**3.2 Chronic mesenteric ischemia**

Postprandial abdominal pain and progressive weight loss are the most common symptoms in patients with CMI. Pain is often described as dull and crampy and located in the midepigastric region. The course of symptoms can be equated with intestinal claudication. Lack of energy leads to failure of the intestinal smooth muscle to relax, which intensifies the cramping pain. Pain often occurs 15 to 45 minutes after a meal, and the severity varies according to the size and type of meal. Patients typically develop "food fear" and decrease their oral intake in anticipation of severe pain after meals. Changes in bowel habits, nausea,

Mesenteric Vascular Disease 239

management remains largely limited to patients with CMI. Balloon angioplasty and stenting are the most common interventions, and recent reports have documented excellent technical results with low patient morbidity.Endovascular therapy should be the treatment of choice in high-risk patients with CMI (13, 14, 15, 16). High technical success rates and decreased patient morbidity and mortality rates have been reasonably well established in such

Fig. 3. A, Lateral arteriogram of the celiac axis and superior mesenteric artery. Note the mild

Laparotomy with visceral revascularization can be used to treat patients with both AMI and CMI. Patients presenting with signs and symptoms of AMI require urgent abdominal exploration, assessment of bowel viability, and revascularization. Several techniques for the restoration of intestinal perfusion are available to the vascular surgeon, and familiarity with a variety of options is crucial. Before revascularization, large segments of both small and

Perfusion of the mesenteric arteries is assessed by palpation and Doppler evaluation. In cases in which the obstruction is caused by an embolus, a proximal SMA pulse is often

orificial stenosis in the celiac axis and the severe stenosis in the proximal superior mesenteric artery. B, Completion study after angioplasty and stenting of the superior mesenteric artery stenosis. Note the widely patent superior mesenteric artery, with no

individuals.

evidence of stenosis

**5.2 Surgical treatment** 

**5.3 Acute mesenteric ischemia** 

**5.3.1 SMA embolectomy** 

large intestine may appear dusky, ischemic, or necrotic.

and vomiting are less common findings. CMI is believed to be more prevalent in elderly women (11). The variable nature of symptoms often makes the diagnosis confusing and can result in delayed treatment. The traditional risk factors for atherosclerosis are usually present. A heavy smoking history is frequently obtained. The majority of patients also have a history of symptomatic manifestations in other vascular beds, most commonly cerebrovascular, coronary, and peripheral arteries.

Physical examination findings are usually nonspecific. Patients are commonly undernourished and cachectic.An abdominal bruit can sometimes be auscultated but is not always present. Bowel sounds are frequently hyperactive. Guarding and rebound tenderness are usually absent. Low prealbumin and albumin levels are often seen, owing to the patient's chronic malnourished state.
