Case Study: Chapter 08

Chapter 8, Mesenteric Arterial Disease: Diagnosis and Treatment

CONSTANTINOS CONSTANTINOU, MD; VIKRAM S. KASHYAP, MD

CASE STUDY:

A 60-year-old female presents complaining of abdominal pain over the past 2 years that has been progressively worsening. On further questioning, she associates the pain with food intake. She states that it starts approximately half an hour following food ingestion and lasts approximately one hour. She also admits to weight loss of 7 kg over the past 6 months. She underwent an upper and a lower gastrointestinal endoscopy and a gallbladder ultrasound, all of which were unremarkable. She has a history of hypertension, hyperlipidemia, and a 40-pack-year smoking history.

On exam, her blood pressure is 125/86, her heart rate is 88, and she weighs 43 kg. She appears emaciated, with a prominent rib cage and a scaphoid abdomen. The abdomen is soft and nontender. On auscultation, a bruit is appreciated in the epigastric region. Laboratory workup, including a renal function panel, is normal.

Case Study: Chapter 8

* 1.) What is the next best diagnostic test in this patient?
* 2.) A mesenteric duplex was obtained. The celiac artery peak systolic velocity (PSV) was 225 cm/ sec and SMA PSV was 400 cm/sec. What is the next step in management?
* 3.) The lesion was not amenable to angioplasty and stenting. Surgery is contemplated. Which of the following statements is true regarding open surgical intervention?