II. Epidemiology
- Age: 60 years is mean age of diagnosis
- Gender predominance: Female (by ratio to 3:1)
III. Causes
- Diffuse atherosclerotic disease in 95% of cases
- All major mesenteric vessels (SMA, IMA, Celiac Artery) with stenosis or Occlusion
- Other causes
- Radiation Therapy
- Malignancy
- Fibromuscular dysplasia
- Vasculitis (often involves smaller vessels)
IV. Risk Factors
- Cardiovascular Risk Factors
- Tobacco Abuse (75-80%)
V. Symptoms
- Symptoms are typically present for 4 -6 months at presentation
- Diagnosis is often delayed as much as 18 months
- Postprandial, diffuse Abdominal Pain
- Crampy, Abdominal Pain
- Pain is typically diffuse and poorly localized, or periumbilical
- Associated findings
- Weight loss of 15-25 pounds
- Nausea
VI. Signs
- Abdominal bruit (60-90%)
- Fecal Occult Blood Testing (10%)
VII. Labs
- See Mesenteric Ischemia
-
Malnutrition Labs in Chronic Mesenteric Ischemia
- Anemia
- Leukopenia or Lymphopenia
- Hypoalbuminemia
VIII. Imaging: Diagnosis
- See Mesenteric Ischemia
-
CT Abdomen and CT Angiography
- First-line study in most cases
- Occlusion of 2 major visceral arteries with significant stenosis of the third
- Angiography (gold standard)
- Contrast-Enhanced MRA Abdomen
- Contrast-Enhanced MRA is the best modality to fully evaluate for abdominal vascular disease
- Mesenteric Duplex Ultrasound
IX. Management
- See Mesenteric Ischemia
- Medical Short-Term Measures while pending surgical management
- Bowel Rest
- Tobacco Cessation
- Perioperative Intra-arterial directed papaverine (vasodilator) to prevent arterial spasm
- Nitroglycerin as needed
- Anticoagulants (Heparin, Warfarin)
- Surgical (Vascular Surgery, Endovascular procedures)
- Indicated in all patients with Chronic Mesenteric Ischemia unless surgical risk outweighs benefit
- Endovascular techniques are preferred for high-risk surgical candidates (esp. short Life Expectancy)
- Angioplasty with stenting has best outcomes
- Lower morbidity and mortality than open procedures
- Initial symptom relief in 95% of cases
- Restenosis occurs in 20-40% patients (with up to half requiring repeat intervention)
- Open revascularization is preferred for patients who can withstand more invasive surgery (esp. younger patients)
- Lower restenosis rates than with endovascular procedures
- Long-term symptomatic relief
- Procedures
- Resection of necrotic bowel
- Transaortic Endarderectomy (Celiac Artery or SMA)
- Anterograde bypass (from supraceliac aorta)
- Retrograde bypass (from infrarenal aorta or common iliac artery)
- References
X. References
- Fraboni (2012) Board Review Express, San Jose
- Kern and Gilley-Avramis (2022) Crit Dec Emerg Med 36(11) 21-8
- Mastoraki (2021) World J Gastrointest Pathophysiol 7(1): 125-30 [PubMed]
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Related Studies
Concepts | Disease or Syndrome (T047) |
ICD9 | 557.1 |
SnomedCT | 111354009, 197008005, 241154007, 197005008, 266448009 |
English | Chro intest vasc insuff, Chronic GIT vasc.insuffic.NOS, Chronic intestinal vascular insufficiency NOS, CMI - Chron mesenteric ischaem, Chr vasc insuff intest, chronic mesenteric ischemia, chronic intestinal ischemia, CMI - Chronic mesenteric ischemia, Chronic intestinal vascular insufficiency NOS (disorder), Chronic mesenteric ischaemia (disorder), CMI - Chronic mesenteric ischaemia, Chronic vascular insufficiency of intestine, Chronic intestinal ischaemia, Chronic intestinal ischemia, Chronic intestinal vascular insufficiency, Chronic mesenteric ischaemia, Chronic intestinal ischaemic syndrome, Chronic intestinal ischemic syndrome, Chronic vascular insufficiency of intestine (disorder), Chronic mesenteric ischemia, ischemia; bowel, chronic, Chronic intestinal ischemic syndrome, NOS, Chronic vascular insufficiency of intestine, NOS, Chronic intestinal ischaemic syndrome, NOS, Chronic mesenteric ischaemia [Ambiguous] |
Dutch | chronische vasculaire insufficiëntie van de ingewanden, ischemie; darm, chronisch |
French | Insuffisance intestinale chronique vasculaire |
German | chronische vaskulaere Insuffizienz des Darms |
Portuguese | Insuficiência vascular crónica do intestino |
Spanish | Insuficiencia vascular crónica del intestino, isquemia mesentérica crónica, insuficiencia vascular intestinal crónica, SAI (trastorno), insuficiencia vascular intestinal crónica, SAI, insuficiencia vascular crónica del intestino (trastorno), insuficiencia vascular crónica del intestino, síndrome de isquemia intestinal crónica |
Japanese | 慢性腸血行不全, マンセイチョウケッコウフゼン |
Italian | Insufficienza vascolare cronica dell'intestino |
Czech | Chronická cévní nedostatečnost střeva |
Hungarian | Bél chronikus vascularis elégtelensége |
Ontology: Abdominal angina (C1280008)
Concepts | Sign or Symptom (T184) |
SnomedCT | 197005008, 240342007, 24988007, 241154007 |
English | Abdominal Angina, intestinal angina, abdominal angina, angina abdominal, angina intestinal, Angina - abdominal, Intestinal angina (disorder), Abdominal angina, Intestinal angina, Abdominal angina (disorder) |
Italian | Angina intestinale |
Japanese | 腸管アンギナ, チョウカンアンギナ |
Czech | Abdominální angina |
Hungarian | Intestinalis angina |
Spanish | angina intestinal, angina intestinal (trastorno), angina abdominal (trastorno), angina abdominal, Angina intestinal |
Portuguese | Angina intestinal |
Dutch | intestinale angina |
French | Angor intestinal |
German | Angina intestinalis |