Management of Chronic Gastrointestinal Ischemia

Abstract

Gastrointestinal ischemia results from a mismatch of blood supply to the main gastrointestinal arteries and the oxygen demand to maintain adequate metabolism. Three aortic branches supply blood to the gastrointestinal tract: the celiac artery, the superior mesenteric artery, and the inferior mesenteric artery. One of the main causes of chronic gastrointestinal ischemia (CGI) is stenotic or occlusive disease of the supplying gastrointestinal arteries. For a long time it was thought that only occlusive disease of two or more gastrointestinal arteries could lead to CGI. The introduction of functional testing has played a pivotal role in the diagnosis of CGI. Functional testing has shown that CGI is more common than previously thought because it can also be caused by single vessel disease. Further studies showed that a majority of patients with single vessel disease had sustained response after adequate treatment. Moreover, functional testing seems to be pivotal to select patients who will benefit from treatment, whether the cause is single- or multi-vessel disease. In this thesis we aimed to study different aspects of diagnosis and treatment of CGI. We studied the predictive value of functional testing in diagnosis of CGI, and determined the diagnostic accuracy of a new minimally invasive technique to detect ischemia in order to optimize the diagnosis of CGI. Furthermore, we assessed the risk factors for atherosclerotic disease of the abdominal arteries, being one of the main causes of CGI. We also evaluated the clinical success of revascularization in single vessel disease and response to vasodilation therapy in patients with non-occlusive CGI