Owing to the rich blood supply to the intestines, symptoms of chronic mesenteric ischemia are estimated at 1/100,000 persons. The major vessels supplying the intestines are the celiac artery for the foregut, the superior mesenteric artery for the midgut, and the inferior mesenteric artery for the hindgut. Additionally, the inferior mesenteric artery receives a rich collateral flow from branches of both internal iliac arteries. With chronic mesenteric occlusion, the rich collateral network usually provides adequate collateral flow to the intestines. However, as stenosis or occlusion occurs in two or more of the three major vessels, patients become symptomatic.

The diagnosis of chronic mesenteric ischemia is usually suggested by the presenting symptoms, and it is confirmed by diagnostic tests. Postprandial pain is the most prevalent complaint, which may be accompanied by symptoms of bloating, weight loss, “food fear,” nausea, vomiting, diarrhea, and/or constipation. The pain is typically dull and crampy, poorly localized to the midepigastric region or midabdomen, and usually occurs within the first hour after eating. The symptoms are often severe enough to cause the patient to restrict food intake (“food fear”). The weight loss may be so acute as to result in cachexia and prompt a work-up for an underlying neoplasm. The outcome for patients with chronic mesenteric ischemia is dire, with 86% of the patients developing symptoms significant enough to warrant revascularization, or dying from bowel ischemia. Since acute mesenteric ischemia carries a mortality rate that can approach 70%, the timely diagnosis and treatment of patients with chronic mesenteric ischemia is crucial to limiting morbidity and mortality in this patient population.