Skip to main content

Advertisement

SpringerLink
Log in

Review Article: Mesenteric Ischemia

  • Small Intestine (D Sachar and AC Stein, Section Editors)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Mesenteric ischemia (MI), both acute (AMI) and chronic (CMI), is a challenging diagnosis to make, and early diagnosis and treatment are vital to improve outcomes. This manuscript summarizes the most up to date information on diagnosis and treatment of these disorders.

Recent Findings

There have been several significant advancements in the computed tomography (CT) diagnostic imaging as well as medical and endovascular management of AMI and CMI. In appropriate populations, endovascular interventions appear superior to open surgical management with lower mortality, morbidity, and cost of care.

Summary

Efficient clinical identification and targeted testing are essential to diagnose AMI and CMI. Aggressive resuscitation and early endovascular (or in select cases, surgical) intervention improve outcomes in those with AMI. In those with CMI, considering this on the differential diagnosis and imaging appropriately can identify those that might benefit from intervention and halt progression to acute episodes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Rosenblum JD, Boyle CM, Schwartz LB. The mesenteric circulation. Anatomy and physiology. Surg Clin North Am. 1997;77(2):289–306. https://doi.org/10.1016/s0039-6109(05)70549-1.

    Article  CAS  PubMed  Google Scholar 

  2. van Petersen AS, Kolkman JJ, Meerwaldt R, Huisman AB, van der Palen J, Zeebregts CJ, et al. Mesenteric stenosis, collaterals, and compensatory blood flow. J Vasc Surg. 2014;60(1):111–9, 9.e1–2. https://doi.org/10.1016/j.jvs.2014.01.063.

    Article  PubMed  Google Scholar 

  3. Chiu CJ, McArdle AH, Brown R, Scott HJ, Gurd FN. Intestinal mucosal lesion in low-flow states. I. A morphological, hemodynamic, and metabolic reappraisal. Arch Surg. 1970;101(4):478–83. https://doi.org/10.1001/archsurg.1970.01340280030009.

    Article  CAS  PubMed  Google Scholar 

  4. Acosta S. Mesenteric ischemia. Curr Opin Crit Care. 2015;21(2):171–8. https://doi.org/10.1097/mcc.0000000000000189.

    Article  PubMed  Google Scholar 

  5. Clair DG, Beach JM. Mesenteric Ischemia. N Engl J Med. 2016;374(10):959–68. https://doi.org/10.1056/NEJMra1503884.

    Article  CAS  PubMed  Google Scholar 

  6. Bhagirath Desai A, Sandeep Shah D, Jagat Bhatt C, Umesh Vaishnav K, Salvi B. Measurement of the distance and angle between the aorta and superior mesenteric artery on CT scan: values in Indian population in different BMI categories. Indian J Surg. 2015;77(Suppl 2):614–7. https://doi.org/10.1007/s12262-013-0941-1.

    Article  PubMed  Google Scholar 

  7. Ozkurt H, Cenker MM, Bas N, Erturk SM, Basak M. Measurement of the distance and angle between the aorta and superior mesenteric artery: normal values in different BMI categories. Surg Radiol Anat. 2007;29(7):595–9. https://doi.org/10.1007/s00276-007-0238-9.

    Article  PubMed  Google Scholar 

  8. Karkkainen JM, Acosta S. Acute mesenteric ischemia (part I) - incidence, etiologies, and how to improve early diagnosis. Best Pract Res Clin Gastroenterol. 2017;31(1):15–25. https://doi.org/10.1016/j.bpg.2016.10.018.

    Article  PubMed  Google Scholar 

  9. Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Arch Intern Med. 2004;164(10):1054–62. https://doi.org/10.1001/archinte.164.10.1054.

    Article  Google Scholar 

  10. Cohn DM, Roshani S, Middeldorp S. Thrombophilia and venous thromboembolism: implications for testing. Semin Thromb Hemost. 2007;33(6):573–81. https://doi.org/10.1055/s-2007-985753.

    Article  CAS  PubMed  Google Scholar 

  11. Al-Diery H, Phillips A, Evennett N, Pandanaboyana S, Gilham M, Windsor JA. The pathogenesis of nonocclusive mesenteric ischemia: implications for research and clinical practice. J Intensive Care Med. 2019;34(10):771–81. https://doi.org/10.1177/0885066618788827.

    Article  PubMed  Google Scholar 

  12. Trompeter M, Brazda T, Remy CT, Vestring T, Reimer P. Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy. Eur Radiol. 2002;12(5):1179–87. https://doi.org/10.1007/s00330-001-1220-2.

    Article  PubMed  Google Scholar 

  13. Kim EN, Lamb K, Relles D, Moudgill N, DiMuzio PJ, Eisenberg JA. Median Arcuate ligament syndrome-review of this rare disease. JAMA Surg. 2016;151(5):471–7. https://doi.org/10.1001/jamasurg.2016.0002.

    Article  PubMed  Google Scholar 

  14. Klass AA. Embolectomy in acute mesenteric occlusion. Ann Surg. 1951;134(5):913–7. https://doi.org/10.1097/00000658-195111000-00016.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. • Tilsed JV, Casamassima A, Kurihara H, Mariani D, Martinez I, Pereira J, et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg. 2016;42(2):253–70. https://doi.org/10.1007/s00068-016-0634-0Guidelines of the European Society for Trauma and Emergency Surgery on AMI management.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Acosta S, Bjorck M. Acute thrombo-embolic occlusion of the superior mesenteric artery: a prospective study in a well defined population. Eur J Vasc Endovasc Surg. 2003;26(2):179–83.

    Article  CAS  Google Scholar 

  17. •• Bala M, Kashuk J, Moore EE, Kluger Y, Biffl W, Gomes CA, et al. Acute mesenteric ischemia: guidelines of the world Society of Emergency Surgery. World J Emerg Surg. 2017;12:38. https://doi.org/10.1186/s13017-017-0150-5Guidelines of the World Society of Emergency Surgery on management of AMI.

    Article  PubMed  PubMed Central  Google Scholar 

  18. •• Bjorck M, Koelemay M, Acosta S, Bastos Goncalves F, Kolbel T, Kolkman JJ, et al. Editor’s Choice - Management of the diseases of mesenteric arteries and veins: clinical practice guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2017;53(4):460–510. https://doi.org/10.1016/j.ejvs.2017.01.010Review and treatment guidelines released by European Society of Vascular Surgery for AMI and CMI in 2017.

    Article  CAS  PubMed  Google Scholar 

  19. Hmoud B, Singal AK, Kamath PS. Mesenteric venous thrombosis. J Clin Exp Hepatol. 2014;4(3):257–63. https://doi.org/10.1016/j.jceh.2014.03.052.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Park WM, Gloviczki P, Cherry KJ Jr, Hallett JW Jr, Bower TC, Panneton JM, et al. Contemporary management of acute mesenteric ischemia: factors associated with survival. J Vasc Surg. 2002;35(3):445–52. https://doi.org/10.1067/mva.2002.120373.

    Article  PubMed  Google Scholar 

  21. Menke J, Luthje L, Kastrup A, Larsen J. Thromboembolism in atrial fibrillation. Am J Cardiol. 2010;105(4):502–10. https://doi.org/10.1016/j.amjcard.2009.10.018.

    Article  PubMed  Google Scholar 

  22. Berland T, Oldenburg WA. Acute mesenteric ischemia. Curr Gastroenterol Rep. 2008;10(3):341–6.

    Article  Google Scholar 

  23. Stahl K, Busch M, Maschke SK, Schneider A, Manns MP, Fuge J, et al. A retrospective analysis of nonocclusive mesenteric ischemia in medical and surgical ICU patients: clinical data on demography, clinical signs, and survival. J Intensive Care Med. 2019;885066619837911. https://doi.org/10.1177/0885066619837911.

  24. Roobottom CA, Dubbins PA. Significant disease of the celiac and superior mesenteric arteries in asymptomatic patients: predictive value of Doppler sonography. AJR Am J Roentgenol. 1993;161(5):985–8. https://doi.org/10.2214/ajr.161.5.8273642.

    Article  CAS  PubMed  Google Scholar 

  25. • Pecoraro F, Rancic Z, Lachat M, Mayer D, Amann-Vesti B, Pfammatter T, et al. Chronic mesenteric ischemia: critical review and guidelines for management. Ann Vasc Surg. 2013;27(1):113–22. https://doi.org/10.1016/j.avsg.2012.05.012A review on CMI that also looked at comparison of endovascular and open interventions in 2013.

    Article  PubMed  Google Scholar 

  26. Dunphy JE. Abdominal pain of vascular origin. Am J Med Sci. 1936;192:109–13.

    Article  Google Scholar 

  27. Mikkelsen WP. Intestinal angina: its surgical significance. Am J Surg. 1957;94(2):262–7; discussion, 7–9. https://doi.org/10.1016/0002-9610(57)90654-2.

    Article  CAS  PubMed  Google Scholar 

  28. •• van Dijk LJ, van Noord D, de Vries AC, Kolkman JJ, Geelkerken RH, Verhagen HJ, et al. Clinical management of chronic mesenteric ischemia. United European Gastroenterol J. 2019;7(2):179–88. https://doi.org/10.1177/2050640618817698A recent comprehensive update on management strategies of CMI.

    Article  PubMed  Google Scholar 

  29. • Kolkman JJ, Geelkerken RH. Diagnosis and treatment of chronic mesenteric ischemia: an update. Best Pract Res Clin Gastroenterol. 2017;31(1):49–57. https://doi.org/10.1016/j.bpg.2017.01.003An updated clinical review on the diagnosis and management of CMI.

    Article  PubMed  Google Scholar 

  30. Mensink PB, van Petersen AS, Geelkerken RH, Otte JA, Huisman AB, Kolkman JJ. Clinical significance of splanchnic artery stenosis. Br J Surg. 2006;93(11):1377–82. https://doi.org/10.1002/bjs.5481.

    Article  CAS  PubMed  Google Scholar 

  31. Kuruvilla A, Murtaza G, Cheema A, Arshad HMS. Median arcuate ligament syndrome: it is not always gastritis. J Investig Med High Impact Case Rep. 2017;5(3):2324709617728750. https://doi.org/10.1177/2324709617728750.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Sunkara T, Caughey ME, Zhen KC, Chiong B, Gaduputi V. Dunbar syndrome-a rare cause of foregut ischemia. J Clin Diagn Res. 2017;11(7):Od13–od4. https://doi.org/10.7860/jcdr/2017/28142.10267.

    Article  PubMed  PubMed Central  Google Scholar 

  33. van den Heijkant TC, Aerts BA, Teijink JA, Buurman WA, Luyer MD. Challenges in diagnosing mesenteric ischemia. World J Gastroenterol. 2013;19(9):1338–41. https://doi.org/10.3748/wjg.v19.i9.1338.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Acosta S, Nilsson T. Current status on plasma biomarkers for acute mesenteric ischemia. J Thromb Thrombolysis. 2012;33(4):355–61. https://doi.org/10.1007/s11239-011-0660-z.

    Article  CAS  PubMed  Google Scholar 

  35. Khadaroo RG, Fortis S, Salim SY, Streutker C, Churchill TA, Zhang H. I-FABP as biomarker for the early diagnosis of acute mesenteric ischemia and resultant lung injury. PLoS One. 2014;9(12):e115242. https://doi.org/10.1371/journal.pone.0115242.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Moschetta M, Telegrafo M, Rella L, Stabile Ianora AA, Angelelli G. Multi-detector CT features of acute intestinal ischemia and their prognostic correlations. World J Radiol. 2014;6(5):130–8. https://doi.org/10.4329/wjr.v6.i5.130.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Lee SS, Park SH. Computed tomography evaluation of gastrointestinal bleeding and acute mesenteric ischemia. Radiol Clin N Am. 2013;51(1):29–43. https://doi.org/10.1016/j.rcl.2012.09.003.

    Article  CAS  PubMed  Google Scholar 

  38. Yikilmaz A, Karahan OI, Senol S, Tuna IS, Akyildiz HY. Value of multislice computed tomography in the diagnosis of acute mesenteric ischemia. Eur J Radiol. 2011;80(2):297–302. https://doi.org/10.1016/j.ejrad.2010.07.016.

    Article  PubMed  Google Scholar 

  39. Lehtimaki TT, Karkkainen JM, Saari P, Manninen H, Paajanen H, Vanninen R. Detecting acute mesenteric ischemia in CT of the acute abdomen is dependent on clinical suspicion: review of 95 consecutive patients. Eur J Radiol. 2015;84(12):2444–53. https://doi.org/10.1016/j.ejrad.2015.09.006.

    Article  PubMed  Google Scholar 

  40. Acosta S, Bjornsson S, Ekberg O, Resch T. CT angiography followed by endovascular intervention for acute superior mesenteric artery occlusion does not increase risk of contrast-induced renal failure. Eur J Vasc Endovasc Surg. 2010;39(6):726–30. https://doi.org/10.1016/j.ejvs.2010.01.017.

    Article  CAS  PubMed  Google Scholar 

  41. Stefanidis D, Richardson WS, Chang L, Earle DB, Fanelli RD. The role of diagnostic laparoscopy for acute abdominal conditions: an evidence-based review. Surg Endosc. 2009;23(1):16–23. https://doi.org/10.1007/s00464-008-0103-x.

    Article  PubMed  Google Scholar 

  42. Yanar H, Taviloglu K, Ertekin C, Ozcinar B, Yanar F, Guloglu R, et al. Planned second-look laparoscopy in the management of acute mesenteric ischemia. World J Gastroenterol. 2007;13(24):3350–3. https://doi.org/10.3748/wjg.v13.i24.3350.

    Article  PubMed  PubMed Central  Google Scholar 

  43. van Noord D, Mensink PB, de Knegt RJ, Ouwendijk M, Francke J, van Vuuren AJ, et al. Serum markers and intestinal mucosal injury in chronic gastrointestinal ischemia. Dig Dis Sci. 2011;56(2):506–12. https://doi.org/10.1007/s10620-010-1303-5.

    Article  CAS  PubMed  Google Scholar 

  44. AbuRahma AF, Stone PA, Srivastava M, Dean LS, Keiffer T, Hass SM, et al. Mesenteric/celiac duplex ultrasound interpretation criteria revisited. J Vasc Surg. 2012;55(2):428–36.e6; discussion 35-6. https://doi.org/10.1016/j.jvs.2011.08.052.

    Article  PubMed  Google Scholar 

  45. Catalini R, Alborino S, Giovagnoli A, Zingaretti O. Color duplex evaluation of the mesenteric artery(). J Ultrasound. 2010;13(3):118–22. https://doi.org/10.1016/j.jus.2010.09.002.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Schaefer PJ, Pfarr J, Trentmann J, Wulff AM, Langer C, Siggelkow M, et al. Comparison of noninvasive imaging modalities for stenosis grading in mesenteric arteries. Rofo. 2013;185(7):628–34. https://doi.org/10.1055/s-0033-1335212.

    Article  CAS  PubMed  Google Scholar 

  47. van Noord D, Kolkman JJ. Functional testing in the diagnosis of chronic mesenteric ischemia. Best Pract Res Clin Gastroenterol. 2017;31(1):59–68. https://doi.org/10.1016/j.bpg.2016.12.002.

    Article  PubMed  Google Scholar 

  48. Friedland S, Benaron D, Coogan S, Sze DY, Soetikno R. Diagnosis of chronic mesenteric ischemia by visible light spectroscopy during endoscopy. Gastrointest Endosc. 2007;65(2):294–300. https://doi.org/10.1016/j.gie.2006.05.007.

    Article  PubMed  Google Scholar 

  49. Van Noord D, Sana A, Benaron DA, Pattynama PM, Verhagen HJ, Hansen BE, et al. Endoscopic visible light spectroscopy: a new, minimally invasive technique to diagnose chronic GI ischemia. Gastrointest Endosc. 2011;73(2):291–8. https://doi.org/10.1016/j.gie.2010.10.025.

    Article  PubMed  Google Scholar 

  50. Kolkman JJ, Otte JA, Groeneveld AB. Gastrointestinal luminal PCO2 tonometry: an update on physiology, methodology and clinical applications. Br J Anaesth. 2000;84(1):74–86. https://doi.org/10.1093/oxfordjournals.bja.a013386.

    Article  CAS  PubMed  Google Scholar 

  51. Kolkman JJ, Groeneveld AB, van der Berg FG, Rauwerda JA, Meuwissen SG. Increased gastric PCO2 during exercise is indicative of gastric ischaemia: a tonometric study. Gut. 1999;44(2):163–7. https://doi.org/10.1136/gut.44.2.163.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Otte JA, Geelkerken RH, Oostveen E, Mensink PB, Huisman AB, Kolkman JJ. Clinical impact of gastric exercise tonometry on diagnosis and management of chronic gastrointestinal ischemia. Clin Gastroenterol Hepatol. 2005;3(7):660–6.

    Article  Google Scholar 

  53. Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2013;(2):Cd000567. https://doi.org/10.1002/14651858.CD000567.pub6.

  54. Bomberg H, Groesdonk HV, Raffel M, Minko P, Schmied W, Klingele M, et al. Vasopressin as therapy during nonocclusive mesenteric ischemia. Ann Thorac Surg. 2016;102(3):813–9. https://doi.org/10.1016/j.athoracsur.2016.03.025.

    Article  PubMed  Google Scholar 

  55. Auchet T, Regnier MA, Girerd N, Levy B. Outcome of patients with septic shock and high-dose vasopressor therapy. Ann Intensive Care. 2017;7(1):43. https://doi.org/10.1186/s13613-017-0261-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Nuzzo A, Maggiori L, Paugam-Burtz C, Cazals-Hatem D, Ronot M, Huguet A, et al. Oral antibiotics reduce intestinal necrosis in acute mesenteric ischemia: a prospective cohort study. Am J Gastroenterol. 2019;114(2):348–51. https://doi.org/10.1038/s41395-018-0389-9.

    Article  CAS  PubMed  Google Scholar 

  57. Wong PF, Gilliam AD, Kumar S, Shenfine J, O'Dair GN, Leaper DJ. Antibiotic regimens for secondary peritonitis of gastrointestinal origin in adults. Cochrane Database Syst Rev. 2005;(2):Cd004539. https://doi.org/10.1002/14651858.CD004539.pub2.

  58. Karkkainen JM, Acosta S. Acute mesenteric ischemia (Part II) - vascular and endovascular surgical approaches. Best Pract Res Clin Gastroenterol. 2017;31(1):27–38. https://doi.org/10.1016/j.bpg.2016.11.003.

    Article  PubMed  Google Scholar 

  59. • Salsano G, Salsano A, Sportelli E, Petrocelli F, Dahmane M, Spinella G, et al. What is the best revascularization strategy for acute occlusive arterial mesenteric ischemia: systematic review and meta-analysis. Cardiovasc Intervent Radiol. 2018;41(1):27–36. https://doi.org/10.1007/s00270-017-1749-3A systematic review in 2018 that showed that endovascular approach has several advantages over surgical in AMI.

    Article  PubMed  Google Scholar 

  60. Lobo Martinez E, Merono Carvajosa E, Sacco O, Martinez ME. Embolectomy in mesenteric ischemia. Rev Esp Enferm Dig. 1993;83(5):351–4.

    CAS  PubMed  Google Scholar 

  61. Al-Samkari H, Connors JM. Approach to thrombophilia testing in patients with splanchnic vein thrombosis. AME Med J. 2018;3(1).

  62. Klotz S, Vestring T, Rotker J, Schmidt C, Scheld HH, Schmid C. Diagnosis and treatment of nonocclusive mesenteric ischemia after open heart surgery. Ann Thorac Surg. 2001;72(5):1583–6. https://doi.org/10.1016/s0003-4975(01)03179-4.

    Article  CAS  PubMed  Google Scholar 

  63. Mitsuyoshi A, Obama K, Shinkura N, Ito T, Zaima M. Survival in nonocclusive mesenteric ischemia: early diagnosis by multidetector row computed tomography and early treatment with continuous intravenous high-dose prostaglandin E(1). Ann Surg. 2007;246(2):229–35. https://doi.org/10.1097/01.sla.0000263157.59422.76.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Acosta S. Surgical management of peritonitis secondary to acute superior mesenteric artery occlusion. World J Gastroenterol. 2014;20(29):9936–41. https://doi.org/10.3748/wjg.v20.i29.9936.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Weber DG, Bendinelli C, Balogh ZJ. Damage control surgery for abdominal emergencies. Br J Surg. 2014;101(1):e109–18. https://doi.org/10.1002/bjs.9360.

    Article  CAS  PubMed  Google Scholar 

  66. Freeman AJ, Graham JC. Damage control surgery and angiography in cases of acute mesenteric ischaemia. ANZ J Surg. 2005;75(5):308–14. https://doi.org/10.1111/j.1445-2197.2005.03373.x.

    Article  PubMed  Google Scholar 

  67. Kaminsky O, Yampolski I, Aranovich D, Gnessin E, Greif F. Does a second-look operation improve survival in patients with peritonitis due to acute mesenteric ischemia? A five-year retrospective experience. World J Surg. 2005;29(5):645–8. https://doi.org/10.1007/s00268-005-7380-5.

    Article  PubMed  Google Scholar 

  68. Klar E, Rahmanian PB, Bucker A, Hauenstein K, Jauch KW, Luther B. Acute mesenteric ischemia: a vascular emergency. Dtsch Arztebl Int. 2012;109(14):249–56. https://doi.org/10.3238/arztebl.2012.0249.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Chandra A, Quinones-Baldrich WJ. Chronic mesenteric ischemia: how to select patients for invasive treatment. Semin Vasc Surg. 2010;23(1):21–8. https://doi.org/10.1053/j.semvascsurg.2009.12.003.

    Article  PubMed  Google Scholar 

  70. American Gastroenterological Association Medical Position Statement: guidelines on intestinal ischemia. Gastroenterology. 2000;118(5):951–3. https://doi.org/10.1016/s0016-5085(00)70182-x.

  71. Cardin F, Fratta S, Perissinotto E, Militello C, Martella B. Influence of splanchnic artery stenosis on the in-hospital clinical course of elderly patients. Aging Clin Exp Res. 2017;29(Suppl 1):131–7. https://doi.org/10.1007/s40520-016-0646-y.

    Article  PubMed  Google Scholar 

  72. Allen RC, Martin GH, Rees CR, Rivera FJ, Talkington CM, Garrett WV, et al. Mesenteric angioplasty in the treatment of chronic intestinal ischemia. J Vasc Surg. 1996;24(3):415–21; discussion 21-3. https://doi.org/10.1016/s0741-5214(96)70197-0.

    Article  CAS  PubMed  Google Scholar 

  73. Matsumoto AH, Tegtmeyer CJ, Fitzcharles EK, Selby JB Jr, Tribble CG, Angle JF, et al. Percutaneous transluminal angioplasty of visceral arterial stenoses: results and long-term clinical follow-up. J Vasc Interv Radiol. 1995;6(2):165–74.

    Article  CAS  Google Scholar 

  74. Oderich GS, Erdoes LS, Lesar C, Mendes BC, Gloviczki P, Cha S, et al. Comparison of covered stents versus bare metal stents for treatment of chronic atherosclerotic mesenteric arterial disease. J Vasc Surg. 2013;58(5):1316–23. https://doi.org/10.1016/j.jvs.2013.05.013.

    Article  PubMed  Google Scholar 

  75. Zhou Y, Ryer EJ, Garvin RP, Pham A, Irvan JL, Orlova K, et al. Outcomes of endovascular treatments for in-stent restenosis in patients with mesenteric atherosclerotic disease. J Vasc Surg. 2019;69(3):833–42. https://doi.org/10.1016/j.jvs.2018.08.166.

    Article  PubMed  Google Scholar 

  76. Pillai AK, Kalva SP, Hsu SL, Walker TG, Silberzweig JE, Annamalai G, et al. Quality improvement guidelines for mesenteric angioplasty and stent placement for the treatment of chronic mesenteric ischemia. J Vasc Interv Radiol. 2018;29(5):642–7. https://doi.org/10.1016/j.jvir.2017.11.024.

    Article  PubMed  Google Scholar 

  77. Rits Y, Oderich GS, Bower TC, Miller DV, Cooper L, Ricotta JJ 2nd, et al. Interventions for mesenteric vasculitis. J Vasc Surg. 2010;51(2):392–400.e2. https://doi.org/10.1016/j.jvs.2009.08.082.

    Article  PubMed  Google Scholar 

  78. Erben Y, Protack CD, Jean RA, Sumpio BJ, Miller SM, Liu S, et al. Endovascular interventions decrease length of hospitalization and are cost-effective in acute mesenteric ischemia. J Vasc Surg. 2018;68(2):459–69. https://doi.org/10.1016/j.jvs.2017.11.078.

    Article  PubMed  Google Scholar 

  79. Gupta PK, Horan SM, Turaga KK, Miller WJ, Pipinos II. Chronic mesenteric ischemia: endovascular versus open revascularization. J Endovasc Ther. 2010;17(4):540–9. https://doi.org/10.1583/09-2935.1.

    Article  PubMed  Google Scholar 

  80. Saedon M, Saratzis A, Karim A, Goodyear S. Endovascular versus surgical revascularization for the management of chronic mesenteric ischemia. Vasc Endovasc Surg. 2015;49(1–2):37–44. https://doi.org/10.1177/1538574415585127.

    Article  Google Scholar 

  81. Alahdab F, Arwani R, Pasha AK, Razouki ZA, Prokop LJ, Huber TS, et al. A systematic review and meta-analysis of endovascular versus open surgical revascularization for chronic mesenteric ischemia. J Vasc Surg. 2018;67(5):1598–605. https://doi.org/10.1016/j.jvs.2017.12.046.

    Article  PubMed  Google Scholar 

  82. Oderich GS, Tallarita T, Gloviczki P, Duncan AA, Kalra M, Misra S, et al. Mesenteric artery complications during angioplasty and stent placement for atherosclerotic chronic mesenteric ischemia. J Vasc Surg. 2012;55(4):1063–71. https://doi.org/10.1016/j.jvs.2011.10.122.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Gnanapandithan K, Sharma A. Mesenteric Vasculitis. StatPearls. Treasure Island: StatPearls Publishing LLC; 2019.

    Google Scholar 

  84. Koster MJ, Warrington KJ. Vasculitis of the mesenteric circulation. Best Pract Res Clin Gastroenterol. 2017;31(1):85–96. https://doi.org/10.1016/j.bpg.2016.12.003.

    Article  PubMed  Google Scholar 

  85. Sun Z, Zhang D, Xu G, Zhang N. Laparoscopic treatment of median arcuate ligament syndrome. Intractable Rare Dis Res. 2019;8(2):108–12. https://doi.org/10.5582/irdr.2019.01031.

    Article  PubMed  PubMed Central  Google Scholar 

  86. You JS, Cooper M, Nishida S, Matsuda E, Murariu D. Treatment of median arcuate ligament syndrome via traditional and robotic techniques. Hawaii J Med Public Health. 2013;72(8):279–81.

    PubMed  PubMed Central  Google Scholar 

  87. Nasr LA, Faraj WG, Al-Kutoubi A, Hamady M, Khalifeh M, Hallal A, et al. Median Arcuate ligament syndrome: a single-center experience with 23 patients. Cardiovasc Intervent Radiol. 2017;40(5):664–70. https://doi.org/10.1007/s00270-016-1560-6.

    Article  PubMed  Google Scholar 

  88. Tulloch AW, Jimenez JC, Lawrence PF, Dutson EP, Moore WS, Rigberg DA, et al. Laparoscopic versus open celiac ganglionectomy in patients with median arcuate ligament syndrome. J Vasc Surg. 2010;52(5):1283–9. https://doi.org/10.1016/j.jvs.2010.05.083.

    Article  PubMed  Google Scholar 

  89. Caluwaerts M, Castanares-Zapatero D, Laterre PF, Hantson P. Prognostic factors of acute mesenteric ischemia in ICU patients. BMC Gastroenterol. 2019;19(1):80. https://doi.org/10.1186/s12876-019-0999-8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  90. Luther B, Mamopoulos A, Lehmann C, Klar E. The ongoing challenge of acute mesenteric ischemia. Visc Med. 2018;34(3):217–23. https://doi.org/10.1159/000490318.

    Article  PubMed  PubMed Central  Google Scholar 

  91. Aliosmanoglu I, Gul M, Kapan M, Arikanoglu Z, Taskesen F, Basol O, et al. Risk factors effecting mortality in acute mesenteric ischemia and mortality rates: a single center experience. Int Surg. 2013;98(1):76–81. https://doi.org/10.9738/cc112.1.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Wadman M, Syk I, Elmstahl S. Survival after operations for ischaemic bowel disease. Eur J Surg. 2000;166(11):872–7. https://doi.org/10.1080/110241500447263.

    Article  CAS  PubMed  Google Scholar 

  93. Feuerstadt P, Aroniadis O, Brandt LJ. Features and outcomes of patients with ischemia isolated to the right side of the colon when accompanied or followed by acute mesenteric ischemia. Clin Gastroenterol Hepatol. 2015;13(11):1962–8. https://doi.org/10.1016/j.cgh.2015.04.011.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Karthik Gnanapandithan

  2. Division of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA

    Paul Feuerstadt

  3. Gastroenterology Center of Connecticut, Yale University School of Medicine, Hamden, CT, USA

    Paul Feuerstadt

Authors
  1. Karthik Gnanapandithan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul Feuerstadt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Feuerstadt.

Ethics declarations

Conflict of Interest

The authors declare no conflict of interest.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Small Intestine

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gnanapandithan, K., Feuerstadt, P. Review Article: Mesenteric Ischemia. Curr Gastroenterol Rep 22, 17 (2020). https://doi.org/10.1007/s11894-020-0754-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11894-020-0754-x

Keywords

Search

Navigation