ABSTRACT
PART 1: INTRODUCTION Atherosclerosis of the mesenteric vessels may result in chronic mesenteric ischemia (CMI). This uncommon condition is often amenable to percutaneous intervention by experienced operators. Percutaneous endovascular procedures have been applied to the mesenteric arterial system since the early 1980s. In most symptomatic patients, at least two splanchnic vessels have severe stenosis. Moawad and Gewertz (1) report at least two-vessel disease in 91% of CMI patients and three-vessel disease in 55% of CMI patients. In this review, only 7% of CMI patients had an occluded superior mesenteric artery (SMA) and 2% had isolated celiac disease. Abrupt occlusion of mesenteric blood vessels can result in acute mesenteric ischemia. In a review of the topic, Oldenburg et al. (2) report the incidence of various etiologies of acute mesenteric ischemia as follows: arterial embolism 40% to 50%, arterial thrombosis 25%, nonocclusive arterial disease resulting in ischemia secondary to other factors such as low cardiac output or adrenergic agonist use 20%, and venous thrombosis 10%. The patient with acute mesenteric ischemia has often developed infarcted bowel by the time of presentation. These patients generally require surgical treatment to remove necrotic tissue. Therefore, the focus of this chapter is the percutaneous treatment of CMI.
