[Endovascular therapy as an alternative treatment in chronic mesenteric ischemia]. / Tratamiento endovascular como alternativa terapéutica en la isquemia mesentérica crónica.

INTRODUCTION: Chronic mesenteric ischemia (CMI) is an uncommon disorder. Traditional treatment consists of open surgical (OS) revascularization. We report a case of CMI treated with percutaneous angioplasty and stenting. CASE REPORT: A 77-year-old-woman reported a history of postprandial abdominal pain, weight loss, asthenia, and anorexia. On physical examination, the only relevant sign was systolic murmur. Oral panendoscopy showed chronic atrophic gastritis and patchy intestinal metaplasia with Helicobacter pylori colonization; rectal sigmoidoscopy showed colonic diverticula. Abdominal ultrasound color-flow imaging confirmed superior mesenteric artery (SMA) stenosis > 70%. Angiography confirmed proximal SMA subocclusion and celiac trunk stenosis of 50%. Percutaneous angioplasty and stenting were carried out. The patient made an immediate recovery and remains without postprandial pain. DISCUSSION: CMI due to atherosclerotic occlusive disease was first reported in 1936 and is a relatively uncommon disorder. This entity usually occurs in patients over 60 years of age with other atherosclerotic symptoms. CMI presents with postprandial abdominal pain, anorexia due to <>, and weight loss. Despite high perioperative morbidity and mortality rates, OS revascularization has traditionally been the treatment of choice. The most frequent indications include pain relief, improvement of nutritional status, and prevention of intestinal infarction. Endovascular therapy seems to be a valid alternative, mainly in high-risk patients, with good immediate and medium-term results.

Tratamiento endovascular como alternativa terapéutica en la isquemia mesentérica crónica / ENDOVASCULAR THERAPY AS AN ALTERNATIVE TREATMENT IN CHRONIC MESENTERIC ISCHEMIA

INTRODUCCIÓN: La isquemia mesentérica crónica es una enfermedad cuyo tratamiento tradicional es la revascularización quirúrigica. Presentamos un caso de isquemia mesentérica crónica tratada con angioplastia y stent. CASO CLÍNICO: Mujer de 77 años de edad, con clínica de dolor abdominal posprandial, pérdida de peso, anorexia y astenia. En la exploración física destacaba un soplo sistólico abdominal. La panendoscopia puso de manifiesto una gastritis crónica atrófica con zonas de metaplasia intestinal colonizadas por Helicobacter pylori, y la colonoscopia, divertículos colónicos. Se realizó una eco-Doppler color abdominal, que confirmó la sospecha de estenosis > 70% de la arteria mesentérica superior (AMS). Una angiografía confirmó la existencia de una suboclusión proximal de la AMS y una estenosis del 50% en el tronco celíaco. Se le realizó una angioplastia con stent. La paciente experimentó una mejoría clínica inmediata, y permanece sin dolor posprandial. DISCUSIÓN: La isquemia crónica secundaria a una enfermedad aterosclerótica oclusiva es una enfermedad relativamente infrecuente, descrita como entidad en 1936. Normalmente, se presenta en las personas mayores de 60 años con manifestaciones ateroscleróticas en otras localizaciones. Los síntomas característicos incluyen dolor abdominal posprandial, anorexia por «miedo a comer» y pérdida de peso. La revascularización quirúrgica ha sido el tratamiento de elección, a pesar de la elevada morbimortalidad perioperatoria. Las indicaciones de tratamiento incluyen alivio del dolor, mejora del estado nutricional y prevención del infarto intestinal. El tratamiento endovascular parece ofrecer una alternativa válida, con un buen resultado inmediato y a medio plazo, principalmente en pacientes con alto riesgo quirúrgico

INTRODUCTION: Chronic mesenteric ischemia (CMI) is an uncommon disorder. Traditional treatment consists of open surgical (OS) revascularization. We report a case of CMI treated with percutaneous angioplasty and stenting. CASE REPORT: A 77-year-old-woman reported a history of postprandial abdominal pain, weight loss, asthenia, and anorexia. On physical examination, the only relevant sign was systolic murmur. Oral panendoscopy showed chronic atrophic gastritis and patchy intestinal metaplasia with Helicobacter pylori colonization; rectal sigmoidoscopy showed colonic diverticula. Abdominal ultrasound color-flow imaging confirmed superior mesenteric artery (SMA) stenosis > 70%. Angiography confirmed proximal SMA subocclusion and celiac trunk stenosis of 50%. Percutaneous angioplasty and stenting were carried out. The patient made an immediate recovery and remains without postprandial pain. DISCUSSION: CMI due to atherosclerotic occlusive disease was first reported in 1936 and is a relatively uncommon disorder. This entity usually occurs in patients over 60 years of age with other atherosclerotic symptoms. CMI presents with postprandial abdominal pain, anorexia due to «fear of food», and weight loss. Despite high perioperative morbidity and mortality rates, OS revascularization has traditionally been the treatment of choice. The most frequent indications include pain relief, improvement of nutritional status, and prevention of intestinal infarction. Endovascular therapy seems to be a valid alternative, mainly in high-risk patients, with good immediate and medium- term results