jcm13051217
- Patients may develop recurrent stenoses and/or recurrent symptoms after both endovascular and open revascularization for CMI.
- In patients with recurrent symptoms of CMI, we recommend remedial treatment as recommended for the de novo lesions.
- An endovascular-first approach is recommended for both failing endovascular and open revascularization with the specifics of the procedure contingent upon the extent of the lesion, the presence of thrombus, and the details of the initial procedure.
- 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.