Skip to main content

Intestinal ischemia

Abstract

Ischemic changes of the abdominal organs are crucial since they develop slowly and are therefore often diagnosed at a late stage. Due to this general aspect, mortality from this disease could not be significantly reduced over the last decade. One of the main causes of these high mortality rates is the insufficient integration of the overall clinical picture into the diagnostic work-up. Acute mesenteric ischemia should be differentiated from chronic visceral ischemia. Acute intestinal ischemia is a vascular emergency with a mortality rate of 60–80%. The incidence of chronic visceral vascular disorders accounts for approximately 1–2% of all abdominal conditions and has to be differentiated from the acute form, since intestinal ischemia has a progressive nature and usually is related to general atherosclerotic disease. Therefore, this condition is associated with an increase of arteriosclerotic-related multimorbidity in an increasingly elderly population. Due to excellent collateralization, extensive chronic occlusion processes affecting the visceral arteries can be asymptomatically treated on a long-term basis.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Rosenblum JD, Boyle CM, Schwartz LB (1997) The mesenteric circulation. Anatomy and physiology. Surg Clin North Am 77:289–306

    PubMed  Article  CAS  Google Scholar 

  2. Nebesar RA, Kornblith PL, Pollard JJ et al (1969) Celiac and superior mesenteric arteries. A correlation between angiograms and dissections. Little, Brown, Boston, pp 43–178

    Google Scholar 

  3. Schwilden ED (2006) Anatomie und physiologie im splanchnikusgebiet. Gefässchirurgie 11:148–158

    Article  Google Scholar 

  4. Griffith JD (1956) Surgical anatomy of the blood supply of the distal colon. Ann R Coll Surg 19:241–256

    Google Scholar 

  5. Luther B (2001) Intestinale Durchblutungsstörungen. Mesenterialinfarkt, Angina abdominalis, Therapieoptionen, Prognosen. Steinkopff Verlag, Darmstadt, S. 105–47

  6. Cokkinis AJ (1961) Intestinal ischaemia. Proc R Soc Lond B Biol Sci 54:354–356

    CAS  Google Scholar 

  7. Bassiouny HS (1997) Nonocclusive mesenteric ischemia. Surg Clin North Am 77:319–326

    PubMed  Article  CAS  Google Scholar 

  8. Cognet F, Ben Salem D, Dranssart M et al (2002) Chronic mesenteric ischemia: imaging and percutaneous treatment. Radiographics 22:863–879

    PubMed  Google Scholar 

  9. AbuRahma AF, Stone PA, Bates MC, Welch CA (2003) Angioplasty/stenting of the superior mesenteric artery and celiac trunk: early and late outcomes. J Endovasc Ther 10:1046–1053

    PubMed  Article  Google Scholar 

  10. Czerny M, Trubel W, Claeys L, Scheuba C, Huk I, Prager M, Polterauer P (1997) Acute mesenteric ischemia. Zentralbl Chir 122(7):538–544

    PubMed  CAS  Google Scholar 

  11. Edwards MS, Cherr GS, Craven TE et al (2003) Acute occlusive mesenteric ischemia: surgical management and outcomes. Ann Vasc Surg 17:72–79

    PubMed  Article  Google Scholar 

  12. Klempnauer MS et al (1997) Long term results after surgery for acute mesenteric ischemia. Surgery 121(3):239–242

    PubMed  Article  CAS  Google Scholar 

  13. Debus ES, Diener H, Larena-Avellaneda A (2010) Acute intestinal ischemia. Chirurg 80(4):375–385

    Article  Google Scholar 

  14. Debus ES, Luther B, Daun H, Larena-Avellaneda A (2009) Chronic intestinal ischemia. Chirurg 80(5):473–484

    PubMed  Article  CAS  Google Scholar 

  15. Fink S, Chaudhuri TK, Davis HH (2000) Acute mesenteric ischemia and malpractice claims. South Med J 93:210–214

    PubMed  CAS  Google Scholar 

  16. Boley SJ, Brandt LJ, Sammartano RJ (1997) History of mesenteric ischemia. The evolution of a diagnosis and management. Surg Clin North Am 77:275–288

    PubMed  Article  CAS  Google Scholar 

  17. Mansour MA (1999) Management of acute mesenteric ischemia. Arch Surg 134:328–330, discussion 331

    PubMed  Article  CAS  Google Scholar 

  18. Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD (2004) Acute mesenteric ischemia—a clinical review. Arch Int Med 164:1054–1062

    Article  Google Scholar 

  19. Eckstein HH (2003) Die acute mesenteriale Ischämie: resektion oder rekonstruktion? Chirurg 74:419–431

    PubMed  Article  Google Scholar 

  20. Leke MA, Hood DB, Rowe VL, Katz SG, Kohl RD, Weaver FA (2002) Technical consideration in the management of chronic mesenteric ischemia. Am Surg 68:1088–1092

    PubMed  Google Scholar 

  21. Kirkpatrick ID, Kroeker MA, Greenberg HM (2003) Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology 229:91–98

    PubMed  Article  Google Scholar 

  22. Rosow DE, Sahani D, Strobel O et al (2005) Imaging of acute mesenteric ischemia using multidetector CT and CT angiography in a porcine model. J Gastrointest Surg 9:1262–1275

    PubMed  Article  Google Scholar 

  23. Hellinger JC (2004) Evaluating mesenteric ischemia with multidetector-row CT angiography. Tech Vasc Intervent Radiol 7:160–166

    Article  Google Scholar 

  24. Martinez JP, Hogan GJ (2004) Mesenteric ischemia. Emerg Med Clin North Am 22:909–928

    PubMed  Article  Google Scholar 

  25. Kumar S, Sarr MG, Kamath PS (2001) Mesenteric venous thrombosis. N Engl J Med 345:1683–1688

    PubMed  Article  CAS  Google Scholar 

  26. Nicoloff AD, Williamson WK, Moneta GL et al (1997) Duplex ultrasonography in evaluation of splanchnic artery stenosis. Surg Clin North Am 77:339–355

    PubMed  Article  CAS  Google Scholar 

  27. Lee RW, Bakken AM, Palchik E, Saad WE, Davies MG (2008) Long-term outcomes of endoluminal therapy for chronic atherosclerotic occlusive mesenteric disease. Ann Vasc Surg 22:541–546

    PubMed  Article  Google Scholar 

  28. Luther B (2006) Akute viszerale Ischämie. Gefässchirurgie 11:167–172

    Article  Google Scholar 

  29. Schoots IG, Levi MM, Teekers JA et al (2005) Thrombolytic therapy for acute superior mesenteric artery occlusion. J Vasc Interv Radiol 16:317–329

    PubMed  Google Scholar 

  30. Kozuch PL, Brandt LJ (2005) Review article: diagnosis and management of mesenteric ischaemia with an emphasis on pharmacotherapy. Aliment Pharmacol Ther 21:201–215

    PubMed  Article  CAS  Google Scholar 

  31. Yamaguchi T, Saeki M, Iwasaki Y et al (1999) Local thrombolytic therapy for superior mesenteric artery embolism: complications and long-term clinical follow-up. Radiat Med 17:27–33

    PubMed  CAS  Google Scholar 

  32. Schaefer PJ, Schaefer FKW, Hinrichsen H, Jahnke T, Charalambous N, Heller M, Müller-Hülsbeck S (2006) Stent placement with the monorail-technique for treatment of mesenteric artery stenosis. J Vasc Interv Radiol 17(4):637–643

    PubMed  Article  Google Scholar 

  33. Schaefer PJ, Schaefer FK, Mueller-Huelsbeck S, Jahnke T (2007) Chronic mesenteric ischemia: stenting of mesenteric arteries. Abdom Imaging 32(3):304–309, Epub 2006 Sep 6. Review

    PubMed  Article  Google Scholar 

  34. Schaefer PJ, Schaefer FK, Hinrichsen H, Jahnke T, Charalambous N, Heller M, Mueller-Huelsbeck S (2006) Stent placement with the monorail technique for treatment of mesenteric artery stenosis. J Vasc Interv Radiol 17(4):637–643

    PubMed  Article  Google Scholar 

  35. Kougias P, Lau D, El Sayed HF, Zhou W, Huynh TT, Lin PH (2007) Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J Vasc Surg 46:467–474

    PubMed  Article  Google Scholar 

  36. Kruger AJ, Walker PJ, Foster WJ, Jenkins JS, Boyne NS, Jenkins J (2007) Open surgery for atherosclerotic chronic mesenteric ischemia. J Vasc Surg 46:941–945

    PubMed  Article  Google Scholar 

  37. English WP, Pearce JD, Craven TE, Edwards MS, Geary RL, Plonk GW, Hansen KJ (2004) Chronic visceral ischemia: symptom-free survival after open surgical repair. Vasc Endovascular Surg 38:493–503

    PubMed  Article  Google Scholar 

  38. Reekers JA (2009) Is endovascular repair of the celiac trunk and the superior mesenteric artery good enough? In: Brancherau A, Jacobs M (eds) Innovative cardiovascular interventions. Minerva, pp 167–171

  39. Kieffer E (2004) Voies d’abord des arteres digestives. Ann Chir 129:46–51

    PubMed  Article  CAS  Google Scholar 

  40. Armstrong PA (2007) Visceral duplex scanning: evaluation before and after artery intervention for chronic mesenteric ischemia. Perspect Vasc Surg Endovasc Ther 19:386–392

    PubMed  Article  Google Scholar 

  41. Atkins MD, Kwolek CJ, LaMuraglia GM, Brewster DC, Chung TK, Cambria RP (2007) Surgical revascularization versus endovascular therapy for chronic mesenteric ischemia: a comparative experience. J Vasc Surg 45:1162–1171

    PubMed  Article  Google Scholar 

  42. Basche S, Neumeister A (2006) Interventionelle Revaskularisation bei schwerer mesenterialer Ischämie kombiniert mit einer Angioplastie einer Nierenarterie. Vasa 35:31–35

    PubMed  Article  CAS  Google Scholar 

  43. Biebl M, Oldenburg WA, Paz-Fumagalli R, McKinney JM, Hakaim AG (2007) Surgical and interventional visceral revascularization for the treatment of chronic mesenteric ischemia—when to prefer which? World J Surg 31:562–568

    PubMed  Article  Google Scholar 

  44. Piffaretti G, Tozzi M, Lomazzi C, Rivolta N, Riva F, Caronno R, Laganà D, Carrafiello G, Castelli P (2007) Endovascular therapy for chronic mesenteric ischemia. World J Surg 31:2416–2421

    PubMed  Article  Google Scholar 

  45. Moore M, McSweeney S, Fulton G, Buckley J, Maher M, Guiney M (2008) Reperfusion hemorrhage following superior mesenteric artery stenting. Cardiovasc Interv Radiol 31(Suppl 2):S57–S61

    Article  Google Scholar 

  46. Randon CD, De Roose JE, Vermassen FE (2006) Antegrade revascularization for chronic mesenteric ischaemia. Acta Chir Belg 106:625–629

    PubMed  CAS  Google Scholar 

  47. Sharafuddin MJ, Olson CH, Sun S, Kresowik TF, Corson JD (2003) Endovascular treatment of celiac and mesenteric arteries stenoses: applications and results. J Vasc Surg 38:692–698

    PubMed  Article  Google Scholar 

  48. Schaefer PJ, Mueller-Huelsbeck S, Lukas R, Schaefer FK, Huemme TH, Heller M, Jahnke T (2008) Low-profile primary stent placement for the treatment of focal calcified ulcerated stenosis in the infrarenal aorta. J Vasc Interv Radiol 19(2 Pt 1):182–188

    PubMed  Article  Google Scholar 

  49. Kasirajan K, O’Hara PJ, Gray BH et al (2001) Chronic mesenteric ischemia: open surgery versus percutaneous angioplasty and stenting. J Vasc Surg 33:63–71

    PubMed  Article  CAS  Google Scholar 

  50. Rose SC, Quingley TM, Raker EJ (1995) Revascularization for chronic mesenteric ischemia: comparison of operative arterial bypass grafting and percutaneous transluminal angioplasty. J Vasc Interv Radiol 6:339–349

    PubMed  Article  CAS  Google Scholar 

  51. Sivamurthy N, Rhodes JM, Lee D, Waldman DL, Green RM, Davies MG (2006) Endovascular versus open mesenteric revascularization: immediate benefits do not equate with short-term functional outcomes. J Am Coll Surg 202:859–867

    PubMed  Article  Google Scholar 

  52. Soga Y, Yokoi H, Iwabuchi M, Nobuyoshi M (2008) Endovascular treatment of chronic mesenteric ischemia. Circ J 72:1198–1200

    PubMed  Article  Google Scholar 

  53. Wilson DB, Mostafavi K, Craven TE, Ayerdi J, Edwards MS, Hansen KJ (2006) Clinical course of mesenteric artery stenosis in elderly Americans. Arch Intern Med 166:2095–2100

    PubMed  Article  Google Scholar 

  54. Klepczyk L, Keeling WB, Stone PA, Shames ML (2008) Superior mesenteric artery stent fracture producing stenosis and recurrent chronic mesenteric ischemia: case report. Vasc Endovascular Surg 42:79–81

    PubMed  Article  Google Scholar 

  55. Brown DJ, Schermerhorn ML, Powell RJ, Fillinger MF, Rzucidlo EM, Walsh DB, Wyers MC, Zwolak RM, Cronenwett JL (2005) Mesenteric stenting for chronic mesenteric ischemia. J Vasc Surg 42:268–274

    PubMed  Article  Google Scholar 

  56. Heiss P, Zorger N, Kaempfe I et al (2009) Stenting in the management of chronic mesenteric ischemia: technical and clinical success rates. RöFo (in press)

  57. Allen RC, Martin GH, Rees CR et al (1996) Mesenteric angioplasty in the treatment of chronic intestinal ischemia. J Vasc Surg 24:415–421

    PubMed  Article  CAS  Google Scholar 

  58. Matsumoto AH, Angle JF, Spinosa DJ, Hagspiel KD, Cage DL, Leung DA, Kern JA, Tribble CG, Kron IL (2002) Percutaneous transluminal angioplasty and stenting in the treatment of chronic mesenteric ischemia: results and long-term follow-up. J Am Coll Surg 194(1 Suppl):22–31

    Article  Google Scholar 

  59. Nyman U, Ivancev K, Lindh M, Uher P (1998) Endovascular treatment of chronic mesenteric ischemia: report of five cases. Cardiovasc Interv Radiol 21:305–313

    Article  CAS  Google Scholar 

  60. Reuter SR, Bernstein EF (1973) The anatomic basis for respiratory variation in median arcuate ligament compression of the celiac artery. Surgery 73:381–385

    PubMed  CAS  Google Scholar 

  61. Hansen KJ, Wilson DB, Craven TE, Pearce JD, English WP, Edwards MS, Ayerdi J, Burke GL (2004) Mesenteric artery disease in the elderly. J Vasc Surg 40:45–52

    PubMed  Article  Google Scholar 

  62. Abularrage CJ, Sidawy AN, Weiswasser JM, White PW, Aidinian G, Arora S (2005) Chronic mesenteric ischemia: treatment of recurrent disease. J Vasc Surg 42:1026

    PubMed  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eike Sebastian Debus.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Debus, E.S., Müller-Hülsbeck, S., Kölbel, T. et al. Intestinal ischemia. Int J Colorectal Dis 26, 1087–1097 (2011). https://doi.org/10.1007/s00384-011-1196-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-011-1196-6

Keywords

  • Ischemia
  • Mesenteric
  • Intestinal
  • Atherosclerotic disease