Chronic mesenteric ischaemia: role of interventional radiology in enhancing clinical outcomes
Chronic mesenteric ischaemia (CMI) is a progressive vascular condition where insufficient blood flow to the gastrointestinal tract leads to postprandial pain, sitophobia and weight loss. Unlike acute mesenteric ischaemia, CMI develops gradually and is often underdiagnosed due to vague symptoms and the protective role of collateral circulation. Although mesenteric arterial stenosis is common, symptomatic CMI is rare, affecting 2–3 per 100,000 individuals.
The condition predominantly affects older adults, especially females, and is primarily caused by atherosclerosis. Diagnosis is challenging and typically involves a multimodal imaging approach, including duplex ultrasound, CT angiography (CTA), and occasionally MR angiography or digital subtraction angiography. CTA is preferred for its rapid and detailed vascular assessment.
Treatment aims to restore mesenteric perfusion and prevent progression to acute ischaemia. Endovascular revascularisation (ER) has become the first-line therapy due to its minimally invasive nature, shorter recovery, and high technical success rates. ER involves angioplasty and stenting, with covered stents offering better patency for focal lesions. Open surgical repair remains an option for complex or recurrent cases.
Post-procedure care includes dual antiplatelet therapy and structured imaging follow-up. Despite high initial success, restenosis and symptom recurrence are common, prompting interest in newer technologies like drug-eluting stents and intravascular lithotripsy.
The article underscores the expanding role of interventional radiology in diagnosing and managing CMI, advocating for early recognition and multidisciplinary collaboration to improve patient outcomes and quality of life.
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