Endovascular Therapy for Chronic Mesenteric Ischemia

Chronic mesenteric ischemia is caused most often by ostial atherosclerotic disease. The typical patient is female, with median age of 65 years old. Most studies quote a 3:1 or 4:1 female-to-male ratio, with age ranging from 40 to 90 years old.

The term intestinal angina has been coined to describe the chronic abdominal pain that occurs within a few minutes to 30 minutes after meals. Patients might describe intolerance to certain types of food, and consequently they alter their eating habits to avoid foods that precipitate symptoms. Unintentional weight loss progresses to malnutrition and cachexia. At times, symptoms are less specific, with vague abdominal pain, nausea, vomiting, or change in bowel habits. Most patients develop the classic symptoms of abdominal pain, weight loss, and food fear once at least two of the three intestinal arteries are severely narrowed or occluded. More than 70% of patients have hypertension, hyperlipidemia, and prior smoking history. Consequently, other manifestations of atherosclerosis are commonplace, including coronary, cerebrovascular, and peripheral arterial disease.

Endovascular treatment has emerged as an alternative to bypass in the elderly or higher-risk patient, but it has become the first choice of treatment in most patients with suitable lesions. The enthusiasm for endovascular techniques is explained by several factors, including high mortality rates (8%–15%) following bypass procedures, the limited experience of vascular surgeons in performing these reconstructions, and the excellent early results of endovascular therapy.