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Chronic Mesenteric Ischemia: Imaging and Percutaneous Treatment¹

¹ From the Department of Radiology and Imaging, Dijon University Hospital, Dijon, France (F.C., D.B.S., M.D., J.P.C., M.W., E.T., D.K.); and the Department of Radiology and Imaging, Clermont-Ferrand University Hospital, Clermont-Ferrand, France (L.B.). Presented as an education exhibit at the 2000 RSNA scientific assembly. Received April 16, 2001; revision requested May 29; final revision received March 1, 2002; accepted March 5. Address correspondence to F.C., Department of Radiology and Imaging, Dijon University Hospital (Le Bocage), 2 Blvd Mal de Lattres de Tassigny, 21034 Dijon, France (e-mail: francois.cognet@chu-dijon.fr).

Chronic mesenteric ischemia (CMI) is rare and is often diagnosed late. Fatal malabsorption-related complications or acute ischemic events occur in the absence of treatment. Diagnosis depends on careful acquisition of a medical history and elimination of other conditions. No sensitive and specific tests are available for functional diagnosis of CMI. If other causes of abdominal pain and weight loss have been confidently ruled out, evidence of visceral artery occlusion at noninvasive imaging (Doppler ultrasonography, computed tomographic angiography, and magnetic resonance angiography) suggests CMI. Until the 1990s, open surgery was considered the treatment of choice; percutaneous transluminal angioplasty (PTA) was reserved for patients for whom surgery carried a high risk. However, open surgery carries a nonnegligible risk of morbidity and mortality. In recent years, PTA with stent placement has been recognized as a minimally invasive means of obtaining good long-term results with an acceptable recurrence rate and consequently has been suggested for primary treatment of CMI. New treatments including administration of fibrinolytic agents before PTA of chronic occlusions, routine revascularization of one or more arteries, and stent placement will probably be validated in the near future. Similarly, new data on selection of the best approach will become available soon.

© RSNA, 2002

Index Terms: Arteries, mesenteric, 95.72 • Arteries, stenosis or obstruction, 95.72 • Arteries, transluminal angioplasty, 95.128 • Mesentery, ischemia, 95.761

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Invited Commentary

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