It is characterized by the sudden onset of pain, pallor, paralysis, and coldness in the legs. Urgent embolectomy is indicated and can usually be performed transfemorally. Because collateral circulation between the major splanchnic trunks is extensive, chronic mesenteric vascular insufficiency almost invariably involves high-grade narrowing or occlusion of both the celiac axis and the superior mesenteric artery. The usual cause is arteriosclerosis. Pain may be relieved quickly by sublingual nitroglycerin, aiding diagnosis.
Patients become fearful of eating, and weight loss, often severe, is the rule.
Intestinal malabsorption may contribute to weight loss. Doppler ultrasonography of the superior mesenteric artery and celiac axis may accurately detect reduced flow through these trunks. Mesenteric arteriography is crucial in demonstrating the presence and severity of the occlusion and the suitability for surgery. Nitroglycerin sometimes provides relief. In severely symptomatic patients, surgical revascularization of the superior mesenteric artery and celiac axis can usually be achieved by bypassing from the supraceliac or infrarenal aorta to the splanchnic arteries distal to the occlusion.