Types and Management of Chronic Intestinal Ischemia

Abstract

SUMMARY C hronic mesenteric ischemia (CMI) is a condition caused by occlusive disease of the mesenteric vessels and occurs when the blood supply is insufficient to meet the metabolic demands of the bowel, resulting from increased motility, secretion, and absorption after meals. The clinical manifestation of CMI is exceedingly rare. It generally occurs in patients over 60 years of age, and is threefold more frequent in women. Although the prevalence of mesenteric artery stenosis (MAS) is high, symptomatic chronic mesenteric ischemia (CMI) is rare. The collateral network in the mesenteric circulation {between the three main visceral arteries (CA, SMA, and IMA) and the internal iliac arteries}, a remnant of the extensive embryonal vascular network, serves to prevent most cases of ischemia. This explains the high incidence of MAS and relative rarity of cases of CMI. So the majority of patients with symptoms of CMI have significant stenosis or occlusion of at least two of the three mesenteric arteries and most subjects with single vessel mesenteric stenosis do not develop ischemic complaints.