A Radiologist’s Endovascular Therapy Guide to Mesenteric Ischemia

Mesenteric ischemia is a broad term encompassing several clinical conditions leading to impaired vascularity of bowel loops. Imaging plays a crucial role in diagnosis and management. Mesenteric ischemia is an uncommon condition resulting from inadequate arterial supply in the splanchnic circulation or deficient venous return, leading to bowel ischemia. Acute mesenteric ischemia (AMI) is a potentially life-threatening condition. The mortality rate in AMI has consistently been reported to be as high as 50–69%. MDCT plays a crucial role in identifying the severity and complexity of mesenteric ischemia. It has high diagnostic performance for the detection of AMI with 64-96% sensitivity and 92-100% specificity.

Mesenteric ischemia is an uncommon entity with high morbidity and mortality in the acute setting. A high degree of clinical suspicion with imaging correlation is pertinent for early diagnosis to improve clinical outcomes. MDCT is the first line imaging modality for the diagnosis of mesenteric ischemia due to its widespread availability, faster acquisition, and great spatial resolution. CT angiography allows for a comprehensive non-invasive assessment of the abdominal vasculature as well as the bowel and mesentery. It not only detects the cause of ischemia but also helps in differentiating reversible and irreversible ischemic events based on the bowel wall and mesenteric findings, thereby predicting the outcome. Endovascular catheter thrombolysis is the preferred treatment option for early reversible acute ischemia with better patient outcomes and lesser morbidity. Percutaneous transluminal angioplasty with stenting is a less invasive, effective treatment option for chronic mesenteric stenosis as compared to surgical revascularization. Therefore, imaging modalities play a crucial role not only in detecting mesenteric ischemia but also in predicting early outcomes.

Journal name: Mesenteric ischemia: a radiologic perspective. Abdom Radiol (NY)

Name of researcher: Sinha D, Kale S, Kundaragi NG, Sharma S.

Date: 2020 Nov 23