Evolution of the Management of Mesenteric Occlusive Disease

Abstract

Current approaches to the diagnosis and management of occlusive disease of the mesenteric arteries have developed over a relatively short period. Five decades ago chronic mesenteric ischemia was almost exclusively a post-mortem diagnosis with the causative link between proximal occlusive lesions of the mesenteric arteries and bowel infarction still in dispute. Successful management of mesenteric occlusive disease has evolved to overcome numerous associated complicating factors, including the relatively inaccessible anatomic location, the cardiovascular co-morbidity present in these patients, the extensive associated atherosclerotic lesions of the paravisceral aorta and the catastrophic consequences of failed revascularization. Although a wide range of surgical strategies are currently used to treat these lesions, many of the most widely used and most successful approaches were developed at the University of California at San Francisco (UCSF). This review will cover the history of treatment of mesenteric occlusive disease, significant contributions made by vascular surgeons at UCSF, and our current approach to this challenging clinical problem.