Chronic Mesenteric Ischemia: A Rare Cause of Chronic Abdominal Pain.
BACKGROUND
Chronic mesenteric ischemia is a rare disease with nonspecific clinical symptoms, such as chronic postprandial abdominal pain and weight loss. Diagnostic modalities and revascularization techniques have evolved during the past 20 years. The significance of stenosis in a single splanchnic vessel remains unclear. Our aims were to assess the outcomes of 2 revascularization techniques and report on the diagnostic modalities of splanchnic vessel stenoses.


METHODS
The demographic data, medical history, technical characteristics, and outcomes of the revascularization procedures were recorded for all of the patients admitted for endovascular revascularization or open surgical revascularization of the splanchnic vessels as treatment for chronic mesenteric ischemia in our tertiary referral center since 2000.


RESULTS
Fifty-four patients were included in this study: 43 received endovascular revascularization, and 11 had open surgical revascularization. The symptoms were abdominal pain, weight loss, and diarrhea in 98%, 53%, and 25% of the cases, respectively. Computed tomography angiography was the key diagnostic tool for 60% of the patients. A single-vessel stenosis was found in one-third of the patients. Endovascular and open revascularization had similar early and late outcomes, and no 30-day mortality was observed. However, we did observe higher morbidity in the open revascularization group (73% vs 19%, P <.03).


CONCLUSIONS
Chronic mesenteric ischemia may be diagnosed in the presence of a splanchnic syndrome and stenosis of a single splanchnic vessel, typically assessed using computed tomography angiography. In selected patients, endovascular revascularization had similar efficacy as, and lower complication rates than open revascularization.
Gastroenterology Department, Georges Pompidou European Hospital, Paris, France; Paris Descartes University, Paris, France. Electronic address: maximilien.barret@aphp.fr.
Maximilien
M
Barret
Gastroenterology Department, Georges Pompidou European Hospital, Paris, France; Paris Descartes University, Paris, France.
Chloé
C
Martineau
Gastroenterology Department, Georges Pompidou European Hospital, Paris, France; Paris Descartes University, Paris, France.
Gabriel
G
Rahmi
Paris Descartes University, Paris, France; Interventional Radiology Department, Georges Pompidou European Hospital, Paris, France; Inserm U970 équipe 2, Paris, France.
Olivier
O
Pellerin
Paris Descartes University, Paris, France; Interventional Radiology Department, Georges Pompidou European Hospital, Paris, France; Inserm U970 équipe 2, Paris, France.
Marc
M
Sapoval
Paris Descartes University, Paris, France; Vascular Surgery Department, Georges Pompidou European Hospital, Paris, France.
Jean-Marc
JM
Alsac
Paris Descartes University, Paris, France; Vascular Surgery Department, Georges Pompidou European Hospital, Paris, France.
Jean-Noël
JN
Fabiani
Gastroenterology Department, Georges Pompidou European Hospital, Paris, France; Paris Descartes University, Paris, France.
Georgia
G
Malamut
Gastroenterology Department, Georges Pompidou European Hospital, Paris, France.
Elia
E
Samaha
Gastroenterology Department, Georges Pompidou European Hospital, Paris, France; Paris Descartes University, Paris, France.
Christophe
C
Cellier
D015746:Abdominal Pain / Q000209:etiology*; D000368:Aged; D000792:Angiography; D002908:Chronic Disease; D059350:Chronic Pain / Q000209:etiology; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008638:Mesenteric Arteries / Q000601:surgery; D065666:Mesenteric Ischemia / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery
Abdominal angina; Chronic mesenteric ischemia; Splanchnic syndrome