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      Is Open Access

      Clinical management of chronic mesenteric ischemia

      review-article

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          Abstract

          This review provides an overview on the clinical management of chronic mesenteric ischemia (CMI). CMI is defined as insufficient blood supply to the gastrointestinal tract, most often caused by atherosclerotic stenosis of one or more mesenteric arteries. Patients classically present with postprandial abdominal pain and weight loss. However, patients may present with, atypically, symptoms such as abdominal discomfort, nausea, vomiting, diarrhea or constipation. Early consideration and diagnosis of CMI is important to timely treat, to improve quality of life and to prevent acute-on-chronic mesenteric ischemia. The diagnosis of CMI is based on the triad of clinical symptoms, radiological evaluation of the mesenteric vasculature and if available, functional assessment of mucosal ischemia. Multidisciplinary consensus on the diagnosis of CMI is of paramount importance to adequately select patients for treatment. Patients with a consensus diagnosis of single-vessel or multi-vessel atherosclerotic CMI are preferably treated with endovascular revascularization.

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          Most cited references45

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          Median Arcuate Ligament Syndrome-Review of This Rare Disease.

          Daniel Relles, Erinn Kim, Joshua A Eisenberg … (2016)
          Median arcuate ligament (MAL) syndrome is a rare disease resulting from compression of the celiac axis by fibrous attachments of the diaphragmatic crura, the median arcuate ligament. Diagnostic workup and therapeutic intervention can be challenging.
          Article 0 comments Cited 87 times – based on 0 reviews     Review now
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            Evaluation of diagnostic tests when there is no gold standard. A review of methods.

            Hans Reitsma, Anne Rutjes, A Coomarasamy … (2007)
            To generate a classification of methods to evaluate medical tests when there is no gold standard. Multiple search strategies were employed to obtain an overview of the different methods described in the literature, including searches of electronic databases, contacting experts for papers in personal archives, exploring databases from previous methodological projects and cross-checking of reference lists of useful papers already identified. All methods available were classified into four main groups. The first method group, impute or adjust for missing data on reference standard, needs careful attention to the pattern and fraction of missing values. The second group, correct imperfect reference standard, can be useful if there is reliable information about the degree of imperfection of the reference standard and about the correlation of the errors between the index test and the reference standard. The third group of methods, construct reference standard, have in common that they combine multiple test results to construct a reference standard outcome including deterministic predefined rules, consensus procedures and statistical modelling (latent class analysis). In the final group, validate index test results, the diagnostic test accuracy paradigm is abandoned and research examines, using a number of different methods, whether the results of an index test are meaningful in practice, for example by relating index test results to relevant other clinical characteristics and future clinical events. The majority of methods try to impute, adjust or construct a reference standard in an effort to obtain the familiar diagnostic accuracy statistics, such as sensitivity and specificity. In situations that deviate only marginally from the classical diagnostic accuracy paradigm, these are valuable methods. However, in situations where an acceptable reference standard does not exist, applying the concept of clinical test validation can provide a significant methodological advance. All methods summarised in this report need further development. Some methods, such as the construction of a reference standard using panel consensus methods and validation of tests outwith the accuracy paradigm, are particularly promising but are lacking in methodological research. These methods deserve particular attention in future research.
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              Mesenteric revascularization: management and outcomes in the United States, 1988-2006.

              Marc L Schermerhorn, Kristina Giles, Allen D Hamdan … (2009)
              Recent reports have suggested that angioplasty, with and without stenting (PTA/S), may have a lower perioperative mortality rate than open surgery for revascularization of acute (AMI) and chronic mesenteric ischemia (CMI). It is unclear if there has been nationwide adoption of this methodology or whether there is actually a mortality benefit.
              Article 0 comments Cited 40 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): United European Gastroenterol J
                Journal ID (iso-abbrev): United European Gastroenterol J
                Journal ID (publisher-id): UEG
                Journal ID (hwp): spueg
                Title: United European Gastroenterology Journal
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Print): 2050-6406
                ISSN (Electronic): 2050-6414
                Publication date (Electronic): 04 December 2018
                Publication date (Print): March 2019
                Volume: 7
                Issue: 2
                Pages: 179-188
                Affiliations
                [1 ]Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
                [2 ]Department of Radiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
                [3 ]Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
                [4 ]Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, the Netherlands
                [5 ]Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands
                [6 ]Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
                [7 ]Technical Medical Center, Faculty Science and Technology, University Twente, Enschede, the Netherlands
                [8 ]Department of Vascular Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
                Author notes
                [*]Louisa JD van Dijk, Department of Gastroenterology and Hepatology and Department of Radiology, Erasmus MC University Medical Center, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. Email: l.vandijk@ 123456erasmusmc.nl
                Author information
                https://orcid.org/0000-0002-6507-5666
                https://orcid.org/0000-0003-4640-8725
                Article
                Publisher ID: 10.1177_2050640618817698
                DOI: 10.1177/2050640618817698
                PMC ID: 6498801
                PubMed ID: 31080602
                SO-VID: d9e6975f-2d4c-48a3-b690-a60fdecf5981
                Copyright © © Author(s) 2018
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 12 September 2018
                Date accepted : 15 November 2018
                Categories
                Subject: Review Article

                Keywords: chronic mesenteric ischemia,atherosclerosis,median arcuate ligament syndrome,computed tomography angiography,endovascular therapy
                Data availability:
                Keywords: chronic mesenteric ischemia, atherosclerosis, median arcuate ligament syndrome, computed tomography angiography, endovascular therapy

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