Visceral Arterial Disease

Visceral arterial disease is important because it can produce intestinal infarction, a relation clearly stated in 1936 by Dunphy, who was among the first to recognize that, “The clinical importance of vascular pain in the abdomen lies in the fact that it may be the precursor of fatal mesenteric vascular occlusion.” This chapter focuses on the most frequent causes of acute and chronic visceral arterial disease, namely atherosclerosis, thromboembolism, and nonocclusive intestinal ischemia. It is divided into a brief description of visceral vascular anatomy and physiology, followed by sections organized according to typical clinical presentations, including acute intestinal ischemia, chronic intestinal ischemia, and colonic ischemia. An unknown number of patients with chronic severe stenosis of the superior mesenteric artery develop thrombosis with resulting acute ischemia. Most are female, and have evidence of vascular disease at other sites or a previous history of cardiovascular surgery.