Key points

• Chronic mesenteric ischaemia (CMI) is a rare condition, accounting for less than 5% of all intestinal ischaemic events

• More than 90% of cases are due to atherosclerotic occlusion or severe stenosis

• Classic symptoms include postprandial abdominal pain, sitophobia and weight loss

• At least two of the three main splanchnic arteries must be significantly compromised to result in chronic mesenteric ischaemia

• Duplex ultrasonography is non-invasive and expedient but may miss up to 20% of vascular lesions in the coeliac trunk

• Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are equally excellent non-invasive modalities with highly accurate diagnosis of vascular disease in the coeliac axis (CA) and superior mesenteric artery (SMA) and replace conventional catheter angiography

• Conventional catheter angiography should be reserved for diagnosis of CMI only when other modalities have been unhelpful or if intervention such as percutaneous transluminal angioplasty (PTA) is planned

• Surgical vascular bypass is the traditional definitive therapy for CMI with an overall 5-year graft patency of 78%

• Endovascular therapy is optimal in short segment atherosclerotic lesions at the ostia of the SMA and CA. Stenting and PTA in short-term follow up have a clinical benefit with stent patency in more than 90% of cases

Background

CMI is an uncommon cause of abdominal pain. It accounts for 5% of all intestinal ischaemic events with acute ischaemia being much more common.