RT Book, Section A1 Torres-Ruiz, Tania A. A1 Osman, Mohamed F. A2 Nazzal, Munier A2 Blebea, John A2 Osman, Mohamed F. SR Print(0) ID 1200678445 T1 Chronic Mesenteric Ischemia T2 Vascular and Endovascular Surgery: Clinical Diagnosis and Management YR 2024 FD 2024 PB McGraw Hill PP New York, NY SN 9781260462715 LK accesssurgery.mhmedical.com/content.aspx?aid=1200678445 RD 2024/03/28 AB Chronic mesenteric ischemia (CMI), also known as intestinal angina, is characterized by abdominal pain after meals due to low mesenteric blood flow as a result of mesenteric occlusive disease. Although atherosclerotic disease in the mesenteric vascular bed is quite common, intenstinal angina is rare.1,2 The prevalence of CMI is estimated to be 1 in 100,000 of the annual US hospital admissions and accounts for 2% of admissions for gastrointestinal (GI) conditions.3 CMI is more commonly seen in females compared to males and atherosclerotic disease in the most common underlying pathology.3,4 The majority of the clinical presentation of this disease process can be attributed to the decreased blood flow. After ingestion of a meal, blood flow increases to around 2000 cc/hr over the following 3 to 6 hours in order to provide adequate oxygenation to the GI system.4,5 Patients with mesenteric ischemia are unable to mount this postprandial hyperemic response that is required for adequate oxygenation and energy to proceed with the metabolic processes of secretion and absorption as well as peristalsis. As such, intestinal angina results from visceral organs failing to meet the regular metabolic requirements. However, the mesenteric circulation is a complex network involving multiple collateral, and due to this, one may not develop symptoms until at least two of the three major mesenteric vessels—the superior mesenteric artery, inferior mesenteric artery, or celiac axis (SMA, IMA, or celiac axis)—are completely occluded or severely narrowed.6