Chronic Mesenteric Ischaemic Syndromes: Role Of Endovascular Revascularisation Techniques

Chronic mesenteric ischaemic syndromes: role of endovascular revascularisation techniquesSymptomatic Chronic Mesenteric Ischemia (CMI) is an uncommon, potentially under-diagnosed condition caused, in most cases, by fixed stenoses or occlusion of at least two visceral arteries. The classic setting for CMI is a female patient presenting with postprandial abdominal discomfort resulting in significant weight loss. Open surgical revascularization has been considered the historical gold standard treatment for mesenteric ischemia although it is associated with an increased risk of morbidity and mortality. Endovascular therapy for CMI has been increasingly utilized. Early outcomes compare favourably with open mesenteric bypass. Intermediate follow-up indicates that significant restenosis and symptom recurrence are common following endovascular treatment of symptomatic CMI: thirty percent of the cohort requires reintervention. As with the surgical paradigm of two-vessel revascularization, endovascular treatment of multiple mesenteric arteries produces better outcomes. A first-line endovascular approach to patients with CMI is a reasonable clinical strategy, but close follow-up is mandatory. During the last decade, despite higher restenosis rates, endovascular revascularization has replaced surgical revascularization as the therapy of choice in most centers.