Clinical significance of splanchnic artery stenosis

• Published in: British journal of surgery Vol. 93; no. 11; pp. 1377 - 1382
• Main Authors: Mensink, P. B. F., van Petersen, A. S., Geelkerken, R. H., Otte, J. A., Huisman, A. B., Kolkman, J. J.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01-11-2006; Wiley
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cohort Studies; Consensus; Constriction, Pathologic; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; General aspects; Humans; Intestines - blood supply; Ischemia - diagnosis; Ischemia - physiopathology; Ischemia - surgery; Male; Manometry; Medical sciences; Mesenteric Vascular Occlusion - diagnosis; Mesenteric Vascular Occlusion - physiopathology; Mesenteric Vascular Occlusion - surgery; Middle Aged; Prospective Studies; Splanchnic Circulation - physiology; Ultrasonography, Doppler; Arterial disease; Vascular disease; Medicine; Treatment; Surgery; Cardiovascular disease; Artery stenosis
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.5481

Background:
The clinical relevance of splanchnic artery stenosis is often unclear. Gastric exercise tonometry enables the identification of patients with actual gastrointestinal ischaemia. A large group of patients with splanchnic artery stenosis was studied using standard investigations, including tonometry.
Methods:
Patients referred with possible intestinal ischaemia were analysed prospectively, using duplex imaging, conventional abdominal angiography and tonometry. All results were discussed within a multidisciplinary team.
Results:
Splanchnic stenoses were found in 157 (49·7 per cent) of 316 patients; 95 patients (60·5 per cent) had one‐vessel, 54 (34·4 per cent) two‐vessel and eight (5·1 per cent) had three‐vessel disease. Chronic splanchnic syndrome was diagnosed in 107 patients (68·2 per cent), 54 (57 per cent) with single‐vessel, 45 (83 per cent) with two‐vessel and all eight with three‐vessel stenoses. Treatment was undertaken in 95 patients, 62 by surgery and 33 by endovascular techniques. After a median follow‐up of 43 months, 84 per cent of patients were symptom free.
Conclusion:
Gastric exercise tonometry proved crucial in the evaluation of possible intestinal ischaemia. Comparing patients with single‐ and multiple‐vessel stenoses, there were significant differences in clinical presentation and mortality rates. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Worse outcomes in multivessel disease