Endovascular treatment of visceral arteries

Abstract

CVI is a potentially underdiagnosed disease with increasing prevalence during the next decade due to demographic changes with increasing life expectancy and an increasing prevalence of atherosclerosis. Advanced stages of CVI disease with significant two- or three-vessel involvement are associated with an increased cardiovascular and intestinal mortality and are thus an indication for revascularization, probably even if asymptomatic. Duplex ultrasonography has become primary screening method for CVI; if inconclusive, MR- and CT-angiography are appropriate alternative diagnostic tools. In patients anatomically suited for endovascular revascularization, percutaneous intervention has replaced surgical revascularization as first-line therapeutic strategy even if patency rates are in favor of surgical revascularization (Table 58.3, (Schermerhorn et al., J Vasc Surg, 50:341–348, 2009; Fioole et al., J Vasc Surg, 51:386–391, 2010)). However, surgery is still indicated in all cases of acutely deteriorated stable CVI or acute visceral ischemia due to the potential need of partial bowel resection.