Abdominal Angina Medication

  • Author: Faisal Aziz, MD; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Jan 6, 2012
 
 

Medication Summary

No effective medical therapy exists.

Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Faisal Aziz, MD  Assistant Professor of Surgery, Divsion of Vascular and Endovascular Surgery, Department of Surgery, Pennsylvania State University College of Medicine

Faisal Aziz, MD is a member of the following medical societies: American College of Surgeons and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Anthony J Comerota, MD, FACS, FRACS(HON), FACC  Director of Jobst Vascular Institute, Program Director of General Vascular Surgery Residency, Toledo Hospital; Director of Jobst (ProMedica) Vascular Laboratories; Adjunct Professor of Surgery, Department of Surgery, University of Michigan Medical School

Anthony J Comerota, MD, FACS, FRACS(HON), FACC is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Chest Physicians, American College of Surgeons, American Heart Association, American Stroke Association, American Surgical Association, American Venous Forum, Association for Academic Surgery, Eastern Vascular Society, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Society of University Surgeons

Disclosure: BMS Honoraria Speaking and teaching; BMS Consulting fee Consulting; BMS Grant/research funds None; Covidien Honoraria Speaking and teaching; Covidien Consulting fee Consulting; Otsuka Honoraria Speaking and teaching; Sanofi/Aventis Speaking and teaching; Sanofi/Aventis Consulting fee Consulting; Sanofi/Aventis Grant/research funds None; Servier Honoraria Speaking and teaching

Specialty Editor Board

Marc D Basson, MD, PhD, MBA, FACS  Professor, Chair, Department of Surgery, Assistant Dean for Faculty Development in Research, Michigan State University College of Human Medicine

Marc D Basson, MD, PhD, MBA, FACS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Gastroenterological Association, Phi Beta Kappa, and Sigma Xi

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David L Morris, MD, PhD, FRACS  Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia

David L Morris, MD, PhD, FRACS is a member of the following medical societies: British Society of Gastroenterology

Disclosure: RFA Medical None Director; MRC Biotec None Director

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA  Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Consulting; ARdelyx Ownership interest Board membership

Additional Contributors

We wish to thank Carol EH Scott-Conner, MD, PhD, and Beth Ballinger, MD, for their previous contributions to this article.

References

  1. Tyson RL. Diagnosis and treatment of abdominal angina. Nurse Pract. Nov 2010;35(11):16-22; quiz 22-3. [Medline].

  2. Schoots IG, Koffeman GI, Legemate DA, Levi M, van Gulik TM. Systematic review of survival after acute mesenteric ischaemia according to disease aetiology. Br J Surg. Jan 2004;91(1):17-27. [Medline].

  3. Fields JM, Dean AJ. Systemic causes of abdominal pain. Emerg Med Clin North Am. May 2011;29(2):195-210, vii. [Medline].

  4. Danse EM, Kartheuser A, Paterson HM, et al. Color Doppler sonography of small bowel wall changes in 21 consecutive cases of acute mesenteric ischemia. JBR-BTR. Jul-Aug 2009;92(4):202-6. [Medline].

  5. Pellerito JS, Revzin MV, Tsang JC, et al. Doppler sonographic criteria for the diagnosis of inferior mesenteric artery stenosis. J Ultrasound Med. May 2009;28(5):641-50. [Medline].

  6. Cunningham CG, Reilly LM, Rapp JH, Schneider PA, Stoney RJ. Chronic visceral ischemia. Three decades of progress. Ann Surg. Sep 1991;214(3):276-87; discussion 287-8. [Medline]. [Full Text].

  7. Thomas JH, Blake K, Pierce GE, et al. The clinical course of asymptomatic mesenteric arterial stenosis. J Vasc Surg. May 1998;27(5):840-4. [Medline].

  8. Schermerhorn ML, Giles KA, Hamdan AD, et al. Mesenteric revascularization: management and outcomes in the United States, 1988-2006. J Vasc Surg. Aug 2009;50(2):341-348.e1. [Medline].

  9. Aksu C, Demirpolat G, Oran I, et al. Stent implantation in chronic mesenteric ischemia. Acta Radiol. Jul 2009;50(6):610-6. [Medline].

  10. Moschetta M, Stabile Ianora AA, Pedote P, et al. Prognostic value of multidetector computed tomography in bowel infarction. Radiol Med. Aug 2009;114(5):780-91. [Medline].

  11. Sarac TP, Altinel O, Kashyap V, Bena J, Lyden S, Sruvastava S, et al. Endovascular treatment of stenotic and occluded visceral arteries for chronic mesenteric ischemia. J Vasc Surg. Mar 2008;47(3):485-91. [Medline].

  12. Cho JS, Carr JA, Jacobsen G, et al. Long-term outcome after mesenteric artery reconstruction: a 37-year experience. J Vasc Surg. Mar 2002;35(3):453-60. [Medline].

  13. Cognet F, Ben Salem D, Dranssart M, et al. Chronic mesenteric ischemia: imaging and percutaneous treatment. Radiographics. Jul-Aug 2002;22(4):863-79; discussion 879-80. [Medline]. [Full Text].

  14. Dalman RL, Li KC, Moon WK, Chen I, Zarins CK. Diminished postprandial hyperemia in patients with aortic and mesenteric arterial occlusive disease. Quantification by magnetic resonance flow imaging. Circulation. Nov 1 1996;94(9 Suppl):II206-10. [Medline].

  15. Desmond CP, Roberts SK. Exercise-related abdominal pain as a manifestation of the median arcuate ligament syndrome. Scand J Gastroenterol. Dec 2004;39(12):1310-3. [Medline].

  16. Dordoni L, Tshomba Y, Giacomelli M, Jannello AM, Chiesa R. Celiac artery compression syndrome: successful laparoscopic treatment-a case report. Vasc Endovascular Surg. Jul-Aug 2002;36(4):317-21. [Medline].

  17. English WP, Pearce JD, Craven TE, Edwards MS, Geary RL, Plonk GW, et al. Chronic visceral ischemia: symptom-free survival after open surgical repair. Vasc Endovascular Surg. Nov-Dec 2004;38(6):493-503. [Medline].

  18. Fidelman N, Wilson MW, Boddington S, Knoess N, Lutz J, Wolanske KA, et al. Postoperative evaluation of complex aortovisceral and aortorenal reconstructions by magnetic resonance angiography. Acad Radiol. Sep 2004;11(9):1055-8. [Medline].

  19. Flinn WR, Rizzo RJ, Park JS, Sandager GP. Duplex scanning for assessment of mesenteric ischemia. Surg Clin North Am. Feb 1990;70(1):99-107. [Medline].

  20. Harward TRS. Chronic mesenteric arterial insufficiency: bypass or endarterectomy?. Adv Vasc Surg. 1996;4:109-29.

  21. Johnston KW, Lindsay TF, Walker PM, Kalman PG. Mesenteric arterial bypass grafts: early and late results and suggested surgical approach for chronic and acute mesenteric ischemia. Surgery. Jul 1995;118(1):1-7. [Medline].

  22. Kihara TK, Blebea J, Anderson KM, Friedman D, Atnip RG. Risk factors and outcomes following revascularization for chronic mesenteric ischemia. Ann Vasc Surg. Jan 1999;13(1):37-44. [Medline].

  23. Kolkman JJ, Mensink PB, van Petersen AS, Huisman AB, Geelkerken RH. Clinical approach to chronic gastrointestinal ischaemia: from 'intestinal angina' to the spectrum of chronic splanchnic disease. Scand J Gastroenterol Suppl. 2004;(241):9-16. [Medline].

  24. Leke MA, Hood DB, Rowe VL, Katz SG, Kohl RD, Weaver FA. Technical consideration in the management of chronic mesenteric ischemia. Am Surg. Dec 2002;68(12):1088-92. [Medline].

  25. Maspes F, Mazzetti di Pietralata G, Gandini R, Innocenzi L, Lupattelli L, Barzi F, et al. Percutaneous transluminal angioplasty in the treatment of chronic mesenteric ischemia: results and 3 years of follow-up in 23 patients. Abdom Imaging. Jul-Aug 1998;23(4):358-63. [Medline].

  26. Montalbano JM, Lee FT Jr, Grist TM, Rappe AH, Weiss JW, Kelcz F, et al. Magnetic resonance imaging detection of extraluminal enterally administered gadopentetate dimeglumine in a rat model of intestinal ischemia. Acad Radiol. Jun 1996;3(6):486-92. [Medline].

  27. Nyman U, Ivancev K, Lindh M, Uher P. Endovascular treatment of chronic mesenteric ischemia: report of five cases. Cardiovasc Intervent Radiol. Jul-Aug 1998;21(4):305-13. [Medline].

  28. Park WM, Cherry KJ Jr, Chua HK, Clark RC, Jenkins G, Harmsen WS, et al. Current results of open revascularization for chronic mesenteric ischemia: a standard for comparison. J Vasc Surg. May 2002;35(5):853-9. [Medline].

  29. Pereles FS, Baskaran V. Abdominal magnetic resonance angiography: principles and practical applications. Top Magn Reson Imaging. Oct 2001;12(5):317-26. [Medline].

  30. Razavi M, Chung HH. Endovascular management of chronic mesenteric ischemia. Tech Vasc Interv Radiol. Sep 2004;7(3):155-9. [Medline].

  31. Reilly LM, Ammar AD, Stoney RJ, Ehrenfeld WK. Late results following operative repair for celiac artery compression syndrome. J Vasc Surg. Jan 1985;2(1):79-91. [Medline].

  32. van Bockel JH, Geelkerken RH, Wasser MN. Chronic splanchnic ischaemia. Best Pract Res Clin Gastroenterol. Feb 2001;15(1):99-119. [Medline].

  33. van Wanroij JL, van Petersen AS, Huisman AB, Mensink PB, Gerrits DG, Kolkman JJ, et al. Endovascular treatment of chronic splanchnic syndrome. Eur J Vasc Endovasc Surg. Aug 2004;28(2):193-200. [Medline].

  34. Williams S, Gillespie P, Little JM. Celiac axis compression syndrome: factors predicting a favorable outcome. Surgery. Nov 1985;98(5):879-87. [Medline].

  35. Wolf YG, Verstandig A, Sasson T, Eidelman L, Anner H, Berlatzky Y. Mesenteric bypass for chronic mesenteric ischaemia. Cardiovasc Surg. Feb 1998;6(1):34-41. [Medline].

  36. Wolfman D, Bluth EI, Sossaman J. Median arcuate ligament syndrome. J Ultrasound Med. Dec 2003;22(12):1377-80. [Medline].

 
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The superior mesenteric artery and inferior mesenteric artery share collateral circulation near the splenic flexure of the colon. When dilated, this vessel is termed the meandering mesenteric artery. As seen on an angiogram, this is a sign of chronic mesenteric ischemia.
The pancreaticoduodenal arcades are collateral pathways between the celiac artery and the superior mesenteric artery.
A lateral aortogram shows abrupt cutoffs at the origin of the visceral vessels and a tapered occlusion of the distal aorta. Because these vessels originate from the anterior surface of the aorta, stenoses and occlusions are not observed clearly on standard anteroposterior views.
This arteriogram illustrates a meandering mesenteric artery. The appearance of a meandering mesenteric artery such as this one supports the diagnosis of chronic mesenteric ischemia.
The celiac artery is exposed at its origin in preparation for antegrade bypass.
The superior mesenteric artery and several branches are exposed for antegrade bypass.
This photo shows an antegrade bypass from the aorta to the superior mesenteric artery and the celiac artery (superior mesenteric artery anastomosis is shown) using a Dacron graft.
This operative photograph shows a completed retrograde bypass to the superior mesenteric artery using ePTFE graft material. Photograph courtesy of Jamal Hoballah, MD, University of Iowa College of Medicine.
This diagram shows the possible incision for a trapdoor aortotomy. Plaque at the orifices of the visceral vessels is removed after the trapdoor incision is lifted. When a satisfactory endarterectomy has been achieved, the trapdoor is sutured shut.
This completion duplex ultrasonographic study shows excellent flow at the distal anastomosis.
Upper gastrointestinal series (barium swallow) shows an ulcer.
 
 
 
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