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Chronic mesenteric ischemia

David A Tendler, MD
J Thomas Lamont, MD
Section Editors
John F Eidt, MD
Joseph L Mills, Sr, MD
David I Soybel, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Mesenteric ischemia is caused by a reduction in intestinal blood flow, which most commonly arises from occlusion, vasospasm and/or hypoperfusion of the mesenteric vasculature. The clinical consequences can be catastrophic, including sepsis, bowel infarction, and death, making rapid diagnosis and treatment imperative.

Intestinal ischemia can be divided into acute and chronic, based upon the rapidity and the degree to which blood flow is compromised.

Acute mesenteric ischemia refers to the sudden onset of intestinal hypoperfusion, which can be due to occlusive or nonocclusive obstruction of arterial or venous blood flow. Occlusive arterial obstruction is most commonly due to emboli or thrombosis of mesenteric arteries while occlusive venous obstruction is most commonly due to thrombosis or segmental strangulation. Nonocclusive arterial hypoperfusion is most commonly due to primary splanchnic vasoconstriction.

Chronic mesenteric ischemia (also called intestinal angina) refers to episodic or constant intestinal hypoperfusion, which usually develops in patients with mesenteric atherosclerotic disease.

Chronic mesenteric ischemia involving the small intestine will be reviewed here. The anatomy of the mesenteric vasculature, acute mesenteric small intestinal ischemia, and colonic ischemia are discussed separately. (See "Overview of intestinal ischemia in adults" and "Colonic ischemia".)


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Literature review current through: Oct 2015. | This topic last updated: Apr 29, 2013.
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  1. Moawad J, Gewertz BL. Chronic mesenteric ischemia. Clinical presentation and diagnosis. Surg Clin North Am 1997; 77:357.
  2. Poole JW, Sammartano RJ, Boley SJ. Hemodynamic basis of the pain of chronic mesenteric ischemia. Am J Surg 1987; 153:171.
  3. Reinus JF, Brandt LJ, Boley SJ. Ischemic diseases of the bowel. Gastroenterol Clin North Am 1990; 19:319.
  4. Wilson DB, Mostafavi K, Craven TE, et al. Clinical course of mesenteric artery stenosis in elderly americans. Arch Intern Med 2006; 166:2095.
  5. Savastano S, Teso S, Corrà S, et al. Multislice CT angiography of the celiac and superior mesenteric arteries: comparison with arteriographic findings. Radiol Med 2002; 103:456.
  6. Cademartiri F, Palumbo A, Maffei E, et al. Noninvasive evaluation of the celiac trunk and superior mesenteric artery with multislice CT in patients with chronic mesenteric ischaemia. Radiol Med 2008; 113:1135.
  7. Nicoloff AD, Williamson WK, Moneta GL, et al. Duplex ultrasonography in evaluation of splanchnic artery stenosis. Surg Clin North Am 1997; 77:339.
  8. Harward TR, Smith S, Seeger JM. Detection of celiac axis and superior mesenteric artery occlusive disease with use of abdominal duplex scanning. J Vasc Surg 1993; 17:738.
  9. Moneta GL, Lee RW, Yeager RA, et al. Mesenteric duplex scanning: a blinded prospective study. J Vasc Surg 1993; 17:79.
  10. Gentile AT, Moneta GL, Lee RW, et al. Usefulness of fasting and postprandial duplex ultrasound examinations for predicting high-grade superior mesenteric artery stenosis. Am J Surg 1995; 169:476.
  11. Moneta GL. Screening for mesenteric vascular insufficiency and follow-up of mesenteric artery bypass procedures. Semin Vasc Surg 2001; 14:186.
  12. Baker AC, Chew V, Li CS, et al. Application of duplex ultrasound imaging in determining in-stent stenosis during surveillance after mesenteric artery revascularization. J Vasc Surg 2012; 56:1364.
  13. Holland GA, Dougherty L, Carpenter JP, et al. Breath-hold ultrafast three-dimensional gadolinium-enhanced MR angiography of the aorta and the renal and other visceral abdominal arteries. AJR Am J Roentgenol 1996; 166:971.
  14. Shirkhoda A, Konez O, Shetty AN, et al. Mesenteric circulation: three-dimensional MR angiography with a gadolinium-enhanced multiecho gradient-echo technique. Radiology 1997; 202:257.
  15. Meaney JF, Prince MR, Nostrant TT, Stanley JC. Gadolinium-enhanced MR angiography of visceral arteries in patients with suspected chronic mesenteric ischemia. J Magn Reson Imaging 1997; 7:171.
  16. Burkart DJ, Johnson CD, Reading CC, Ehman RL. MR measurements of mesenteric venous flow: prospective evaluation in healthy volunteers and patients with suspected chronic mesenteric ischemia. Radiology 1995; 194:801.
  17. Li KC, Hopkins KL, Dalman RL, Song CK. Simultaneous measurement of flow in the superior mesenteric vein and artery with cine phase-contrast MR imaging: value in diagnosis of chronic mesenteric ischemia. Work in progress. Radiology 1995; 194:327.
  18. Boley SJ, Brandt LJ, Veith FJ, et al. A new provocative test for chronic mesenteric ischemia. Am J Gastroenterol 1991; 86:888.
  19. Walley KR, Friesen BP, Humer MF, Phang PT. Small bowel tonometry is more accurate than gastric tonometry in detecting gut ischemia. J Appl Physiol (1985) 1998; 85:1770.
  20. Kolkman JJ, Groeneveld AB. Occlusive and non-occlusive gastrointestinal ischaemia: a clinical review with special emphasis on the diagnostic value of tonometry. Scand J Gastroenterol Suppl 1998; 225:3.
  21. Otte JA, Geelkerken RH, Oostveen E, et al. Clinical impact of gastric exercise tonometry on diagnosis and management of chronic gastrointestinal ischemia. Clin Gastroenterol Hepatol 2005; 3:660.
  22. Mensink PB, Geelkerken RH, Huisman AB, et al. Twenty-four hour tonometry in patients suspected of chronic gastrointestinal ischemia. Dig Dis Sci 2008; 53:133.
  23. Friedland S, Benaron D, Coogan S, et al. Diagnosis of chronic mesenteric ischemia by visible light spectroscopy during endoscopy. Gastrointest Endosc 2007; 65:294.
  24. Biebl M, Oldenburg WA, Paz-Fumagalli R, et al. Surgical and interventional visceral revascularization for the treatment of chronic mesenteric ischemia--when to prefer which? World J Surg 2007; 31:562.
  25. Atkins MD, Kwolek CJ, LaMuraglia GM, et al. Surgical revascularization versus endovascular therapy for chronic mesenteric ischemia: a comparative experience. J Vasc Surg 2007; 45:1162.
  26. Shanley CJ, Ozaki CK, Zelenock GB. Bypass grafting for chronic mesenteric ischemia. Surg Clin North Am 1997; 77:381.
  27. Park WM, Cherry KJ Jr, Chua HK, et al. Current results of open revascularization for chronic mesenteric ischemia: a standard for comparison. J Vasc Surg 2002; 35:853.
  28. Cho JS, Carr JA, Jacobsen G, et al. Long-term outcome after mesenteric artery reconstruction: a 37-year experience. J Vasc Surg 2002; 35:453.
  29. Jimenez JG, Huber TS, Ozaki CK, et al. Durability of antegrade synthetic aortomesenteric bypass for chronic mesenteric ischemia. J Vasc Surg 2002; 35:1078.
  30. Mell MW, Acher CW, Hoch JR, et al. Outcomes after endarterectomy for chronic mesenteric ischemia. J Vasc Surg 2008; 48:1132.
  31. English WP, Pearce JD, Craven TE, et al. Chronic visceral ischemia: symptom-free survival after open surgical repair. Vasc Endovascular Surg 2004; 38:493.
  32. Davenport DL, Shivazad A, Endean ED. Short-term outcomes for open revascularization of chronic mesenteric ischemia. Ann Vasc Surg 2012; 26:447.
  33. Allen RC, Martin GH, Rees CR, et al. Mesenteric angioplasty in the treatment of chronic intestinal ischemia. J Vasc Surg 1996; 24:415.
  34. Hallisey MJ, Deschaine J, Illescas FF, et al. Angioplasty for the treatment of visceral ischemia. J Vasc Interv Radiol 1995; 6:785.
  35. Matsumoto AH, Tegtmeyer CJ, Fitzcharles EK, et al. Percutaneous transluminal angioplasty of visceral arterial stenoses: results and long-term clinical follow-up. J Vasc Interv Radiol 1995; 6:165.
  36. Matsumoto AH, Angle JF, Spinosa DJ, et al. Percutaneous transluminal angioplasty and stenting in the treatment of chronic mesenteric ischemia: results and longterm followup. J Am Coll Surg 2002; 194:S22.
  37. Silva JA, White CJ, Collins TJ, et al. Endovascular therapy for chronic mesenteric ischemia. J Am Coll Cardiol 2006; 47:944.
  38. Sharafuddin MJ, Olson CH, Sun S, et al. Endovascular treatment of celiac and mesenteric arteries stenoses: applications and results. J Vasc Surg 2003; 38:692.
  39. Yamakado K, Takeda K, Nomura Y, et al. Relief of mesenteric ischemia by Z-stent placement into the superior mesenteric artery compressed by the false lumen of an aortic dissection. Cardiovasc Intervent Radiol 1998; 21:66.
  40. Waybill PN, Enea NA. Use of a Palmaz stent deployed in the superior mesenteric artery for chronic mesenteric ischemia. J Vasc Interv Radiol 1997; 8:1069.
  41. Sarac TP, Altinel O, Kashyap V, et al. Endovascular treatment of stenotic and occluded visceral arteries for chronic mesenteric ischemia. J Vasc Surg 2008; 47:485.
  42. Aschenbach R, Bergert H, Kerl M, et al. Stenting of stenotic mesenteric arteries for symptomatic chronic mesenteric ischemia. Vasa 2012; 41:425.
  43. Tallarita T, Oderich GS, Macedo TA, et al. Reinterventions for stent restenosis in patients treated for atherosclerotic mesenteric artery disease. J Vasc Surg 2011; 54:1422.
  44. Rose SC, Quigley TM, Raker EJ. Revascularization for chronic mesenteric ischemia: comparison of operative arterial bypass grafting and percutaneous transluminal angioplasty. J Vasc Interv Radiol 1995; 6:339.
  45. Kasirajan K, O'Hara PJ, Gray BH, et al. Chronic mesenteric ischemia: open surgery versus percutaneous angioplasty and stenting. J Vasc Surg 2001; 33:63.
  46. Davies, RS, Wall, ML, Silverman, SH, et al. Surgical versus endovascular reconstruction for chronic mesenteric ischemia: A contemporary UK series. Vasc Endovascular Surg 2008; [Epub ahead of print].