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8.3.3.1.3 Follow-up. Most patients treated for AMI require lifelong

anticoagulant/antiplatelet therapy to prevent recurrence. Patients undergoing revascularization should have surveillance with CTA or DUS within 6 months,833 as recurrent AMI after mesenteric revascularization accounts for 6%–8% of late deaths.834 Current Society for Vascular Surgery (SVS) Guidelines recommend DUS at 1, 6, and 12 months after the intervention, and then annually thereafter.754

8.3.3.2 Chronic mesenteric artery disease

Occlusive CMI is mostly caused by atherosclerosis and more frequently affects females (65%–72%).835,836 Symptoms typically manifest when at least two mesenteric vessels are involved due to extensive collaterals. Prevalence of asymptomatic coeliac artery and/or SMA stenosis is 3% in patients under 65 years of age and 18% in those aged >65.837

However, inadequate anastomoses can result in symptomatic ischaemia even with a single-vessel atherosclerotic occlusion.838,839

8.3.3.2.1 Clinical presentation and diagnosis. Clinical examination

Like AMI, early diagnosis of CMI relies on clinical suspicion. Classic symptoms include post-prandial abdominal pain, weight loss, and gastrointestinal disturbances like diarrhoea or constipation. Patients may develop food aversion to avoid pain, but their appetite remains

Patient with suspected CMI

Exclude other causes

Diagnosis

Functional test Confirmed

Isolated CA or SMA stenosis No stenosis

Chronic NOMI MALS Atherosclerosis

Multidisciplinary meeting for

consensus treatment

Endovascular or surgical revascularization

Secondary prevention

of atherosclerosis Therapy of underlying condition

Multi-vessel stenosis

CTA (Class I)

Figure 20 Algorithm of chronic mesenteric ischaemia management. CA, coeliac artery; CMI, chronic mesenteric ischaemia; CTA, computed tomography angiography; MALS, median arcuate ligament syndrome; NOMI, non-occlusive mesenteric ischaemia; SMA, superior mesenteric artery.

ESC Guidelines                                                                                                                                                                                          3601

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