Review Articles

A Nonsurgical Approach to Mesenteric Vascular Disease

Tabriziani, Hossein MD, FACP, FASN^*; Ahmad, Armaghan DMD^†; Bergamaschi, Roberto MD^‡; Frishman, William H. MD^§

From the ^*Division of Nephrology/Transplant, Loma Linda University, Loma Linda, CA; ^†Division of Oral and Maxillofacial Radiology and Diagnostic Sciences, University of Connecticut, Farmington, CT; ^‡Department of Surgery, New York Medical College/Westchester Medical Center, Valhalla, NY; and ^§Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY.

The authors declare no conflict of interest.

Correspondence: Hossein Tabriziani, MD, FACP, FASN, 11234 Andreson St, MC-1521, Lorna Linda, CA 92354. E-mail: [email protected]

Cardiology in Review 26(2):p 99-106, March/April 2018. | DOI: 10.1097/CRD.0000000000000180

Abstract

Mesenteric ischemia is a rare disorder, with considerably high morbidity and mortality rates. It can manifest in several ways, including acute mesenteric ischemia, chronic mesenteric ischemia, nonocclusive mesenteric ischemia, mesenteric venous thrombosis, and colonic ischemia. Of these, acute mesenteric ischemia is the most severe form of intestinal ischemia, with a high mortality rate. The mainstay of therapy for mesenteric ischemia is surgical exploration and resection of infarcted bowel; however, medical therapy can play an important adjunctive role. When diagnosed early, before bowel infarction, endovascular therapy can be used as the primary treatment option. Endovascular therapy includes catheter-based thrombolysis, thromboembolectomy, and stenting. Vasodilators also play an important role in the early management of mesenteric ischemia. Anticoagulation is the main form of therapy in mesenteric venous thrombosis.