Chronic splanchnic ischaemia

Chronic splanchnic ischaemia is a relatively unusual clinical entity consis ting of pain and/or weight loss and caused by chronic splanchnic disease (i .e. stenosis and/or occlusion of the coeliac and superior mesenteric artery ). The occlusive disease is usually caused by atherosclerosis and is in its elf not rare in older individuals. Extensive collateral circulation can dev elop between the three splanchnic arteries and may compensate for the decre ased splanchnic perfusion over time. The pathophysiology of chronic splanch nic ischaemia has still not been completely elucidated. A reliable diagnosis of chronic splanchnic ischaemia, based on a proven cau sal relationship between the occlusive disease and the symptoms, can be ver y difficult. Traditionally, tests for evaluating the haemodynamic consequen ces of the vascular stenoses were not available. Important improvements in establishing a more reliable diagnosis have been achieved with duplex ultra sound and magnetic resonance evaluation of the splanchnic circulation. Tono metry is another promising functional test that may prove useful not only f or gaining greater insight into the pathophysiology of chronic splanchnic i schaemia but also for the clinical evaluation of this syndrome. The natural history of chronic splanchnic disease suggests that progressive disease may result in acute mesenteric ischaemia. Surgical reconstruction of the coeliac and/or the superior mesenteric artery is the therapeutic sta ndard with excellent short and longterm results. Satisfactory early results using angioplasty with or without stent suggest that this type of interven tion may relieve symptoms in selected patients with a higher surgical risk.