Diagnosis and management of splanchnic ischemia

Jeroen J. Kolkman*, Marloes Bargeman, Ad B. Huisman, Robert H. Geelkerken

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

60 Citations (Scopus)
11 Downloads (Pure)

Abstract

Splanchnic or gastrointestinal ischemia is rare and randomized studies are absent. This review focuses on new developments in clinical presentation, diagnostic approaches, and treatments. Splanchnic ischemia can be caused by occlusions of arteries or veins and by physiological vasoconstriction during low-flow states. The prevalence of significant splanchnic arterial stenoses is high, but it remains mostly asymptomatic due to abundant collateral circulation. This is known as chronic splanchnic disease (CSD). Chronic splanchnic syndrome (CSS) occurs when ischemic symptoms develop. Ischemic symptoms are characterized by postprandial pain, fear of eating and weight loss. CSS is diagnosed by a test for actual ischemia. Recently, gastro-intestinal tonometry has been validated as a diagnostic test to detect splanchnic ischemia and to guide treatment. In single-vessel CSD, the complication rate is very low, but some patients have ischemic complaints, and can be treated successfully. In multi-vessel stenoses, the complication rate is considerable, while most have CSS and treatment should be strongly considered. CT and MR-based angiographic reconstruction techniques have emerged as alternatives for digital subtraction angiography for imaging of splanchnic vessels. Duplex ultrasound is still the first choice for screening purposes. The strengths and weaknesses of each modality will be discussed. CSS may be treated by minimally invasive endoscopic treatment of the celiac axis compression syndrome, endovascular antegrade stenting, or laparotomy-assisted retrograde endovascular recanalization and stenting. The treatment plan is highly individualized and is mainly based on precise vessel anatomy, body weight, comorbidity and severity of ischemia.

Original languageEnglish
Pages (from-to)7309-7320
Number of pages12
JournalWorld Journal of Gastroenterology
Volume14
Issue number48
DOIs
Publication statusPublished - 28 Dec 2008
Externally publishedYes

Keywords

  • Blood flow
  • Celiac artery compression syndrome
  • Chronic mesenteric ischemia
  • Chronic splanchnic disease
  • Chronic splanchnic syndrome
  • Ischemic colitis
  • Mesenteric ischemia
  • Splanchnic ischemia
  • Tonometry

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