Abstract
Chronic mesenteric ischemia (CMI) is a complex disorder, which typically affects elderly
patients who classically present with longstanding abdominal pain and nonspecific
clinical symptoms, such as food aversion and weight loss. The disease progression
is often gradual due to a rich collateral network, and symptoms are generally not
clinically apparent until two or more primary visceral arteries are affected. Symptomatic
stenosis or occlusion of the mesenteric arteries can be the result of multiple etiologies,
although atherosclerosis is the most common. Given its low incidence, a high clinical
suspicion is necessary for diagnosis and to prevent a delay in treatment. Multiple
imaging modalities are utilized to confirm the presence of mesenteric vessel involvement
and to guide treatment. While open surgical revascularization was once the definitive
treatment, endovascular management has become the first-line treatment for atherosclerotic
CMI. The endovascular approach with stent placement has shown excellent primary success
and encouraging long-term outcomes with reduction in morbidity and mortality compared
with open surgical revascularization. Although controversial, median arcuate ligament
syndrome (MALS) is a less common cause of CMI, which can affect a more varied patient
population. Clinical approach, imaging characteristics, and treatment for this syndrome
will also be discussed.
Keywords
mesenteric ischemia - chronic - endovascular
