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Chronic mesenteric ischemia
What's new
Updated 2024 ESC guidelines for the management of chronic mesenteric ischemia .
Background
Overview
Definition
Chronic mesenteric ischemia is a clinical condition characterized by reduced blood flow to the mesenteric arteries, usually due to atherosclerotic occlusive disease at the origins of the mesenteric vessels, which can lead to ischemia to the intestinal tissues.
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Pathophysiology
The primary pathophysiological mechanism underlying chronic mesenteric ischemia is atherosclerotic occlusive disease at the origins of the mesenteric vessels. Rare causes include thromboangiitis obliterans, FMD, and aortic dissection.
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Epidemiology
Chronic mesenteric ischemia is a relatively rare condition, with a reported incidence of 9.2 per 100,000 person-years and a prevalence of 0.03%.
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Risk factors
Risk factors for chronic mesenteric ischemia include age, smoking, and comorbidities such as hypertension and diabetes. These factors contribute to the development of atherosclerosis, which in turn leads to the narrowing or occlusion of the mesenteric arteries.
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Disease course
Clinically, chronic mesenteric ischemia presents with postprandial abdominal pain, unintended weight loss, nausea, vomiting, early satiety, anorexia, and changes in bowel habits. These symptoms are progressive and can lead to fear of food due to the associated pain.
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Prognosis and risk of recurrence
The prognosis of chronic mesenteric ischemia can be severe if left untreated. Patients often develop severe malnutrition due to the associated weight loss and changes in eating patterns. Endovascular interventions have improved postoperative morbidity but have also resulted in early symptom recurrence and reintervention. Age > 80 years, diabetes, CKD stage IV or V, and home oxygen are independent predictors of any-cause mortality.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of chronic mesenteric ischemia are prepared by our editorial team based on guidelines from the European Society of Cardiology (ESC 2024), the Society for Vascular Surgery (SVS 2021), the European Association for Gastroenterology, Endoscopy and Nutrition (EAGEN/CIRSE/NVMDL/HSGO/UEG/DMIS/ESGAR 2020), the American College of Radiology (ACR 2018), the European Society of Cardiology (ESC/ESVS ...
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