Improvement of the splanchnic blood flow and hepatic vein oxygenation following revascularisation in patients with chronic mesenteric ischaemia.

OBJECTIVES: Chronic Mesenteric Ischaemia (CMI) is an underdiagnosed but severe condition. Access to functional testing is often limited and the diagnosis is usually based primarily on symptoms and imaging. One of the functional tests available is measurement of the Splanchnic Blood Flow (SBF). The purpose of the present investigation was to evaluate if changes in the splanchnic perfusion after revascularisation can be detected by measuring the SBF and hepatic vein oxygenation.

MATERIALS AND METHODS: The SBF was measured in ten patients before and after revascularisation of the mesenteric arteries by either percutaneous transluminal angioplasty (n=9) or open revascularisation (n=1). The SBF was measured indirectly using Fick's principle and using the tracer Tc-99m Mebrofenin along with assessment of hepatic blood oxygenation, before and after a standard meal, following catheterisation of a hepatic vein and the femoral artery.

RESULTS: Nine of ten patients (90%) achieved a profound increase in SBF after revascularisation (mean increase in postprandial response to meal stimulation from 71±95 mL/min to 531±295 mL/min, P=.001), and an increase in postprandial hepatic vein oxygen saturation (from 52±14% to 59±13%, P=.006). The symptoms of the patients diminished accordingly. One patient had no symptom relief, and no increase in postprandial SBF, but an angiographic result with no significant stenosis post revascularisation.

CONCLUSIONS: Revascularisation increased the SBF and hepatic vein oxygen saturation significantly concurrent with symptom relief and according with the angiographic successful result in the vast majority of patients. A satisfying angiographic result post vascular intervention does not rule out CMI. This article is protected by copyright. All rights reserved.