الفهرس 
Anatomy of the abdominal aortaOnly 14 pages are availabe for public view
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Abstract
Abdominal angina is an uncommon and under recognized syndrome caused by repeated episodes of postprandial intestinal ischemia. Although it usually does not require emergency therapy, it can lead to marked weight loss and significantly impair the quality of life. Furthermore, there are substantial risks of progressive occlusion or acute thrombosis of one of the involved vessels. Diagnosis requires a high index of suspicion, careful exclusion of other abdominal disorders, and the anatomical demonstration of an occlusive process of the splanchnic vessels. Surgical reconstruction and angioplasty are effective treatments.
Because CMI is rare, its pathophysiology remains poorly understood. In particular, the relation between symptoms and arterial lesions is unclear. There is no specific diagnostic test, and the diagnosis continues to rest on clinical grounds. A high index of suspicion should be maintained in patients with postprandial pain and weight loss. An important step is to eliminate other conditions, even in patients with occlusive visceral artery lesions.
The clinical outcome of asymptomatic mesenteric vascular disease has been studied and is a predictor of morbidity and mortality. In a longitudinal study of patients with asymptomatic mesenteric vascular stenoses of >50% in all three vessels, 86% developed symptoms during a 6-year follow-up period. Furthermore, there was an overall 40% mortality rate for this patient population likely related to concurrent atherosclerotic disease of other vascular beds.
As imaging technology continues to evolve, its recognition is becoming more common. However, early detection relies on clinical suspicion and a combination of medical history, physical examination, and diagnostic testing. Conventional angiography is rivaled by highly accurate noninvasive imaging modalities such as CTA and MRA. Traditionally, patients with CMI have undergone surgical bypass or embolectomy with fairly good outcomes. However, minimally invasive endovascular therapies have emerged as a viable alternative for single or short segment vascular disease. While initial studies are promising, long-term studies comparing these techniques to surgical management with regard to vessel patency, morbidity and mortality are awaited. Nevertheless, the recognition and management of CMI as an unusual but important cause of chronic abdominal pain needs to be expedient to avoid complications of the illness and its potential to progress into acute intestinal infarction.
The low morbidity and high technical success rate of catheter-based techniques have made this approach the first line therapy for CMI due to visceral artery stenosis. Endovascular treatment has been advocated for high-risk patients and for patients with vague symptoms and a doubtful diagnosis, with open surgery being reserved for patients who fail this treatment modality. Furthermore, open surgery can be performed when repeated endovascular interventions fail.
Percutaneous stent placement for the treatment of CMI can be performed with a high procedural success and a low complication rate. The long-term freedom from symptoms and vascular patency are comparable with surgical results. The inherent lower procedural morbidity and mortality makes the endovascular approach the preferred revascularization technique for these patients.
CMI is a chronic debilitating disorder, which frequently resists prompt diagnosis as the patient is worked up for a range of other gastrointestinal ailments. Once diagnosed, operative and interventional modalities exist to re-establish flow in the diseased vessels. Operative intervention via bypass procedures or endarterectomies provides lasting results, but may be associated with considerable postoperative morbidity and mortality. Endovascular treatment with angioplasty and/or stenting can be performed with less morbidity, but the results are not as durable and symptoms recur at a higher rate than with surgical intervention. Although norandomized, large cohort trials are likely to be forthcoming, it seems reasonable to treat older, higher risk patients with the less for younger, healthier patients with longer life expectancies invasive procedure and reserve operative bypass.