UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Chronic mesenteric ischemia

Authors
David A Tendler, MD
J Thomas Lamont, MD
Section Editors
John F Eidt, MD
Joseph L Mills, Sr, MD
Lillian S Kao, MD, MS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

Mesenteric ischemia is caused by a reduction in intestinal blood flow and is classified as acute (sudden onset of intestinal hypoperfusion) or chronic depending on the time course of symptoms. Chronic mesenteric ischemia, also called intestinal angina, refers to episodic or constant hypoperfusion of the small intestine that can occur, typically in patients with multivessel mesenteric stenosis or occlusion.

The clinical features, diagnosis, and management of chronic mesenteric ischemia will be reviewed here. The diagnosis and management of acute mesenteric ischemia, including acute-on-chronic ischemia (usually related to sudden thrombotic occlusion of an already stenotic mesenteric vessel), and colonic ischemia are reviewed separately. (See "Overview of intestinal ischemia in adults" and "Acute mesenteric arterial occlusion" and "Colonic ischemia".)

ETIOLOGY AND ASSOCIATIONS

The majority of cases of chronic mesenteric ischemia are caused by atherosclerotic narrowing of the origins of the celiac or superior mesenteric arteries [1,2]. Atherosclerosis of the mesenteric vessels is fairly common; however, clinical manifestations as a consequence of mesenteric arterial disease are rare [3,4]. Up to 18 percent of individuals over 65 in the general population have significant stenosis of the celiac or superior mesenteric artery without any known prior symptoms [3,5,6]. In one autopsy series, 29 of 120 individuals showed atherosclerotic disease within 2 cm of the origins of the celiac or mesenteric arteries, and 18 of 120 had at least two stenotic vessels; only one patient had evidence of bowel necrosis [7]. The occurrence of disease was strongly associated with aging and correlated with atherosclerotic disease of cerebral arteries at the skull base. In a smaller autopsy study, 6 of 30 had disease, which was complicated by ulceration, hemorrhage, or thrombus in 5 patients [8]. In a separate study of 184 asymptomatic patients, the prevalence of celiac or superior mesenteric artery stenosis or occlusion was 18 percent for those over 65 using duplex ultrasound [6]. Single-vessel disease was more common in the celiac artery compared with the superior mesenteric artery (81 versus 19 percent). A population-based study found a similar prevalence of 17.5 percent among 870 patients over 65 [3]. Multivariate analysis identified renal artery stenosis and high-density lipoprotein>40 mg/dL as significantly associated with celiac or mesenteric artery stenosis or occlusion.

Rare causes of chronic mesenteric ischemia include median arcuate ligament syndrome (compression of the celiac artery from the median arcuate ligament of the diaphragm), fibromuscular dysplasia, aortic or mesenteric artery dissection, vasculitis (polyarteritis nodosum, Takayasu’s disease [9]), and retroperitoneal fibrosis [10]. Advanced endografts (eg, fenestrated) can cause partial obstruction of the visceral vessels during endovascular aortic repair. (See "Celiac artery compression syndrome" and "Clinical manifestations and diagnosis of fibromuscular dysplasia" and "Gastrointestinal manifestations of vasculitis" and "Clinical features and diagnosis of acute aortic dissection" and "Complications of endovascular abdominal aortic repair" and "Clinical manifestations and diagnosis of retroperitoneal fibrosis".)

CLINICAL FEATURES

History — Most patients with atherosclerotic mesenteric vascular disease do not exhibit symptoms, because a large collateral network can form to compensate for reduced flow (figure 1). In one review of 270 patients with occlusive disease of one or more splanchnic vessels, 61 (60 percent) had no symptoms [11]. In a study of 82 patients identified on arteriography to have a 50 percent stenosis in at least one mesenteric artery, 4 of15 patients with significant three-vessel disease developed mesenteric ischemia during follow-up [4]. One of these had no abdominal complaints prior to an acute presentation resulting in necrosis of the entire gut. The others developed typical symptoms of chronic mesenteric ischemia at 7, 24, and 24 months.

                  

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Aug 2016. | This topic last updated: Jul 27, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Acosta S. Epidemiology of mesenteric vascular disease: clinical implications. Semin Vasc Surg 2010; 23:4.
  2. Oderich GS. Current concepts in the management of chronic mesenteric ischemia. Curr Treat Options Cardiovasc Med 2010; 12:117.
  3. Hansen KJ, Wilson DB, Craven TE, et al. Mesenteric artery disease in the elderly. J Vasc Surg 2004; 40:45.
  4. Thomas JH, Blake K, Pierce GE, et al. The clinical course of asymptomatic mesenteric arterial stenosis. J Vasc Surg 1998; 27:840.
  5. Wilson DB, Mostafavi K, Craven TE, et al. Clinical course of mesenteric artery stenosis in elderly americans. Arch Intern Med 2006; 166:2095.
  6. Roobottom CA, Dubbins PA. Significant disease of the celiac and superior mesenteric arteries in asymptomatic patients: predictive value of Doppler sonography. AJR Am J Roentgenol 1993; 161:985.
  7. Järvinen O, Laurikka J, Sisto T, et al. Atherosclerosis of the visceral arteries. Vasa 1995; 24:9.
  8. Naeem A, Nasim N, Ihsan U, Masood A. A morphological study of celiac, superior mesenteric and inferior mesenteric arteries in atherosclerosis. J Ayub Med Coll Abbottabad 2012; 24:18.
  9. Rits Y, Oderich GS, Bower TC, et al. Interventions for mesenteric vasculitis. J Vasc Surg 2010; 51:392.
  10. Tzou M, Gazeley DJ, Mason PJ. Retroperitoneal fibrosis. Vasc Med 2014; 19:407.
  11. ter Steege RW, Sloterdijk HS, Geelkerken RH, et al. Splanchnic artery stenosis and abdominal complaints: clinical history is of limited value in detection of gastrointestinal ischemia. World J Surg 2012; 36:793.
  12. Keese M, Schmitz-Rixen T, Schmandra T. Chronic mesenteric ischemia: time to remember open revascularization. World J Gastroenterol 2013; 19:1333.
  13. Veenstra RP, ter Steege RW, Geelkerken RH, et al. The cardiovascular risk profile of atherosclerotic gastrointestinal ischemia is different from other vascular beds. Am J Med 2012; 125:394.
  14. Sreenarasimhaiah J. Chronic mesenteric ischemia. Best Pract Res Clin Gastroenterol 2005; 19:283.
  15. Poole JW, Sammartano RJ, Boley SJ. Hemodynamic basis of the pain of chronic mesenteric ischemia. Am J Surg 1987; 153:171.
  16. Moawad J, Gewertz BL. Chronic mesenteric ischemia. Clinical presentation and diagnosis. Surg Clin North Am 1997; 77:357.
  17. White CJ. Chronic mesenteric ischemia: diagnosis and management. Prog Cardiovasc Dis 2011; 54:36.
  18. Pecoraro F, Rancic Z, Lachat M, et al. Chronic mesenteric ischemia: critical review and guidelines for management. Ann Vasc Surg 2013; 27:113.
  19. Reinus JF, Brandt LJ, Boley SJ. Ischemic diseases of the bowel. Gastroenterol Clin North Am 1990; 19:319.
  20. Zeller T, Rastan A, Sixt S. Chronic atherosclerotic mesenteric ischemia (CMI). Vasc Med 2010; 15:333.
  21. Silva JA, White CJ, Collins TJ, et al. Endovascular therapy for chronic mesenteric ischemia. J Am Coll Cardiol 2006; 47:944.
  22. Brandt LJ, Boley SJ. AGA technical review on intestinal ischemia. American Gastrointestinal Association. Gastroenterology 2000; 118:954.
  23. Oliva IB, Davarpanah AH, Rybicki FJ, et al. ACR Appropriateness Criteria ® imaging of mesenteric ischemia. Abdom Imaging 2013; 38:714.
  24. 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.
  25. 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.
  26. Cognet F, Ben Salem D, Dranssart M, et al. Chronic mesenteric ischemia: imaging and percutaneous treatment. Radiographics 2002; 22:863.
  27. 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.
  28. 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.
  29. 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.
  30. Nicoloff AD, Williamson WK, Moneta GL, et al. Duplex ultrasonography in evaluation of splanchnic artery stenosis. Surg Clin North Am 1997; 77:339.
  31. 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.
  32. Moneta GL, Lee RW, Yeager RA, et al. Mesenteric duplex scanning: a blinded prospective study. J Vasc Surg 1993; 17:79.
  33. 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.
  34. Seidl H, Tuerck J, Schepp W, Schneider AR. Splanchnic arterial blood flow is significantly influenced by breathing-assessment by duplex-Doppler ultrasound. Ultrasound Med Biol 2010; 36:1677.
  35. van Petersen AS, Meerwaldt R, Kolkman JJ, et al. The influence of respiration on criteria for transabdominal duplex examination of the splanchnic arteries in patients with suspected chronic splanchnic ischemia. J Vasc Surg 2013; 57:1603.
  36. Gruber H, Loizides A, Peer S, Gruber I. Ultrasound of the median arcuate ligament syndrome: a new approach to diagnosis. Med Ultrason 2012; 14:5.
  37. Boley SJ, Brandt LJ, Veith FJ, et al. A new provocative test for chronic mesenteric ischemia. Am J Gastroenterol 1991; 86:888.
  38. 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.
  39. 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.
  40. 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.
  41. 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.
  42. Friedland S, Benaron D, Coogan S, et al. Diagnosis of chronic mesenteric ischemia by visible light spectroscopy during endoscopy. Gastrointest Endosc 2007; 65:294.
  43. 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.
  44. Okamura K, Morizumi S, Kawata M, Suematsu Y. Conservative therapy as a primary treatment for spontaneous isolated dissection of the superior mesenteric artery. Ann Vasc Surg 2014; 28:1939.
  45. Braga M, Ljungqvist O, Soeters P, et al. ESPEN Guidelines on Parenteral Nutrition: surgery. Clin Nutr 2009; 28:378.
  46. Corcos O, Castier Y, Sibert A, et al. Effects of a multimodal management strategy for acute mesenteric ischemia on survival and intestinal failure. Clin Gastroenterol Hepatol 2013; 11:158.
  47. Mueller C, Borriello R, Perlov-Antzis L. Parenteral nutrition support of a patient with chronic mesenteric artery occlusive disease. Nutr Clin Pract 1993; 8:73.
  48. Malgor RD, Oderich GS, McKusick MA, et al. Results of single- and two-vessel mesenteric artery stents for chronic mesenteric ischemia. Ann Vasc Surg 2010; 24:1094.
  49. McAfee MK, Cherry KJ Jr, Naessens JM, et al. Influence of complete revascularization on chronic mesenteric ischemia. Am J Surg 1992; 164:220.
  50. Schneider DB, Nelken NA, Messina LM, Ehrenfeld WK. Isolated inferior mesenteric artery revascularization for chronic visceral ischemia. J Vasc Surg 1999; 30:51.
  51. Sharafuddin MJ, Nicholson RM, Kresowik TF, et al. Endovascular recanalization of total occlusions of the mesenteric and celiac arteries. J Vasc Surg 2012; 55:1674.
  52. Grilli CJ, Fedele CR, Tahir OM, et al. Recanalization of chronic total occlusions of the superior mesenteric artery in patients with chronic mesenteric ischemia: technical and clinical outcomes. J Vasc Interv Radiol 2014; 25:1515.
  53. Manunga JM, Oderich GS. Orbital atherectomy as an adjunct to debulk difficult calcified lesions prior to mesenteric artery stenting. J Endovasc Ther 2012; 19:489.
  54. Malgor RD, Oderich GS. Technique of recanalization of long-segment flush superior mesenteric artery occlusions. Vasc Endovascular Surg 2011; 45:733.
  55. Gentile AT, Moneta GL, Taylor LM Jr, et al. Isolated bypass to the superior mesenteric artery for intestinal ischemia. Arch Surg 1994; 129:926.
  56. Arya S, Kingman S, Knepper JP, et al. Open Mesenteric Interventions Are Equally Safe as Endovascular Interventions and Offer Better Midterm Patency for Chronic Mesenteric Ischemia. Ann Vasc Surg 2016; 30:219.
  57. SHAW RS, MAYNARD EP 3rd. Acute and chronic thrombosis of the mesenteric arteries associated with malabsorption; a report of two cases successfully treated by thromboendarterectomy. N Engl J Med 1958; 258:874.
  58. Lau H, Chew DK, Whittemore AD, et al. Transaortic endarterectomy for primary mesenteric revascularization. Vasc Endovascular Surg 2002; 36:335.
  59. Shanley CJ, Ozaki CK, Zelenock GB. Bypass grafting for chronic mesenteric ischemia. Surg Clin North Am 1997; 77:381.
  60. Geroulakos G, Tober JC, Anderson L, Smead WL. Antegrade visceral revascularisation via a thoracoabdominal approach for chronic mesenteric ischaemia. Eur J Vasc Endovasc Surg 1999; 17:56.
  61. Stanton PE Jr, Hollier PA, Seidel TW, et al. Chronic intestinal ischemia: diagnosis and therapy. J Vasc Surg 1986; 4:338.
  62. Rheudasil JM, Stewart MT, Schellack JV, et al. Surgical treatment of chronic mesenteric arterial insufficiency. J Vasc Surg 1988; 8:495.
  63. Farber MA, Carlin RE, Marston WA, et al. Distal thoracic aorta as inflow for the treatment of chronic mesenteric ischemia. J Vasc Surg 2001; 33:281.
  64. 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.
  65. Mateo RB, O'Hara PJ, Hertzer NR, et al. Elective surgical treatment of symptomatic chronic mesenteric occlusive disease: early results and late outcomes. J Vasc Surg 1999; 29:821.
  66. Kruger AJ, Walker PJ, Foster WJ, et al. Open surgery for atherosclerotic chronic mesenteric ischemia. J Vasc Surg 2007; 46:941.
  67. Rapp JH, Reilly LM, Qvarfordt PG, et al. Durability of endarterectomy and antegrade grafts in the treatment of chronic visceral ischemia. J Vasc Surg 1986; 3:799.
  68. Johnston KW, Lindsay TF, Walker PM, Kalman PG. Mesenteric arterial bypass grafts: early and late results and suggested surgical approach for chronic and acute mesenteric ischemia. Surgery 1995; 118:1.
  69. Wolf YG, Verstandig A, Sasson T, et al. Mesenteric bypass for chronic mesenteric ischaemia. Cardiovasc Surg 1998; 6:34.
  70. Jimenez JG, Huber TS, Ozaki CK, et al. Durability of antegrade synthetic aortomesenteric bypass for chronic mesenteric ischemia. J Vasc Surg 2002; 35:1078.
  71. English WP, Pearce JD, Craven TE, et al. Chronic visceral ischemia: symptom-free survival after open surgical repair. Vasc Endovascular Surg 2004; 38:493.
  72. Dorweiler B, Neufang A, Schneider J, et al. Long-term patency of open revascularization for visceral artery pathologies. Thorac Cardiovasc Surg 2011; 59:329.
  73. 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.
  74. Mell MW, Acher CW, Hoch JR, et al. Outcomes after endarterectomy for chronic mesenteric ischemia. J Vasc Surg 2008; 48:1132.
  75. Lejay A, Georg Y, Tartaglia E, et al. Chronic mesenteric ischemia: 20 year experience of open surgical treatment. Eur J Vasc Endovasc Surg 2015; 49:587.
  76. Modrall JG, Sadjadi J, Joiner DR, et al. Comparison of superficial femoral vein and saphenous vein as conduits for mesenteric arterial bypass. J Vasc Surg 2003; 37:362.
  77. Davenport DL, Shivazad A, Endean ED. Short-term outcomes for open revascularization of chronic mesenteric ischemia. Ann Vasc Surg 2012; 26:447.
  78. Aburahma AF, Campbell JE, Stone PA, et al. Perioperative and late clinical outcomes of percutaneous transluminal stentings of the celiac and superior mesenteric arteries over the past decade. J Vasc Surg 2013; 57:1052.
  79. Ahanchi SS, Stout CL, Dahl TJ, et al. Comparative analysis of celiac versus mesenteric artery outcomes after angioplasty and stenting. J Vasc Surg 2013; 57:1062.
  80. Hallisey MJ, Deschaine J, Illescas FF, et al. Angioplasty for the treatment of visceral ischemia. J Vasc Interv Radiol 1995; 6:785.
  81. 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.
  82. 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.
  83. 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.
  84. 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.
  85. 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.
  86. Aschenbach R, Bergert H, Kerl M, et al. Stenting of stenotic mesenteric arteries for symptomatic chronic mesenteric ischemia. Vasa 2012; 41:425.
  87. Fioole B, van de Rest HJ, Meijer JR, et al. Percutaneous transluminal angioplasty and stenting as first-choice treatment in patients with chronic mesenteric ischemia. J Vasc Surg 2010; 51:386.
  88. Allen RC, Martin GH, Rees CR, et al. Mesenteric angioplasty in the treatment of chronic intestinal ischemia. J Vasc Surg 1996; 24:415.
  89. Peck MA, Conrad MF, Kwolek CJ, et al. Intermediate-term outcomes of endovascular treatment for symptomatic chronic mesenteric ischemia. J Vasc Surg 2010; 51:140.
  90. Schoch DM, LeSar CJ, Joels CS, et al. Management of chronic mesenteric vascular insufficiency: an endovascular approach. J Am Coll Surg 2011; 212:668.
  91. Kanamori KS, Oderich GS, Fatima J, et al. Outcomes of reoperative open or endovascular interventions to treat patients with failing open mesenteric reconstructions for mesenteric ischemia. J Vasc Surg 2014; 60:1612.
  92. Oderich GS, Erdoes LS, Lesar C, et al. Comparison of covered stents versus bare metal stents for treatment of chronic atherosclerotic mesenteric arterial disease. J Vasc Surg 2013; 58:1316.
  93. Rawat N, Gibbons CP, Joint Vascular Research Group. Surgical or endovascular treatment for chronic mesenteric ischemia: a multicenter study. Ann Vasc Surg 2010; 24:935.
  94. Maspes F, Mazzetti di Pietralata G, Gandini R, et al. Percutaneous transluminal angioplasty in the treatment of chronic mesenteric ischemia: results and 3 years of follow-up in 23 patients. Abdom Imaging 1998; 23:358.
  95. 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.
  96. Dias NV, Acosta S, Resch T, et al. Mid-term outcome of endovascular revascularization for chronic mesenteric ischaemia. Br J Surg 2010; 97:195.
  97. Lee RW, Bakken AM, Palchik E, et al. Long-term outcomes of endoluminal therapy for chronic atherosclerotic occlusive mesenteric disease. Ann Vasc Surg 2008; 22:541.
  98. Landis MS, Rajan DK, Simons ME, et al. Percutaneous management of chronic mesenteric ischemia: outcomes after intervention. J Vasc Interv Radiol 2005; 16:1319.
  99. AbuRahma AF, Stone PA, Bates MC, Welch CA. Angioplasty/stenting of the superior mesenteric artery and celiac trunk: early and late outcomes. J Endovasc Ther 2003; 10:1046.
  100. van Wanroij JL, van Petersen AS, Huisman AB, et al. Endovascular treatment of chronic splanchnic syndrome. Eur J Vasc Endovasc Surg 2004; 28:193.
  101. Brown DJ, Schermerhorn ML, Powell RJ, et al. Mesenteric stenting for chronic mesenteric ischemia. J Vasc Surg 2005; 42:268.
  102. Hawkins BM, Khan Z, Abu-Fadel MS, et al. Endovascular treatment of mesenteric ischemia. Catheter Cardiovasc Interv 2011; 78:948.
  103. Heiss P, Zorger N, Kaempfe I, et al. [Stenting in the treatment of chronic mesenteric ischemia: technical and clinical success rates]. Rofo 2008; 180:906.
  104. Kougias P, El Sayed HF, Zhou W, Lin PH. Management of chronic mesenteric ischemia. The role of endovascular therapy. J Endovasc Ther 2007; 14:395.
  105. 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.
  106. Daliri A, Grunwald C, Jobst B, et al. Endovascular treatment for chronic atherosclerotic occlusive mesenteric disease: is stenting superior to balloon angioplasty? Vasa 2010; 39:319.
  107. Turba UC, Saad WE, Arslan B, et al. Chronic mesenteric ischaemia: 28-year experience of endovascular treatment. Eur Radiol 2012; 22:1372.
  108. Oderich GS, Tallarita T, Gloviczki P, et al. Mesenteric artery complications during angioplasty and stent placement for atherosclerotic chronic mesenteric ischemia. J Vasc Surg 2012; 55:1063.
  109. Saedon M, Saratzis A, Karim A, Goodyear S. Endovascular Versus Surgical Revascularization for the Management of Chronic Mesenteric Ischemia. Vasc Endovascular Surg 2015; 49:37.
  110. Barret M, Martineau C, Rahmi G, et al. Chronic Mesenteric Ischemia: A Rare Cause of Chronic Abdominal Pain. Am J Med 2015; 128:1363.e1.
  111. Davies RS, Wall ML, Silverman SH, et al. Surgical versus endovascular reconstruction for chronic mesenteric ischemia: a contemporary UK series. Vasc Endovascular Surg 2009; 43:157.
  112. 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.
  113. 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.
  114. Gupta PK, Horan SM, Turaga KK, et al. Chronic mesenteric ischemia: endovascular versus open revascularization. J Endovasc Ther 2010; 17:540.
  115. Oderich GS, Bower TC, Sullivan TM, et al. Open versus endovascular revascularization for chronic mesenteric ischemia: risk-stratified outcomes. J Vasc Surg 2009; 49:1472.
  116. 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.
  117. Indes JE, Giacovelli JK, Muhs BE, et al. Outcomes of endovascular and open treatment for chronic mesenteric ischemia. J Endovasc Ther 2009; 16:624.
  118. Assar AN, Abilez OJ, Zarins CK. Outcome of open versus endovascular revascularization for chronic mesenteric ischemia: review of comparative studies. J Cardiovasc Surg (Torino) 2009; 50:509.
  119. Zerbib P, Lebuffe G, Sergent-Baudson G, et al. Endovascular versus open revascularization for chronic mesenteric ischemia: a comparative study. Langenbecks Arch Surg 2008; 393:865.
  120. Wain RA, Hines G. Surgical management of mesenteric occlusive disease: a contemporary review of invasive and minimally invasive techniques. Cardiol Rev 2008; 16:69.
  121. van Petersen AS, Kolkman JJ, Beuk RJ, et al. Open or percutaneous revascularization for chronic splanchnic syndrome. J Vasc Surg 2010; 51:1309.
  122. Sivamurthy N, Rhodes JM, Lee D, et al. Endovascular versus open mesenteric revascularization: immediate benefits do not equate with short-term functional outcomes. J Am Coll Surg 2006; 202:859.
  123. Kougias P, Huynh TT, Lin PH. Clinical outcomes of mesenteric artery stenting versus surgical revascularization in chronic mesenteric ischemia. Int Angiol 2009; 28:132.
  124. Verma H, Oderich GS, Tripathi RK. Surgical and endovascular interventions for chronic mesenteric ischemia. J Cardiovasc Surg (Torino) 2015; 56:299.
  125. Arthurs ZM, Titus J, Bannazadeh M, et al. A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia. J Vasc Surg 2011; 53:698.
  126. Cai W, Li X, Shu C, et al. Comparison of clinical outcomes of endovascular versus open revascularization for chronic mesenteric ischemia: a meta-analysis. Ann Vasc Surg 2015; 29:934.
  127. Hogendoorn W, Hunink MG, Schlösser FJ, et al. A comparison of open and endovascular revascularization for chronic mesenteric ischemia in a clinical decision model. J Vasc Surg 2014; 60:715.
  128. 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.
  129. Zacharias N, Eghbalieh SD, Chang BB, et al. Chronic mesenteric ischemia outcome analysis and predictors of endovascular failure. J Vasc Surg 2016; 63:1582.
  130. Lopera JE, Trimmer CK, Lamba R, et al. MDCT angiography of mesenteric bypass surgery for the treatment of chronic mesenteric ischemia. AJR Am J Roentgenol 2009; 193:1439.
  131. 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.
  132. Mitchell EL, Chang EY, Landry GJ, et al. Duplex criteria for native superior mesenteric artery stenosis overestimate stenosis in stented superior mesenteric arteries. J Vasc Surg 2009; 50:335.
  133. Schermerhorn ML, Giles KA, Hamdan AD, et al. Mesenteric revascularization: management and outcomes in the United States, 1988-2006. J Vasc Surg 2009; 50:341.
  134. Kihara TK, Blebea J, Anderson KM, et al. Risk factors and outcomes following revascularization for chronic mesenteric ischemia. Ann Vasc Surg 1999; 13:37.
  135. Tallarita T, Oderich GS, Gloviczki P, et al. Patient survival after open and endovascular mesenteric revascularization for chronic mesenteric ischemia. J Vasc Surg 2013; 57:747.