Chronic mesenteric ischaemia: diagnostic and therapeutic difficulties

Abstract

Chronic mesenteric ischaemia is most often caused by the development of atherosclerosis of two or three mesenteric arteries. Some patients require treatment not only because of significant symptoms, but also because of the potential risk of intestinal necrosis. This study presents the case of a 56-year-old female patient admitted to the Department due to severe abdominal pain, cyclic diarrhoea, and significant weight loss lasting for a period of 1.5 years. Duplex ultrasound and angioCT examinations showed complete occlusion of the proximal segment of the superior mesenteric artery. The patient was qualified to aorto-mesenteric graft surgery below the renal arteries. The segment of the saphenous vein that was used initially did not ensure sufficient circulation in the vicinity of the superior mesenteric artery. The vein was replaced by a PTFE prosthesis of greater diameter, which enabled a good treatment effect. Two years after the operation the patient is asymptomatic, has gained 10 kg, and the prosthesis remains patent - which was confirmed by means of Duplex ultrasound. The Authors mention the often delayed diagnosis in these patients, and need for the individual selection of the therapeutic method.
Acta Angiol 2010; 16, 2: 85-92