eMedicine Specialties > Gastroenterology > Intestine

Chronic Mesenteric Ischemia: Follow-up

Author: Deron J Tessier, MD, Staff Surgeon, Kaiser Permanente Medical Center, Fontana, CA
Coauthor(s): Russell A Williams, MBBS, Program Director, Professor, Department of Surgery, University of California Medical Center at Irvine
Contributor Information and Disclosures

Updated: Oct 10, 2006

Follow-up

Further Inpatient Care

  • Postoperative care includes the following:
    • Ambulate early because of the high rate of postoperative ileus.
    • Monitor blood pressure to prevent hypotension, which can induce ischemia.

Further Outpatient Care

  • Monitor the PT and INR.
  • Routine visceral duplex ultrasonography is recommended every 4-6 months.

Complications

  • The risk of MI is increased but can be reduced with the following steps:
    • Identify patients at risk preoperatively.
    • Place a Swan-Ganz catheter perioperatively.
    • Inform the anesthesiologist when cross-clamping the aorta, so that myocardial protective maneuvers are used.
  • Acute renal failure can be prevented with the following steps:
    • Adequately hydrate the patient before and during surgery.
    • Administer mannitol before cross-clamping the aorta.
    • Monitor BUN and creatinine levels in the preoperative and postoperative periods.

Prognosis

  • The mortality rate associated with visceral reconstruction is approximately 4-6%.
  • A 2004 study from the Wake Forest School of Medicine found the following:
    • The symptom-free survival rate for hospital survivors is 57% at 70 months.
    • Primary and primary-assisted patency rates are 81% and 89%, respectively
    • Patients with acute-on-chronic mesenteric ischemia had significantly higher perioperative mortality rates (54% vs 10%) than those with chronic symptoms alone.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to have a high enough index of suspicion for the disease is the major medical pitfall. Many emergency department physicians and surgeons overlook placing this diagnosis on their differential. This can be disastrous.
  • Failure to treat the disorder as aggressively as it deserves is also a pitfall. Once the diagnosis is considered, a complete workup, including an angiogram, should be performed.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor, Yale D Podnos, MD, MPH, to the development and writing of this article.



More on Chronic Mesenteric Ischemia

Overview: Chronic Mesenteric Ischemia
Differential Diagnoses & Workup: Chronic Mesenteric Ischemia
Treatment & Medication: Chronic Mesenteric Ischemia
Follow-up: Chronic Mesenteric Ischemia
Multimedia: Chronic Mesenteric Ischemia
References
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References

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Further Reading

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Keywords

chronic visceral ischemia, postprandial abdominal pain, atherosclerotic plaque, thrombus, superior mesenteric artery, atherosclerosis, visceral atherosclerosis, thromboendarterectomy, malnutrition, malnourishment, coronary artery disease, CAD, transaortic visceral thromboendarterectomy, aortovisceral bypass

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Contributor Information and Disclosures

Author

Deron J Tessier, MD, Staff Surgeon, Kaiser Permanente Medical Center, Fontana, CA
Deron J Tessier, MD is a member of the following medical societies: American College of Surgeons and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Russell A Williams, MBBS, Program Director, Professor, Department of Surgery, University of California Medical Center at Irvine
Russell A Williams, MBBS is a member of the following medical societies: American College of Surgeons, American Pancreatic Association, Association for Surgical Education, Association of VA Surgeons, Society for Surgery of the Alimentary Tract, Southern California Society of Gastroenterology, and Southwestern Surgical Congress
Disclosure: Nothing to disclose.

Medical Editor

Mounzer Al Al Samman, MD, Department of Internal Medicine, Division of Gastroenterology, Assistant Professor, Texas Tech University School of Medicine
Mounzer Al Al Samman, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, and American Gastroenterological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

BS Anand, MD, Department of Internal Medicine, Division of Gastroenterology, Professor, Baylor University College of Medicine
BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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