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Acute and Chronic Ischemic Disorders of the Small Bowel

  • Small Intestine (D Sachar, Section Editor)
  • Published:
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Abstract

Purpose of Review

Ischemic disorders of the small bowel represent a rare but highly morbid disease process which is often difficult to diagnose and has a complex management course involving multidisciplinary care. Given recent advances in radiologic modalities and surgical/endovascular techniques, this review seeks to provide a disease overview as well as a summary of emerging management strategies.

Recent Findings

In cases of acute mesenteric ischemia without evidence of frank bowel necrosis, an endovascular-first strategy employing thrombolysis, pharmacomechanical thrombectomy, and/or adjunctive angioplasty/stenting has been shown to have positive outcomes. In cases requiring open laparotomy, retrograde open mesenteric stenting may facilitate less dissection and more straightforward revascularization. While endovascular intervention for chronic mesenteric ischemia was historically limited by high rates of restenosis, use of covered stents in these vascular beds has been shown to have excellent patency rates.

Summary

Ischemia of the small bowel can be acute or chronic in nature—endovascular treatment modalities have been shown to have excellent results given appropriate patient selection and should be an important tool in the armamentarium of management options for this complex disease process.

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Authors and Affiliations

  1. Division of Vascular Surgery, Department of Surgery, The Mount Sinai Hospital, New York, NY, USA

    Vivek S. Prakash, Michael Marin & Peter L. Faries

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  1. Vivek S. Prakash
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  2. Michael Marin
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Correspondence to Peter L. Faries.

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Prakash, V.S., Marin, M. & Faries, P.L. Acute and Chronic Ischemic Disorders of the Small Bowel. Curr Gastroenterol Rep 21, 27 (2019). https://doi.org/10.1007/s11894-019-0694-5

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