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The Society for Vascular Surgery clinical practice guidelines define the optimal care of patients with chronic mesenteric ischemia

  • Erica L. Mitchell
    Correspondence
    Correspondence: Erica L. Mitchell, MD, MEd SE, Division of Vascular and Endovascular Surgery, Regional One Health, 877 Jefferson Ave, Memphis, TN 38103
    Affiliations
    Department of Surgery, University of Tennessee, and the Division of Vascular and Endovascular Surgery, Regional One Health, Memphis, Tenn
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      Chronic mesenteric ischemia (CMI), caused by insufficient postprandial intestinal perfusion, results from atherosclerotic occlusive disease of the celiac artery (CA), superior mesenteric artery (SMA), and/or inferior mesenteric artery. Although the reported incidence of CMI has slightly increased during the past two decades,
      • Wilson D.B.
      • Mostafavi K.
      • Craven T.E.
      • Ayerdi J.
      • Edwards M.S.
      • Hansen K.J.
      Clinical course of mesenteric artery stenosis in elderly Americans.
      ,
      • Kolkman J.J.
      • Geelkerken R.H.
      Diagnosis and treatment of chronic mesenteric ischemia: an update.
      a dramatic shift has also occurred, paralleling the larger discipline of vascular surgery, in both the imaging,
      • Ginsburg M.
      • Obara P.
      • Lambert D.L.
      • Hanley M.
      • Steigner M.L.
      • et al.
      Expert Panels on Vascular Imaging and Gastrointestinal Imaging
      ACR Appropriateness Criteria® imaging of mesenteric ischemia.
      and the definitive treatment, of the condition.
      • Oderich G.S.
      • Gloviczki P.
      • Bower T.C.
      Open surgical treatment for chronic mesenteric ischemia in the endovascular era: when it is necessary and what is the preferred technique?.
      • Schermerhorn M.L.
      • Giles K.A.
      • Hamdan A.D.
      • Wyers M.C.
      • Pomposelli F.B.
      Mesenteric revascularization: management and outcomes in the United States, 1988-2006.
      • Bjorck M.
      • Koelemay M.
      • Acosta S.
      • Bastos Goncalves F.
      • Kölbel T.
      • Kolkman J.J.
      • et al.
      Editor's choice – management of the diseases of mesenteric arteries and veins: clinical practice guidelines of the European Society of Vascular Surgery (ESVS).
      The Society for Vascular Surgery (SVS) Evidence Review Committee has proposed guidelines, based on a formal systematic review and meta-analyses of the literature, for the six components for the evaluation and treatment of patients with CMI, including diagnostic evaluation, indications for treatment, choice of treatment, perioperative evaluation, endovascular or open revascularization, and surveillance or remediation.
      • Alahdab F.
      • Arwani R.
      • Pasha A.K.
      • Razouki Z.A.
      • Prokop L.J.
      • Huber T.S.
      • et al.
      A systematic review and meta-analysis of endovascular versus open surgical revascularization for chronic mesenteric ischemia.
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      Linked Article

      • Chronic mesenteric ischemia: Clinical practice guidelines from the Society for Vascular Surgery
        Journal of Vascular SurgeryVol. 73Issue 1
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          Chronic mesenteric ischemia (CMI) results from the inability to achieve adequate postprandial intestinal blood flow, usually from atherosclerotic occlusive disease at the origins of the mesenteric vessels. Patients typically present with postprandial pain, food fear, and weight loss, although they can present with acute mesenteric ischemia and bowel infarction. The diagnosis requires a combination of the appropriate clinical symptoms and significant mesenteric artery occlusive disease, although it is often delayed given the spectrum of gastrointestinal disorders associated with abdominal pain and weight loss.
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