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13 - Chronic mesenteric ischaemia

Mohamed Abdelhamid
University Hospital Birmingham, UK
Robert Davies
University Department of Vascular Surgery, UK
Rajiv Vohra
Selly Oak Hospital, UK
Vish Bhattacharya
Queen Elizabeth Hospital
Gerard Stansby
Freeman Hospital
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Key points

  • Chronic mesenteric ischaemia (CMI) is a rare condition, accounting for less than 5% of all intestinal ischaemic events

  • More than 90% of cases are due to atherosclerotic occlusion or severe stenosis

  • Classic symptoms include postprandial abdominal pain, sitophobia and weight loss

  • At least two of the three main splanchnic arteries must be significantly compromised to result in chronic mesenteric ischaemia

  • Duplex ultrasonography is non-invasive and expedient but may miss up to 20% of vascular lesions in the coeliac trunk

  • Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are equally excellent non-invasive modalities with highly accurate diagnosis of vascular disease in the coeliac axis (CA) and superior mesenteric artery (SMA) and replace conventional catheter angiography

  • Conventional catheter angiography should be reserved for diagnosis of CMI only when other modalities have been unhelpful or if intervention such as percutaneous transluminal angioplasty (PTA) is planned

  • Surgical vascular bypass is the traditional definitive therapy for CMI with an overall 5-year graft patency of 78%

  • Endovascular therapy is optimal in short segment atherosclerotic lesions at the ostia of the SMA and CA. Stenting and PTA in short-term follow up have a clinical benefit with stent patency in more than 90% of cases


CMI is an uncommon cause of abdominal pain. It accounts for 5% of all intestinal ischaemic events with acute ischaemia being much more common.

Postgraduate Vascular Surgery
The Candidate's Guide to the FRCS
, pp. 156 - 163
Publisher: Cambridge University Press
Print publication year: 2011

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