Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science


Vascular Surgery


Dr. Tom Colletti, DHSc, MPAS, PA-C, DFAAPA


Chronic mesenteric ischemia (CMI) occurs when postprandial intestinal blood flow is limited. This review article aims to provide an overview of CMI, to include etiology, clinical manifestations, diagnostics, and current treatment methods, as well as to guide providers on the clinical application. Usually caused by atherosclerosis of the mesenteric vessels, CMI results in a reduction of blood flow to the small intestines. CMI occurs as the vessels deteriorate and narrow over time, and often collateral vessels form, allowing adequate blood flow and preventing symptoms. When these collateral vessels do not exist or become atherosclerotic, symptoms occur. Typical symptoms associated with CMI include postprandial pain, weight loss, and abdominal bruit. These three symptoms make up the classic triad of CMI. Other various gastrointestinal (GI) symptoms may also be present. The non-specific, wide variety of presenting symptoms leads to a broad differential, including chronic cholecystitis, inflammatory bowel disease, peptic ulcer disease, and malignancy. Diagnostic testing typically starts with an extensive GI workup, and if negative, CT angiography or duplex ultrasound is done to assess for hypoperfusion of the mesenteric vessels. Treatment for CMI consists of revascularization, which can be done endovascularly or with an open approach, and depends on a number of patient-dependent factors. Learning to recognize CMI and utilizing a stepwise approach to the diagnosis of treatment can be beneficial to medical providers in a variety of clinical settings.


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