Recent trends in the diagnosis and management of chronic intestinal ischemia.

This paper reviews the operative management over the past 27 years of 102 patients with chronic mesenteric ischemia, and summarizes recent clinical trends and ongoing research in this area. The most important trends in the diagnosis and management of chronic intestinal ischemia include: (1) increasing use of duplex ultrasound scanning in the initial evaluation of patients with possible intestinal angina; (2) rapidly evolving noninvasive clinical tests to assess mucosal perfusion (reflectance spectrophotometry, laser Doppler flow analysis, and tonometry); and (3) preferential use of antegrade mesenteric grafts or transaortic endarterectomy for mesenteric atherosclerotic occlusive disease. Surgical revascularization continues to provide excellent early relief of symptoms (93%) and a low late recurrence rate (10%). New noninvasive diagnostic tests for chronic intestinal ischemia and excellent results of surgical revascularization support a continued aggressive approach to the early recognition and treatment of patients with chronic intestinal angina. With the aging population, we anticipate that the number of patients with chronic intestinal ischemia will increase.