Mesenteric Ischemia

Mesenteric ischemia occurs when the arterial blood supply fails to meet the functional demands of the intestine. This may cause abdominal pain, malnutrition, and/or bowel infarction, depending on the severity of mismatch between demand and supply. It is most commonly seen in the elderly and may be categorized as acute or chronic mesenteric ischemia. Common etiologies of acute mesenteric ischemia (AMI) include arterial embolus from atrial fibrillation, mesenteric arterial thrombosis, aortic dissection, superior mesenteric and/or portal venous thrombosis, and nonocclusive mesenteric ischemia. Chronic mesenteric ischemia (CMI) is most commonly caused by atherosclerosis; it is relatively uncommon due to the rich collateral circulation of the gastrointestinal tract and its slow insidious course. Bowel infarction in the setting of mesenteric ischemia is associated with mortality rates that have approached 90% in some studies. Thus, it is important to establish an early diagnosis and implement prompt treatment prior to the onset of bowel infarction. Acuity of presentation, presence of bowel infarction, etiology of ischemia, and risk factors may influence the treatment approach. While traditional therapy for mesenteric ischemia involved surgical management, successful endovascular approaches have been increasingly reported in multiple case series.