Chronic mesenteric ischaemia: the importance of the individual mesenteric artery

• Published in: Clinical physiology and functional imaging 2022-01, Vol.42 (1), p.15-22
• Main Authors: Høyer, Christian, Christensen, Mette Høgh, Sandermann, Jes, Leusink, Robert, Abrahamsen, Jan
• Format: Article
• Language: English
• Subjects: Angiography; Aniline Compounds; Atherosclerosis; Blood flow; Blood vessels; Chronic Disease; clinical laboratory techniques; diagnosis; Glycine; Hepatic vein; Humans; intestinal angina; Ischemia; Liver; Mesenteric Arteries; Mesenteric Ischemia - diagnostic imaging; Oxygen content; Oxygen Saturation; Oxygenation; Stenosis; Veins; Veins & arteries; Weight loss
• ISSN: 1475-0961; 1475-097X
• DOI: 10.1111/cpf.12730

Background Chronic mesenteric ischaemia (CMI) is a vastly underdiagnosed condition that typically leads to postprandial abdominal pain and weight loss. The aim of the study was to explore the involvement of various mesenteric vessels in total splanchnic blood flow (SBF) and hepatic vein oxygenation. Methods Single‐blinded comparative trial of 476 patients clinically suspected of CMI. Routine investigation included measurement of hepatic vein oxygen saturation, indirect measurement of the total splanchnic blood flow (SBF), using Fick's principle and the tracer [99mTc]Mebrofenin, before and after a meal, and digital subtraction angiography. Results A total of 176 of the 476 patients (36%) had at least one angiographically significant stenosis (lumen reduction ≥70%). In patients with a significant one‐vessel disease, the percentage having CMI according to SBF was 10% for a celiac trunk stenosis (n = 60), 50% for a superior mesenteric stenosis (n = 24) and 6% for an inferior mesenteric artery stenosis (n = 34). In patients with a significant two‐vessel disease, the percentage with CMI according to SBF response was 92%, 18% and 79%, for no significant stenosis of the celiac trunk (n = 13), superior mesenteric artery (n = 17) and inferior mesenteric artery (n = 19), respectively. Conclusion Patients with significant one‐ or two‐vessel stenosis involving the superior mesenteric artery have a higher likelihood of CMI according to flow criteria and a greater postprandial decrease in hepatic vein saturation on average than patients with no involvement of the superior mesenteric artery.