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Rutherford's 134: Chronic Mesenteric Ischemia: Epidemiology, Pathophysiology, Clinical Evaluation, скачать в хорошем качестве

Rutherford's 134: Chronic Mesenteric Ischemia: Epidemiology, Pathophysiology, Clinical Evaluation, 5 месяцев назад

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Rutherford's 134: Chronic Mesenteric Ischemia: Epidemiology, Pathophysiology, Clinical Evaluation,

#ChronicMesentericIschemia #CMI #AbdominalAngina #VascularSurgery #Atherosclerosis #PostMealPain #FoodFear #WeightLoss #Diagnosis #CTAngiography #Endovascular #Stenting #OpenSurgery #Revascularization #RutherfordChapters #DrGregoryWeir Chronic Mesenteric Ischemia (CMI), also known as abdominal or intestinal angina, is a condition where arteries supplying the intestines become gradually narrowed or blocked, reducing blood flow over time. This slow reduction leads to a specific set of symptoms. Key Features & Symptoms: The classic symptom is abdominal pain that starts after eating. This often leads to "food fear" – a reluctance to eat because of anticipated pain. Significant unintentional weight loss is common due to altered eating habits. Other symptoms can include nausea, vomiting, and changes in bowel habits. Physical examination is often normal, sometimes revealing pain out of proportion to findings. CMI is relatively uncommon, accounting for less than one in a hundred thousand US hospital admissions. It affects women about three times more often than men. The intestines require a significant blood flow surge after eating. In CMI, narrowed arteries cannot meet this increased demand, causing pain akin to cardiac angina. Causes: Atherosclerosis (plaque buildup) is responsible for about 90% of cases, typically near where mesenteric arteries branch off the aorta. Less common causes, often seen in younger patients, include vasculitis, fibromuscular dysplasia, and artery dissections. Diagnosis: Often involves ruling out other gastrointestinal issues first. Imaging is crucial. Duplex ultrasound is a recommended first-line screening test to measure blood flow velocities. CT Angiography (CTA) is frequently used for detailed anatomical mapping and intervention planning. MRA and traditional angiography (mostly now for intervention) are also used. Treatment Goals & Options: Relieve symptoms (pain, food fear). Improve nutritional status and regain weight. Prevent progression to life-threatening acute mesenteric ischemia. Revascularization (restoring blood flow) is the key treatment for symptomatic patients. Prophylactic treatment in asymptomatic patients is debated but may be considered for severe multi-vessel disease or if requiring other aortic surgery. Revascularization Methods: *Endovascular (Angioplasty/Stenting):* Less invasive, increasingly common, especially for short, focal narrowings. Often preferred as the initial approach. Risks include restenosis (re-narrowing), though covered stents show promise for better long-term patency. Recovery is typically faster with shorter hospital stays. *Open Surgery (Bypass Graft):* More invasive, generally reserved for complex anatomy, failed endovascular attempts, or as a potentially more durable option. Involves creating a new blood flow pathway around blockages. Complication rates and hospital stays are higher than endovascular methods. Outcomes: Both methods are highly effective at relieving symptoms. Endovascular procedures have lower short-term morbidity and shorter hospital stays but historically higher restenosis rates than open bypass. Overall 30-day mortality rates are often similar between the two approaches. Long-term survival is more influenced by the patient's overall health and other medical conditions than the type of mesenteric revascularization procedure. A multidisciplinary approach following guidelines like those in Rutherford's is crucial for diagnosis and management, with ongoing follow-up needed after treatment.

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