Chronic Mesenteric Ischemia – Surgical and Interventional Options in Therapy

Chronic mesenteric ischemia (CMI) is an unusual but important cause of abdominal pain accounting for 5 - 8% of all intestinal ischemic events. Most commonly it is caused by atherosclerotic occlusions or severe stenosis. Symptoms occur when at least two of the three main splanchnic vessels are affected. The course is frequently asymptomatic, resulting from an extensive collateralization. Intestinal angina combined with weight loss and sitophobia are typical clinical features. Therapeutic options are conventional surgical therapy with thromben-darterectomy or bypass as well as percutaneous angioplasty with or without stenting. In symptomatic disease immediate therapy is essential because the natural course is life-threatening. Invasive treatment of asymptomatic but significant CMI has to be seriously considered as it developed into symptomatic disease with a high possibility.