**5. Treatment of acute and chronic mesenteric ischemia**

Medical treatment alone is not effective in these patients. Preventive risk factor modification helps control the progression of atherosclerosis in the mesenteric circulation as well as other vascular beds. Patients with known risks for inheritable hypercoagulable disorders should undergo screening and should be treated with systemic anticoagulation if indicated.

#### **5.1 Endovascular treatment**

Advances in endovascular techniques have greatly expanded the role of percutaneous interventions for patients with mesenteric ischemia in recent years. However, endovascular

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

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

Duplex ultrasonography is a useful tool for the early, noninvasive diagnosis of visceral ischemic syndromes. Color Doppler scanning can be used to assess the flow velocities and resistance index in the splanchnic arteries and their arterial beds, as well to evaluate end-

Computed tomography (CT) is an accurate, noninvasive imaging modality for diagnosing mesenteric ischemia, CTA diagnosed AMI with a sensitivity of 96% and a specificity of 94%.

Magnetic resonance angiography (MRA) is useful for diagnosing mesenteric occlusive disease. Because MRA takes significantly longer to perform than CTA, its role in evaluating

Conventional angiography remains the "gold standard" in the diagnosis of mesenteric ischemia. Anteroposterior and lateral views of the visceral aorta as well as selective catheterization of the celiac trunk, SMA, and IMA, provide the most accurate and specific localization of stenotic and occlusive lesions. Therapeutic alternatives such as balloon angioplasty, stenting, and thrombolysis and percutaneous thrombus extraction can all be

Medical treatment alone is not effective in these patients. Preventive risk factor modification helps control the progression of atherosclerosis in the mesenteric circulation as well as other vascular beds. Patients with known risks for inheritable hypercoagulable disorders should

Advances in endovascular techniques have greatly expanded the role of percutaneous interventions for patients with mesenteric ischemia in recent years. However, endovascular

undergo screening and should be treated with systemic anticoagulation if indicated.

cerebrovascular, coronary, and peripheral arteries.

the patient's chronic malnourished state.

**4. Diagnostic evaluation 4.1 Noninvasive evaluation** 

organ vascularity (12).

patients with AMI is limited.

**5.1 Endovascular treatment** 

used to restore luminal visceral blood flow.

**5. Treatment of acute and chronic mesenteric ischemia** 

**4.2 Invasive evaluation** 

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 individuals.

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