الفهرس 
Anatomy of The Mesenteric ArteriesOnly 14 pages are availabe for public view
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Abstract
T
he incidence of CMI in the general population is approximately 1/100,000 per year. In patients with known atherosclerotic disease, the prevalence of CMI may range from 8% to 70% and a greater than 50% stenosis of more than one splanchnic artery may be detected in up to 15% of cases. CMI is a potentially underdiagnosed disease with increasing prevalence during the next decade due to demographic changes with increasing life expectancy (Oderich GS et al., 2009).
Advanced stages of CMI disease with significant two- or three-vessel disease are associated with an increased cardiovascular and intestinal mortality and are thus an indication for revascularization, even if asymptomatic. Duplex ultrasonography has become the primary screening method for CMI; if inconclusive, MR- or CT-angiography are appropriate alternative diagnostic tools. In patients anatomically suited for endovascular revascularization, percutaneous revascularization has replaced surgical revascularization as the first-line therapeutic strategy, even if patency rates are in favor of surgical revascularization (Wilson DB et al., 2006).
Vomiting, diarrhea, and postprandial abdominal pain occur in many cases of CMI because of stenosis or occlusion of 2 or more visceral blood vessels. Generally, CMI is diagnosed by exclusion, which often results in a delayed diagnosis. Balloon angioplasty for CMI has been reported occasionally after it was first used in 1980, but patency in the chronic phase (6–24 months) is generally insufficient (about 50–80%).The outcome of this procedure has been improved by the development of stents, and a review of recent reports indicates a procedural success rate of 88–100% and a clinical success rate of 82–100%, with a complication rate of 3–16% (Silva JA et al., 2006).
Open revascularization should focus on mesenteric artery revascularization as the primary goal and should avoid extensive aortic or renal artery reconstruction in all but the rarest of cases. This approach has clearly lowered our mortality rate. However, infrarenal aortic replacement, if needed for inflow, can be safely done. Certainly patient selection, preoperative cardiac evaluation and treatment, and improvement in anesthesia and intensive care monitoring have contributed the lower mortality. Older, poor-risk patients may be best served by interventional techniques. SMA Stenting is being used more as first-line therapy in good-risk patients with suitable artery and does not seem to preclude operation if it is needed later (McAfee MK et al., 1992).………………………………………..
Higher restenosis and intervention rates should be anticipated compared to open revascularization. If operative repair is necessary in this group, single-vessel reconstruction to the SMA may be preferable. We believe it is no longer necessary to revascularize all three mesenteric arteries (McAfee MK et al., 1992).
However, we continue to favor antegrade two-vessel reconstruction to the SMA and the celiac artery in select patients because of the excellent durability and symptom-free survival achieved in this group. Since mesenteric disease involves multiple arteries, there may be some margin of safety in a two-vessel reconstruction should one limb occlude or become stenotic during follow-up (McBride KD and Gaines PA, 2002).………………. ……