Chronic Mesenteric Ischemia

In patients with abdominal pain, weight loss, and food fear, we recommend an expedited workup to exclude gastrointestinal malignancies and other potential causes. The expedited workup may include an esophagogastroduodenoscopy, a colonoscopy, an abdominal CT scan, and an abdominal ultrasound. (S – Strong, M)

We recommend making a diagnosis of CMI in patients with the appropriate clinical scenario and the presence of significant stenoses (>70%) within the celiac axis and superior mesenteric artery (SMA). The diagnosis may also be made in patients with the appropriate clinical scenario and a significant stenosis (>70%) in either the celiac axis or SMA alone. (S – Strong, M)

We recommend using the mesenteric duplex ultrasound examination as the preferred screening test for mesenteric artery occlusive disease (MAOD). (S – Strong, M)

We recommend using CT arteriography (CTA) as the preferred definitive imaging test for MAOD unless unusual anatomic features obscure the anatomy such that a catheter-based arteriogram may be required. (S – Strong, M)