الفهرس 
Introduction 1Only 14 pages are availabe for public view
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Abstract
Mesenteric ischemia (MI) is a life-threatening vascular emergency
that requires early diagnosis and intervention to adequately restore
mesenteric blood flow and to prevent bowel necrosis and patient death.
MI can be chronic or acute at clinical manifestation. chronic mesenteric
ischemia is relatively rare and is considered imminent AMI, which is
most commonly caused by atherosclerotic stenosis or occlusion of two or
more major visceral arteries.
Single arterial occlusion usually does not cause symptoms because
of rich mesenteric collaterals that develop during the slow progression of
the disease. Typically, patients over 60 years of age (female predominant)
present with characteristic symptoms that include postprandial abdominal
pain (abdominal angina) and weight loss.
Open surgical treatment with bypass, endarterectomy, or
embolectomy has been the standard for many years. Recently, various
endovascular procedures have been increasingly successful and are safe
in certain cases of mesenteric ischemia. Revascularization for chronic
mesenteric ischemia (CMI) is typically performed in elderly patients with
extensive atherosclerotic disease and malnutrition. In both chronic and
acute settings, angioplasty and stenting have been successfully described
for management of stenoses or occlusions.
Nowadays, apart from percutaneous transluminal angioplasty
(PTA) and stenting, other endovascular techniques are available,
including the use of intra-arterial thrombolysis, vasodilators and suction
embolectomy. Endovascular therapy can potentially modify clinical
outcomes in patients with acute bowel ischemia; however, given the
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relative infrequency of this disease, it is hard to obtain wide experience
over a relatively short interval and only small case series are available in
the literature.
The aim of the present study was to highlight the recent trends in
management of patients with mesenteric vascular occlusion.
This was is a prospective study, conducted at Ain Shams University
Hospitals and Nasser institute Hospital in Cairo on 30 patients
complaining of acute or chronic intestinal ischemia in the form of
abdominal pain and post prandial meal.
The main results of the study revealed that:
The mean age of the studied group was 4.69 (±12.36 SD)with
range (21-64) and among the studied cases there were 13 (43.3%)
females and 17 (56.7%)males.
Among the studied cases there were 21 (70%) with hypertension,
19 (63.3%) with atrial fibrillation, 3 (10%) with chronic obstructive
pulmonary disease, 6 (20%) with diabetes mellitus, 3 (10%) with
previous myocardial infarction and 13 (43.3%) with congestive
heart failure.
Among the studied cases there were 20 (66.7%) with abdominal
pain, 28 (93.3%) with Postprandial pain, 3 (10%) with diarrhea, 1
(3.3%) with bloody diarrhea, 20 (66.7%) with nausea, 22 (73.3%)
with vomiting and 4 (13.3%) with history of oncologic disease.
Among the studied cases there were 23 (76.7%) with embolization
to superior mesenteric artery branches, 21 (70%) with stenosis and
2 (6.7%) with total occlusion of superior mesenteric artery.
Mean CRP of the studied group was 19.52 (±22.4 SD) with range
(1.4-116.1), the mean creatinine was 1.92 (±0.41 SD) with range
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(1.29-2.63), the mean Hb was 11.4 (±1.05 SD)with range (8.2-
12.7) and the mean WBCs of the studied group was 7.34 (±2.22
SD)with range (4.7-11.3).
Among the studied cases there were 4 (13.3%) with complete
effect of thrombolysis, 1 (3.3%) with partial effect, 2 (6.7%) with
no lysis, 8 (25.7%) with dilatation, 13 (43.3%) dilatation and stent
and 13 (43.3%) with failed dilatation.
Among the studied cases there were 8 (26.7%) with bleeding as
complication, 7 (23.3%) with bowel resection, 7 (23.3%) who died
in hospital and 6 (26.1%) with recurrence of symptoms.
After 6 months there were 20 (87%) with no symptoms, 2 (8.7%)
who had recurrence of disease and 1 (4.3%) who died.
Based on our results we recommend for further studies on larger patients
and longer period of follow up to emphasize our conclusion.