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At least 19 recordsLinked to original sources
PubMed2001

Mesenteric ischemia.

Mesenteric ischemia is an important clinical condition becoming more prevalent with aging of the population. Mesenteric ischemia may be manifest in an acute presentation, usually secondary to thromboembolism or cardiac insufficiency. Patients have abdominal pain, lactic acidosis, benign abdominal examination, and, often, coexistent multisystem organ dysfunction. Chronic mesenteric ischemia is secondary to proximal arterial stenosis or occlusions inadequately compensated by collateral flow. Clinical presentation may simulate occult malignancy. In this review article, the role of Doppler sonography and other diagnostic imaging tests in suspected acute mesenteric ischemia and mesenteric arterial insufficiency are evaluated with emphasis on diagnostic criteria and appropriate use in each clinical context.

Journal Article↗
PubMedDate not supplied

Analysis of the correlation of plasma NO and ET-1 levels in rats with acute mesenteric ischemia.

Mesenteric ischemia is a devastating disease process that frequently challenges clinicians. To enhance the early diagnosis of gut ischemia and judgment of its severity, it may be helpful to detect the unusual existence or increase in biomarkers in the body fluid. The aim of the present study was to evaluate the correlation of plasma nitric oxide (NO) and endothelin-1 (ET-1) levels to mesenteric ischemia using an animal model. Acute mesenteric ischemia (AMI) was produced experimentally by occlusion of the mesenteric vessels in the terminal ileum by the tenting of a thread. The determination of plasma NO and ET-1 levels were obtained before operation (T0, baseline value), and at 10 (T10), 20 (T20), 30 (T30), and 60 (T60) min after the creation of AMI. Sham-operated rats served as controls. After 30 min of experiments, the plasma NO and ET-1 levels were significantly higher in the AMI group than in the control group (both p < .01). Both the plasma NO and ET-1 levels in AMI group increased significantly after 30 min of ischemia (both p < .001 vs. respective baseline value), and they were 60% and 84% above the baseline value, respectively. In addition, ischemic intestinal injury was confirmed by the significantly elevated histological scores in the AMI group after 60 min of ischemia (p < .001). Our preliminary results suggest the possibility of important insights regarding NO and ET-1 changes into the mechanism of pathogenesis in AMI in rats. The increases in plasma NO and ET-1 levels may potentially be noninvasive biomarkers for the early detection of this disease.

Acute Disease↗
PubMed2005

Mesenteric ischemia.

Mesenteric ischemia is a morbid, potentially life-threatening disease that is associated with a relatively high mortality, often due to its late diagnosis. Currently, the incidence of mesenteric ischemia in the United States is low; however, the incidence is predicted to increase because of the aging population. Therefore, whether the presentation is acute or chronic in nature, the challenge for the physician remains early diagnosis through a high index of suspicion based on vague and often atypical presentations. Surgical intervention remains the mainstay of therapy. Despite ongoing investigations of the different treatment options, including single vs multivessel bypass, antegrade vs retrograde graft placement, autogenous vs prosthetic conduits, and endovascular vs open surgical repair, many questions remain unanswered. This review summarizes the clinical presentation, diagnosis, and treatment options, including both open and endovascular approaches, for acute and chronic mesenteric ischemia.

Acute Disease↗
PubMed2004

Laparoscopic "second-look" in the management of mesenteric ischemia.

Mesenteric ischemia is a major cause of mortality in surgery. Despite the advances in medicine, considerable number of patients undergoes reoperations for a better assessment of intestinal viability. Although great majority of these second-look operations are "negative explorations," progressive nature of this devastating disease pushes surgeons to re-explore the abdomen. This study compares open and laparoscopic "second-look" procedures in patients with mesenteric ischemia. In the first group (n = 41), abdomen was closed and second-look laparotomy was performed to 23 patients. In the second group (n = 36), a 10-mm trocar was inserted before closing the abdomen and second-look intervention was performed by a telescope to 23 patients. Sixteen of relaparotomies in the first group (70%) revealed nothing and were unnecessary. Two patients (8%) in the laparoscopy group needed re-resection while 20 patients (87%) were rescued from unnecessary laparotomies. Conclusively, patients with mesenteric ischemia are "ill enough" to deserve the "minimal invasion" spirit of laparoscopic surgery.

Comorbidity↗
PubMed2006

Update in management of mesenteric ischemia.

Mesenteric ischemia disorders are precipitated by a circulation insufficiency event that deprives one or several abdominal organs of adequate respiration to meet metabolic demands. Although mesenteric ischemia occurs infrequently, the mortality rate is from 60% to 100%, depending on the source of obstruction. The successful outcome is dependent upon a high index of suspicion and prompt management. We briefly review the pathophysiology and presentation of the various ischemic entities and review the current state of the art in diagnosis and treatment. Despite advances in both diagnosis and treatment, prompt diagnosis and supportive care remain critical for successful outcome. New imaging techniques, endovascular therapy and emerging research may improve our approach to this deadly condition.

Diagnosis, Differential↗
PubMed1988

Mesenteric ischemia.

Mesenteric ischemia secondary to vascular disease remains a significant problem in patients presenting with acute abdominal conditions, especially if they are elderly. Although rare, it is nevertheless an important and perhaps increasing cause of death or significant morbidity. Occasionally, it may be a mode of dying, but more often, it is the reason for death. Individual cases can manifest an almost overwhelming spectrum from chronic to acute, mild to catastrophic, arterial to venous, occlusive to hemodynamic, extensive to limited, or precisely diagnosed to accidentally found. Treatment principles are well defined, but continued refinement of supportive therapies of several types is occurring. In contrast, improved screening tests that can lead to early specific etiologic diagnosis remain at the experimental stage. Thus, good "clinical suspicion" is foremost and essential.

Abdomen, Acute↗
PubMedDate not supplied

The role of gastrointestinal microflora in the pathogenesis of complications of mesenteric ischemia.

Mesenteric ischemia is a catastrophic event, which has a mortality due to florid sepsis that approaches 100%. The demography of the bacterial changes has not been documented. After 72 hr of colonic ischemia in the dog, the total number of anaerobic organisms increased while the number of aerobic organisms decreased. After 24 hr of ischemia, anaerobic bacteria appeared only in the portal vein and persisted. Cultures of peritoneal fluid and aortic blood became positive for the same anaerobic organisms after 48 hr. Acute colonic ischemia promotes a relative overgrowth of intraluminal anaerobic bacteria, which progressively invade the portal vein and later the systemic circulation.

Animals↗
PubMed1980

Radioxenon washout for evaluation of vasodilator therapy in mesenteric ischemia.

Mesenteric ischemia follows a critical reduction in blood flow to the intestine. Absence of a practical diagnostic test results in delayed diagnosis and inability to evaluate changes in blood flow due to vasodilator therapy. We recorded the disappearance of radioxenon (133Xe) from ischemic bowel to quantitate the decreased perfusion and to assess changes in submucosal blood flow after intra-arterial papaverine. The ischemic colon, its only blood supply from collaterals, was formed into a Thirty-Vella loop. An infusion catheter placed at the origin of the superior mesenteric artery (SMA) was used to deliver saline or papaverine (0.1 mg./kg./min). Eleven control dogs received N.S. only. In nine dogs papaverine infusion was started immediately and in another 12 dogs two hours after the production of ischemia. Submucosal blood flow was determined by the per cent washout at two minutes of an 0.05 ml. injection of 133Xe dissolved in N.S., made into the submucosal space of the colostomy.

Animals↗
PubMed1996

[Role of coagulation disorders in mesenteric ischemia].

Mesenteric ischemic process can lead to bowel infarction or indolent low-grade ischemia. Inherited thrombophilia represents about 30 to 40% of mesenteric vein thrombosis. Analysis of thromboembolism sites occurring during genetic defect of coagulant factors showed that mesenteric thrombosis is the third localization after lung and legs, in equal incidence with cerebral thrombosis. The genetic defects known to be associated with thrombophilia, as deficiencies of protein C, protein S, antithrombin III, and dysfibrinogenemia, are discussed. A special interest is devoted to resistance to activated protein C. Acquired diseases, as myeloproliferative disease or paroxysmal nocturnal hemoglobinemia, inducing thrombosis are also discussed. Recent advances in both basic and clinical research have provided new insights that may be integrated into diagnostic and therapeutic practices.

Adult↗
PubMed2006

Surgical and medical management of mesenteric ischemia.

Acute mesenteric ischemia frequently results in bowel necrosis, which necessitates laparotomy to assess bowel viability. Reduction in mortality requires a high index of suspicion and prompt diagnosis. Bowel resection should be preceded by visceral artery revascularization. Medical management includes the use of anticoagulation, vasodilators, and the use of inhibitors of reperfusion injury. The management of chronic mesenteric ischemia largely depends on the general condition of the patient, who is often affected by malnutrition and dehydration. Surgery, although associated with greater morbidity and mortality, is more durable and effective in relieving the symptoms of chronic mesenteric ischemia. Endovascular treatment options for chronic mesenteric ischemia include percutaneous balloon angioplasty and stenting. This treatment is more likely to be successful in dealing with stenotic rather than occlusive lesions and offers a minimal invasive approach but is associated with a smaller primary success rate and a higher recurrence rate.

Journal Article↗
PubMed2000

[Chronic mesenteric ischemia].

Chronic mesenteric ischemia often called intestinal angina too, is the clinical syndrome that originates as a result of chronic obstruction of the splanchnic arteries. Intestinal angina is defined by the clinical triad of postprandial abdominal pain, sitophobia (fear of eating) and chronic weight loss. Postprandial abdominal pain is analogous to angina pectoris and calf claudication, two more common manifestations of episodic tissue hypoxia. The authors present the case-history of a 50-year-old woman with intestinal angina due to obliteration of the all three main splanchnic arteries. The authors describe the course of the disease and point out new diagnostic approaches in the diagnosis of chronic mesenteric ischemia (Doppler ultrasound of the splanchnic arteries, helical CT angiography of the splanchnic vasculature). In the discussion they point out the possible atypical clinical manifestation of chronic mesenteric ischemia and existence of gastric ulceration and chronic ischemic gastritis caused by chronic mesenteric ischemia.

Arteriosclerosis↗
PubMed2004

Endovascular treatment as a bridge to successful surgical revascularization for chronic mesenteric ischemia.

Chronic mesenteric ischemia (CMI) can be treated with surgical revascularization or with angioplasty and stenting. As experience has been gained, endovascular treatment appears safe and effective in selected patients. Currently, surgical revascularization has better success and patency rates but also a higher short- and midterm mortality and morbidity, especially in patients at high surgical risk. A 72-year-old female with severe respiratory dysfunction presented with CMI resulting in profound malnutrition. Serial percutaneous interventions averted urgent surgery and reversed the mesenteric ischemia. Nine months later, after repeated angioplasty and stenting had failed, elective uncomplicated iliomesenteric bypass, in a medically optimized patient, resolved the ischemia. At an 18-month follow-up, the graft remained widely patent and the patient asymptomatic with a body weight corresponding to her ideal body weight. Compared to surgical revascularization, reocclusion or restenosis occurs more frequently after endovascular treatment of CMI, and reintervention may be necessary. Nevertheless, percutaneous intervention effectively provides relief from mesenteric ischemia and has lower perioperative complication rates compared to surgery in patients at high surgical risk. After initial relief of the CMI, the patient's condition may improve, allowing for more definitive secondary surgical revascularization, if needed.

Aged↗
PubMed2005

Chronic mesenteric ischemia.

Chronic mesenteric ischemia is an unusual but important cause of abdominal pain. Although this condition accounts for only 5% of all intestinal ischemic events, it can have significant clinical consequences. Among its many causes, atherosclerotic occlusion or severe stenosis is the most common. This disorder has an indolent course that results in extensive collateral vascular formation. Thus, symptoms occur when at least two of the three main splanchnic vessels are affected. Intestinal angina, weight loss, and sitophobia are common clinical features. Diagnosis can often be made by noninvasive methods such as computerised axial tomographic angiography, magnetic resonance angiography, and duplex ultrasonography as well as by invasive catheter angiography. Therapy of chronic mesenteric ischemia depends on the extent and location of vascular disease. Alternatives to traditional surgical bypass are becoming more common including embolectomy, thrombolysis, and percutaneous angioplasty with vascular stenting. Early intervention is vital as the natural course of this illness can be debilitating. Furthermore, this has potential to develop into life-threatening acute mesenteric ischemia with subsequent bowel infarction and death. Long-term studies have shown that the risk of developing symptoms from asymptomatic but significant mesenteric vascular disease is 86% with overall 40% mortality rate. The recognition and management of this unusual but important cause of abdominal pain is discussed in detail in this review.

Abdominal Pain↗
PubMed1975

Experimental use of prostaglandin E1 in nonocclusive mesenteric ischemia.

Nonocclusive mesenteric ischemia was produced in dogs by intraarterial infusion of digoxin and by hemorrhage of 1/3 of total blood volume. Both methods produced a substantial drop in the superior mesenteric arterial blood flow rate. In each case, a superior mesenteric arterial infusion of 0.1 mug./kg. per minute of prostaglandin E1 allowed the blood flow rate to increase to above the control level without significantly altering heart rate or systemic arterial pressure. The improved arterial blood flow rates were accompanied by a reversal of the diffuse mesenteric vasoconstriction that was seen in the ischemic state. These findings were demonstrated by superior mesenteric arteriography performed prior to and following the production of mesenteric ischemia and again following the infusion of prostaglandin E1.

Animals↗
PubMed1993

Acute mesenteric ischemia.

Acute mesenteric ischemia is a potentially life-threatening vascular disorder affecting the gastrointestinal tract. The prognosis depends on early recognition, accurate diagnosis, and timely intervention to prevent extensive tissue necrosis and the onset of sepsis and multi-organ complications. Identifying the patient at risk, evaluating physical findings and laboratory data, maintaining adequate cardiac output and perfusion pressure, and implementing medical interventions are nursing care measures essential to patient survival. Future directions for the management of acute mesenteric ischemia are focused on identifying early markers of ischemia and mucosal injury to diagnose the condition accurately and reliably before the onset of systemic consequences.

Acute Disease↗
PubMed2005

Mesenteric stenting for chronic mesenteric ischemia.

BACKGROUND: Mesenteric stenting has not been widely adopted for the treatment of chronic mesenteric ischemia (CMI). The recent availability of embolic protection and low-profile devices with the theoretical ability to decrease perioperative bowel necrosis, led us to begin using mesenteric stenting for patients with CMI. We review our initial experience to examine short-term outcomes. METHODS: We performed a retrospective analysis of all patients who were treated by vascular surgeons with mesenteric stenting for CMI. Patients with acute mesenteric ischemia were excluded. We evaluated perioperative morbidity and mortality, restenosis, recurrent symptoms, and reintervention. Kaplan-Meier methods were used to assess events during follow-up. We also compared these outcomes with a historical control group of patients treated with open surgical revascularization. RESULTS: Fourteen patients underwent mesenteric stenting over the past 3 years. Mean age was 73, and 64% were women. There was no perioperative or 30-day mortality or major morbidity. Early restenosis and recurrent symptoms occurred in 10% and 9% of patients at 6 months. At a mean follow-up of 13 months, 53% of patients underwent reintervention. However, 93% were symptom-free at their last follow-up. Compared with open surgery, stent patients had lower perioperative major morbidity (30% vs 0%, P < .01) and shorter hospital and intensive care unit length of stay (median 10 days vs 2 days, and 3 days vs 0 days, respectively, P < .01 for both). However, stent patients were seven times as likely to develop restenosis (P < .01), four times more likely to develop recurrent symptoms (P < .01), and 15 times more likely to undergo reintervention (P < .01). There was one death 13 months after stenting due to mesenteric infarction in a patient lost to follow-up. One patient was successfully converted to open surgery after a second restenosis. He had regained 20 pounds and was determined to be a better operative candidate than at his initial presentation. There was no perioperative or 30-day mortality or major morbidity with reintervention after mesenteric stenting. CONCLUSION: Mesenteric stenting for CMI can be performed with low perioperative risk. However, stenting is associated with early restenosis and recurrent symptoms requiring secondary procedures. Patients with severe nutritional depletion or high surgical risk may benefit from mesenteric stenting for CMI, but close follow-up is required. Later open surgery can be performed for restenosis if nutritional status and surgical risk are improved, or repeat angioplasty and stenting can be effectively performed if operative risk remains high.

Aged↗
PubMed1999

Acute mesenteric ischemia.

Acute mesenteric ischemia (AMI) remains a complex and difficult clinical problem. Such acute ischemia is usually either embolic or thrombotic in nature, but other etiologies exist. The diagnosis of AMI is difficult to establish and often delayed, resulting in irreversible bowel injury that requires intestinal resection. Mortality for AMI remains high, and patients requiring extensive gut resection are unlikely to survive. Patients surviving intestinal resection may develop short gut syndrome. The prognosis dramatically improves if revascularization can be achieved prior to intestinal infarction.

Angiography↗
PubMed1993

Acute mesenteric ischemia.

Acute mesenteric ischemia resulting from specific etiologies is a treatable vascular emergency. It requires a high index of suspicion and prompt, aggressive resuscitation and diagnostic maneuvers to determine the specific underlying cause. This will allow specific directed surgical revascularization, optimization of cardiac performance, or correction of a hypercoagulable state, all directed at maximizing the amount of functional bowel that is salvageable. These strategies are the cornerstones for a successful outcome in this life-threatening vascular catastrophe.

Acute Disease↗