Endovascular Therapy for Mesenteric Disease

Abstract

In 1966, Dr. Trygve Aakhus touted the role of angiography in the evaluation of mesenteric ischemia. Eleven years later in 1977, Boley described the intra-arterial administration of papaverine to treat mesenteric ischemia. The 1st report of mesenteric angioplasty was published in 1980 by Gruntzig et al. During the past 31 years, percutaneous management of mesenteric vascular disease has expanded considerably. Though endovascular therapy in mesenteric disease is performed for aneurysmal, oncologic, traumatic, and hemorrhagic indications, the most common indication is the treatment of ischemic diseases. It has been estimated that 1 of 1,000 hospital admissions is due to intestinal ischemic disorders, which can be classified as chronic and acute mesenteric ischemia. In the general population, the incidence of chronic mesenteric ischemia is 1/100,000; however, in populations with known atherosclerotic disease, the prevalence is much higher. Chronic mesenteric ischemia is most frequently due to multivessel atherosclerotic arterial disease in the abdomen. In contrast, acute mesenteric ischemia can result from arterial embolism, arterial or venous thrombosis, or low cardiac output states complicated by profound mesenteric vasoconstriction.